Laryngeal cancer
What is it?
Laryngeal cancer is the most common cancer of the head and neck region. The larynx is the part of the respiratory system that communicates with the mouth and throat at the top and the trachea at the bottom.
It participates in the mechanisms of breathing, phonation and swallowing, being a very valuable valve structure located between the respiratory and food transit pathways (pharynx, esophagus). In Italy, it occurs in 3 cases per 100,000 people per year and is more common in Europe than in the United States. Men are affected 10 times more often than women, especially between the ages of 50 and 60.
The most common areas of occurrence are the true vocal cords and the epiglottis.
Causes and risk factors
Known causes are cigarette smoking habits, alcohol consumption, chronic inflammation resulting from voice fatigue, and vocal cord wear and tear. In fact, about 90% of patients with these neoplasms smoke and drink.
Which are the symptoms?
The initial laryngeal tumor most often manifests as a voice change (dysphonia), but with a more extensive tumor, it may also manifest as difficulty and pain when swallowing, which can extend all the way up to the ear. Less often, the tumor manifests as shortness of breath. Shortness of breath may occur at night, if stressed, or if the tumor is large, difficulty in breathing may be present even at rest.
- dysphonia
- difficulty or pain in swallowing
- shortness of breath
- coughing and hoarseness
- enlarged lymph nodes in the neck
How is it diagnosed?
In this case, a quick otolaryngological evaluation by a specialist is needed, supported by an endoscopic examination called a laryngoscopy, a painless procedure that allows the doctor to examine the larynx and vocal cords.
This examination is performed with a fiberoptic laryngoscope, which has its own light and is inserted into the pharynx through the nasal cavity (flexible laryngoscope) or placed on the tongue (rigid fiberoptic): they allow you to assess the laryngeal function (mobility of the vocal cords) and possible presence of ulcerations or masses in the pharynx and larynx.
In addition to ENT examinations with fibroscopy, NBI (Narrow Band Imaging), an innovative system of optical technology that uses endoscopic techniques to emphasize mucosal vascularization, revealing even the most superficial carcinomas based on their neoangiogenic appearance, can be used.
If suspected, concomitant radiologic studies will be performed, such as: computed axial tomography (CT) of the neck, chest and abdomen with and without MDC, followed by positron emission tomography (PET) if necessary and, if indicated, magnetic resonance imaging (MRI).
The diagnosis of cancer should be confirmed by a biopsy of the site of origin or, if that is not possible, a lymph node biopsy.
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How is it treated?
Treatment of early stages of the disease consists of either radiotherapy alone or surgery alone, whereas in locally disseminated disease, surgical intervention is the first consideration. However, if destruction of the entire larynx is necessary, preservation of the larynx by simultaneous chemotherapy and radiotherapy or, in selected cases, chemotherapy followed by radiotherapy may be considered in order to achieve a cure and avoid complete removal of the larynx and subsequent permanent tracheostomy.
Tracheostomy is a surgical procedure in which an opening is formed at the base of the neck, excluding the larynx, to which the trachea is attached to provide breathing and, after adequate exercise, phonation. The opening is kept open with a cannula (small tube) that penetrates the trachea.
Tracheotomy, on the other hand, is different: it consists solely in creating a non-permanent opening in the trachea to facilitate breathing at certain critical moments, but without excluding the larynx and without changing phonation.
However, preservation of the organ is not advisable in cases where the disease penetrates the cartilage, life expectancy is reduced due to other diseases, poor general condition, advanced age, larynx that did not function before treatment, history of frequent pneumonia in the last year and enteral feeding through a nasogastric tube or percutaneous gastrostomy.
In advanced forms of the disease, the goal is the chronic course of the disease through the use of chemotherapy, possibly in combination with biological therapy, and secondarily, for patients in good general condition, immunotherapy, as recently approved, or further chemotherapy.
These treatments may be combined with radiotherapy for symptomatic or bleeding/fracture risk areas, as well as surgical treatment of individual metastases.
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Where do we treat it?
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