December 3, 2018 Sandra 0Comment

Dr Johann Kluge educates us on laryngeal cancer.


Laryngeal cancer is a type of throat cancer that affects your larynx (voice box). The larynx contains cartilage and muscles that enable you to talk and prevents food from entering the lungs. This type of cancer can damage your voice. 

The most common type of larynx cancer is squamous cell carcinoma (SCC) and entails 

85-95% of all malignant lesions. 

The larynx is divided in three parts (see below):

Larynx Anatomical Description Incidence
Supraglottis Above the vocal cords 35%
Glottis The level of the vocal cords 60%
Subglottis Below the vocal cords 5%

Risk factors

Laryngeal cancer is diagnosed predominantly in men. The most common carcinogens are:

  • Tobacco 
  • Alcohol (the combination of alcohol and tobacco is synergistic with a higher incidence for developing cancer, and 90% of patients have a history of consuming both.)
  • Workplace exposure to wood and metal dusts, asbestos, paint fumes, and other chemical inhalants.
  • A diet deficient in vitamins A and E.
  • Gastroesophageal reflux disease (GERD). Though GERD is not a proven cause of laryngeal cancers, multiple studies have shown a link between acid reflux and throat cancer.
  • Human papillomavirus (HPV) – especially subtypes 16 and 18.
  • Aplastic anaemia – a form of bone marrow failure that can be life-threatening.
  • A history of previous radiation. 

Symptoms

  • Hoarseness or progressive change in voice. 
  • Lump in the neck due to an enlarged lymph node.
  • Ear pain (otalgia). This is usually a referred pain due to the nerves of the throat/larynx reaching the brain through the same pathway as one of the nerves supplying the ear.
  • Difficulty swallowing different consistencies of food. 
  • Coughing up blood (haemoptysis). 
  • Choking easily.
  • Weight loss.
  • Feeling that there’s something stuck in the throat.

Management

Depending on the staging, laryngeal cancer is divided in early and late stage cancer. The goal in treatment is to cure (if possible), restore and/or preserve a patient’s voice and to prevent the cancer from recurring. Treatment options include (one or a combination): surgery, radiation and chemotherapy. 

Early stage cancer  

For early (Stage I and II) laryngeal cancer, both radiation and surgery offer equivalent control and curing rates. Surgical options include transoral laser microsurgery (TLM), transoral robotic surgery (TORS) and open surgery. 

Currently the gold standard is laser surgery (where the tumour is removed through the mouth with the aid of a microscope and a CO2 laser), with open surgery and robotic surgery being utilised in specific cases. Robotic surgery is a modality gaining more popularity but is regarded as expensive and still in the infant stage.

Radiation involves directing high-energy beams of particles at the cancerous growth. These particles are aimed to damage the DNA of the cancer cells. Radiation is often the primary treatment for people with early-stage laryngeal cancer

Late stage cancer

Late stage cancer is referred to Stage III and IV. The current consensus is to make the decision on trying to spare the larynx or not. This entails either removing the whole larynx through a procedure, called a total laryngectomy (a person needs to learn to talk again with assistance), with radiation after surgery. Chemotherapy is sometimes given in combination with radiation. This approach is called chemoradiation. It can be used alone in an attempt to spare a person’s voice.

Prognosis

The prognosis refers to the outcome and chance of curing a patient. This is also influenced by certain factors related to the cancer and the person being diagnosed with cancer. 

Stage This is the most important factor that affects the chances of being cured.
Spread to lymph nodes, spread of cancer cells outside lymph node capsule Another important factor. If there is cancerous spread to lymph glands in the neck, there is a lower chance of a curing a patient.
Tumour margins The ability to completely remove the tumour can be a very important factor that will influence the likelihood of being cured.
Spread into local structures Cancerous spread into large nerves, blood vessels, lymphatic channels elsewhere might make the outcome worse.

Five-year survival for Stage I is more than 95%, Stage II 85-90%, Stage III 70-80%, and Stage IV 50-60%. 


References:

Dr Johann Kluge MBChB (UP), MMed (ENT) (UP) is a head and neck surgeon at Life Groenkloof Hospital as well as one of the consultants, Department of General Surgery, University of Pretoria. He completed a two-year fellowship, in 2016, with the International Federation of Head and Neck Oncologic Societies under Professor Jatin Shah.

MEET OUR EXPERT  – Dr Johann Kluge


Dr Johann Kluge MBChB (UP), MMed (ENT) (UP) is a head and neck surgeon at Life Groenkloof Hospital as well as one of the consultants, Department of General Surgery, University of Pretoria. He completed a two-year fellowship, in 2016, with the International Federation of Head and Neck Oncologic Societies under Professor Jatin Shah.


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