Laryngeal cancer
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2008-07-11T19:54:30Z
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{{Infobox_Disease
| Name = Laryngeal cancer
| Image = Larynx cancer 01.jpg
| Caption = Larynx cancer.
| DiseasesDB =
| ICD10 = {{ICD10|C|32||c|30}}
| ICD9 = {{ICD9|161}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID = D007822
}}
'''Laryngeal cancer''' may also be called '''cancer of the larynx''' or '''laryngeal carcinoma'''. Most laryngeal cancers are [[squamous cell carcinoma]]s, reflecting their origin from the [[squamous cell]]s which form the majority of the laryngeal [[epithelium]].
[[Cancer]] can develop in any part of the [[larynx]], but the cure rate is affected by the location of the tumor. For the purposes of tumour [[Cancer staging|staging]], the larynx is divided into three anatomical regions: the [[glottis]] (true vocal cords, anterior and posterior commissures); the [[supraglottis]] ([[epiglottis]], [[arytenoids]] and [[aryepiglottic folds]], and [[false cords]]); and the [[subglottis]].
Most laryngeal cancers originate in the [[glottis]]. [[Supraglottic]] cancers are less common, and [[subglottic]] tumours are least frequent.
Laryngeal cancer may spread by direct extension to adjacent structures, by [[metastasis]] to regional cervical [[lymph node]]s, or more distantly, through the blood stream. Distant metastates to the [[lung]] are most common.
==Causes==
There is no single cause of laryngeal cancer. It is likely that several factors combine to cause it. Not all of these factors are known, but research is going on continually into possible causes.
[[Smoking]] and heavy [[alcoholic beverage|drinking of alcohol]] (especially [[liquor|spirits]]) greatly increase the risk of developing laryngeal cancer.
Laryngeal cancer occurs mainly in middle-aged and older people, but it can occur in younger people who started smoking at an early age. It is more common in men than in women.
==Risk factors ==
[[Image:Tumor Laryngis-01.jpg|thumb|250px|right|Larynx cancer - endoscopic view.]]
Smoking is the most important risk factor for laryngeal cancer. Heavy chronic consumption of [[alcohol]], particularly alcoholic spirits, is also significant. When combined, these two factors appear to have a synergistic effect.
Some other quoted risk factors are likely, in part, to be related to prolonged alcohol and tobacco consumption. These include low socioeconomic status, male sex, and age greater than 55 years.
People with a previous history of head and [[neck cancer]] are known to be at higher risk (about 25%) of developing a second cancer of the head, neck, or lung. This is mainly because in a significant proportion of these patients, the [[aerodigestive tract]] and lung [[epithelium]] have been exposed chronically to the carcinogenic effects of alcohol and [[tobacco]]. In this situation, a [[field change effect]] may occur, where the epithelial tissues start to become diffusely [[dysplastic]] with a reduced threshold for malignant change. This risk may be reduced by quitting alcohol and tobacco.
==Symptoms ==
The symptoms of laryngeal cancer depend on the size and location of the tumor. Symptoms may include the following:
*[[Hoarseness]] or other voice changes
*A lump in the neck
*A [[sore throat]] or feeling that something is stuck in the throat
*Persistent [[cough]]
*[[Stridor]]
*[[Bad breath]]
*[[Earache]]
==Incidence==
5 in 100,000 (12,500 new cases per year) in USA.<ref name=AMN>{{cite web | author = Samuel W. Beenken, MD | title =Laryngeal Cancer (Cancer of the larynx)| work =Laryngeal Cancer (Cancer of the larynx) | url=http://www.health.am/cr/laryngeal-cancer/ | publisher=Armenian Health Network, Health.am | accessdate=2007-03-22}}</ref> The American Cancer Society estimates that 9,510 men and women (7,700 men and 1,810 women) will be diagnosed with and 3,740 men and women will die of laryngeal cancer in 2006.
Laryngeal cancer is listed as a "rare disease" by the Office of Rare Diseases (ORD) of the [[National Institutes of Health]] (NIH). This means that laryngeal cancer affects fewer than 200,000 people in the U.S.<ref name=NIH>{{cite web | title =Annual Report on the Rare Diseases and Conditions Research| url=http://rarediseases.info.nih.gov/ | publisher=National Institutes of Health | accessdate=2007-03-22}}</ref>
Each year, about 2,200 people in the U.K. are diagnosed with laryngeal cancer.<ref name=UK>{{cite web | title =Causes of laryngeal cancer| url=http://www.cancerbackup.org.uk/Cancertype/Larynx/Causesdiagnosis/Causes | publisher=Cancerbackup-cancerbackup.org.uk | accessdate=2007-03-22}}</ref>
==Diagnosis ==
Diagnosis is made by the doctor on the basis of a careful [[medical history]], [[physical examination]], and special investigations which may include a [[chest x-ray]], [[Computed tomography|CT]] or [[MRI]] scans, and tissue biopsy. The examination of the larynx requires some expertise, which may require specialist referral.
The [[physical exam]] includes a systematic examination of the whole patient to assess general health and to look for signs of associated conditions and metastatic disease. The neck and [[supraclavicular fossa]] are palpated to feel for cervical [[adenopathy]], other masses, and laryngeal crepitus. The [[oral cavity]] and [[oropharynx]] are examined under direct vision. The larynx may be examined by [[indirect laryngoscopy]] using a small angled mirror with a long handle (akin to a dentist's mirror) and a strong light. Indirect laryngoscopy can be highly effective, but requires skill and practice for consistent results. For this reason, many specialist clinics now use fibre-optic [[nasal endoscopy]] where a thin and flexible [[endoscope]], inserted through the [[nostril]], is used to clearly visualise the entire [[pharynx]] and larynx. Nasal endoscopy is a quick and easy procedure performed in clinic. [[Local anaesthetic]] spray may be used.
If there is a suspicion of cancer, [[biopsy]] is performed, usually under [[general anaesthetic]]. This provides definitive [[histological]] proof of cancer type and grade. If the [[lesion]] appears to be small and well localised, the surgeon may undertake excision biopsy, where an attempt is made to completely remove the tumour at the time of first biopsy. In this situation, the [[pathologist]] will not only be able to confirm the diagnosis, but can also comment on the completeness of excision, i.e., whether the tumour has been completely removed. A full endoscopic examination of the larynx, [[Vertebrate trachea|trachea]], and [[esophagus]] is often performed at the time of biopsy.
For small [[glottic]] tumours further imaging may be unnecessary. In most cases, tumour staging is completed by scanning the head and neck region to accurately assess the local extent of the tumour and any pathologically enlarged cervical [[lymph node]]s.
The final management plan will depend on the specific site, stage (tumour size, nodal spread, distant [[metastasis]]), and histological type. The overall health and wishes of the patient must also be taken into account.
== Treatment ==
Specific treatment depends on the location, type, and stage of the tumour. Treatment may involve [[surgery]], [[radiotherapy]], or [[chemotherapy]], alone or in combination. This is a specialised area which requires the coordinated expertise of dedicated ear, nose and throat (ENT) surgeons ([[otolaryngologists]]) and [[oncologists]].
==References==
{{reflist}}
==External links==
* [http://www.cancerhelp.org.uk/help/default.asp?page=5606 Staging cancer of the larynx]
{{Respiratory tract neoplasia}}
[[Category:Types of cancer]]
[[de:Kehlkopfkrebs]]
[[es:Cáncer de laringe]]
[[nl:Larynxcarcinoom]]
[[pl:Rak krtani]]