Laryngeal cancer is a malignant tumour in the epithelial tissue of the corresponding organ. It is considered common with 1,5-3% of all cancer cases in different countries.
If detected at an early stage, the disease has a favourable prognosis. However, laryngeal cancer is usually detected during stage 3 or 4 for most patients and therefore the survival rates are reduced.
The main risk factors for laryngeal cancer:
The neoplastic process is often preceded by precancerous and background conditions. These may include:
Obligate precancerous conditions include:
Facultative precancerous conditions of the larynx include:
The first symptoms of pharyngeal cancer do not always cause a patient to go see a doctor, therefore, the disease is diagnosed quite late, usually at stages 3-4.
The first signs include:
Over time, a person develops a hoarseness, which is quite pronounced. A growing intensity of pain follows. The pain is also often felt in the ear. This is followed by a dry cough. If the tumour grows into the lumen of the larynx, this can cause respiratory disorders.
If cancer is located in the area of vocal folds, the symptoms are the fastest to occur. In this case, there is vocal fatigue, again followed by hoarseness and sometimes breathing problems.
The diagnosis of laryngeal cancer includes two stages. The first one involves detection of the tumour, while the second one is aimed at the determination of the histological type of the tumour.
The tumour can be diagnosed by means of:
The following diagnostic procedures include fiberoptic laryngoscopy and a needle biopsy of the tumour. A biopsy sample is sent to histology that helps to determine the type of the neoplasm.
Laryngeal cancer can only be diagnosed after a histological examination. This diagnosis has both high sensitivity and specificity, thus, these indicators can lead to 100% diagnosis in good European hospitals.
To evaluate the prevalence of the tumorous process and to plan a treatment strategy, doctors use the following diagnostic methods:
The hospitals of Germany and other developed countries use positron emission tomography, which involves introduction of radioactive sugar (fluorodeoxyglucose) into the patient’s body. The tumour cells accumulate it and thus are highlighted. This technique helps not only to detect laryngeal cancer, but also its metastases.
The main treatment methods include surgery and radiation therapy. The surgery is necessary during stage 3 and 4 (if the tumour is resectable and there are no contraindications). Sometimes radiation is enough in case of stage 1 and 2 and 85-95% of patients are completely cured with the preservation of the organ and its function.
One more option is laser treatment. It can be effective during the initial stages (stages 0 and 1). This kind of treatment is endoscopic (without any skin incisions). There can be a tumour recurrence after radiation or laser therapy. In this case, laryngeal cancer needs surgical treatment.
During stage 3, or in some earlier stages radiation therapy alone can fail to be effective. Therefore, a tumour resection or a partial resection of the larynx is performed. In some situations, it is necessary to completely remove the organ, as well as a part of the larynx or other adjacent structures.
An oncologist determines the feasibility and scope of surgery on the basis of a specific clinical situation assessing all risks and advantages.
Chemotherapy is an additional treatment method. It is used in the following cases:
If chemotherapy failed to be efficient, the treatment can be completed by immunotherapy. European hospitals use drugs, which allow a human immunity to attack the tumour more intensively. Pembrolizumab (drug) is prescribed specifically for this purpose.
There are new treatments for laryngeal cancer constantly being developed. The surgical techniques are improved, while new methods of radiation and drug therapy also come into being.
Laryngeal cancer can be endophytic and exophytic, depending on the type of tumour growth. Exophytic has a more favourable prognosis, because it is characterised by clear boundaries and a low degree of infiltration in the laryngeal tissues. It does not grow to the side of the organ wall, but to its lumen.
The prognosis depends on the location. The most malignant cancer develops in the upper third of the larynx. It metastases spread quite early. Cancer of the vocal folds is the most favourable one. It grows slowly and its metastases spread quite late. It is characterised by exophytic growth.
The table below details the data of five-year survival rate of patients with laryngeal cancer in different areas. The table shows variations depending on the stage and location of the cancer.
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