With cancer of the larynx, or voice box, malignant cells develop in or near the vocal cords. The disease usually occurs after age 55; males with this cancer outnumber females four to one. The condition is most common among smokers, and those who also consume large amounts of alcohol suffer the highest incidence. Some studies have suggested that long-term asbestos exposure may also increase the risk. An early symptom is a voice change, especially increasing hoarseness. As the cancer progresses, it may also cause a sore throat, difficulty in swallowing, a chronic cough, bloody sputum, ear pain, and a lump in the neck.
Other Causes of Voice Loss
Larynx polyps, nodules, and chronic laryngitis can produce hoarseness and other symptoms similar to those of larynx cancer. The accidental swallowing of lye or another caustic substance can also damage the larynx, and result in loss of voice.
Diagnostic Studies And Procedures
A doctor begins by feeling the patient’s throat for lumps and examining the larynx through a lighted tube inserted into the throat. At this time, a small biopsy sample can be taken from any suspicious-looking tissue. If malignant cells are detected, additional tests will be ordered to determine the extent or stage of the cancer. These tests usually include X-rays, blood studies, and MRI or other imaging studies.
Treatment depends on what part of the larynx is affected and whether the cancer is strictly localized or has spread. The patient’s age and general health are also important considerations. Often treatment is carried out by a team of specialists that includes a surgeon, a cancer specialist , an ear nose throat specialist a radiation oncologist, speech pathologist, nurse, dietitian, and dentist. Treatment options should be discussed with the patient so that he can make informed choices, especially because these choices may affect the way he will look and speak. A speech pathologist is usually present at these preliminary discussions to answer questions and help plan later rehabilitation and speech therapy techniques. The following treatments may be used separately or in combination:
Radiation therapy is used to kill the cancer cells and shrink tumors. This approach is tried first whenever possible, especially for early, localized cancer, because it preserves normal speech.
Surgery is often combined with radiation. The type of surgery is determined by the extent of the cancer. A small tumor on the vocal cord can often be removed by laser surgery, leaving all or most of the cord intact. More extensive cancer may require complete surgical removal of the larynx, a procedure called a laryngectomy. In such cases, a tracheostomy, an opening in the front of the neck, will be made to allow air to pass through the windpipe, or the trachea, on its way to and from the lungs, and a prosthetic speech devise may be inserted. In addition to learning how to breathe through the opening, the patient must also learn a new way to speak with the prosthesis . If only part of the larynx is removed to facilitate breathing, a temporary tracheostomy will be created. Eventually, the tracheostomy tube will be removed, allowing the patient to breathe normally. Most patients also regain their ability to speak normally, although the voice may be weak and hoarse.
Chemotherapy is used if the cancer has spread to other parts of the body. It may also be employed to shrink a large tumor before further treatment with surgery or radiation.
There are no effective alternative therapies for larynx cancer itself, but they can playa critical role in rehabilitation and adjustment during and after treatment. In particular, speech therapists can help patients regain the ability to speak, even after a total laryngectomy.
During treatment, it may be difficult to eat. In such cases, intravenous feeding may be necessary until it’s possible to swallow normally again. After first resuming eating, the patient may need a liquid diet to reduce the risk of choking. A dietitian or pharmacist can recommend an enriched product to maintain good nutrition.
A technique called esophageal speech allows people who have had a total laryngectomy to speak again. A speech therapist teaches the patient how to trap air in the upper esophagus and use it to form sounds. If this cannot be learned, mechanical devices or an artificial larynx may help the person regain speech.
If you have been treated for larynx cancer, avoid strong chemical fumes and secondhand smoke, which will irritate the vocal cords. Above all, abstain from using alcohol and tobacco. After a partial laryngectomy, avoid shouting and other activities that tax your voice. A consultation with a speech therapist can provide guidance in protecting your remaining voice. Joining a self help support group, such as the Lost Chords or New Voice clubs sponsored by the American Cancer Society, can help in adjusting to life if you have had a total laryngectomy.