Laryngeal Cancer

21.03.2024

LARYNX CANCER DIAGNOSIS AND TREATMENT

Laryngeal cancer is a type of cancer that develops in the larynx area known as the vocal cords. The larynx is an organ located in the upper part of the trachea and plays an important role in breathing, speaking and swallowing functions. Laryngeal cancer is often associated with long-term tobacco use and excessive alcohol consumption, but other environmental factors and genetic predisposition may also be among the risk factors. This type of cancer can manifest itself with symptoms such as hoarseness, shortness of breath, difficulty swallowing, sore throat and a feeling of mass in the neck area. When diagnosed early, laryngeal cancer is often treatable and voice preservation may be possible. However, in cases diagnosed late, treatment may become more complex and may affect the patient's ability to speak. Therefore, it is important for individuals at risk to have regular health checks and get the necessary medical attention for early diagnosis, especially if they have symptoms such as long-term hoarseness. Laryngeal cancer is an important issue for both individual and public health, because prevention and early diagnosis of this type of cancer can significantly improve patients' quality of life and survival rates

WHAT ARE THE RISK FACTORS?

Larynx Cancer is a type of cancer that develops in the voice box and is associated with various risk factors. Some of these factors are related to lifestyle, some are environmental factors.or are genetic factors. Known risk factors of laryngeal cancer include:

Cigarettes and Tobacco Products: It is the most important risk factor. Smoking, chewing tobacco, or using other tobacco products significantly increases the risk of laryngeal cancer.

Excessive Alcohol Consumption: Alcohol increases the risk of laryngeal cancer, especially when consumed together with cigarettes.

Asbestos Exposure: Exposure to asbestos may increase the risk of laryngeal cancer, especially in individuals who smoke.

Other Environmental Exposures: Exposure to chemicals and dust may increase the risk of laryngeal cancer.

Gender: Men get laryngeal cancer more often than women.

Age: The risk increases with age. Most cases of laryngeal cancer occur in individuals over the age of 65.

Nutrition: Low intake of vegetables and fruits may increase the risk of cancer.

Human Papillomavirus (HPV): Some laryngeal cancers, especially oropharyngeal cancers, are associated with high-risk HPV types.

Family History: Having a family member with laryngeal cancer may increase an individual's risk of developing this cancer.

Gastroesophageal Reflux Disease (GERD): GERD and other chronic reflux conditions can cause irritation in the laryngeal area and, as a result, an increased risk of cancer.

Understanding the risk factors of laryngeal cancer is important for developing prevention strategies and early diagnosis. Quitting smoking, limiting alcohol consumption, and maintaining a healthy diet are among the effective methods for reducing the risk of laryngeal cancer.

Image 1: Laryngeal cancer occurs in the area where the vocal cords are located.

HOW DOES IT OCCUR?

The mechanisms of larynx cancer development often involve the interaction of various environmental and genetic factors. Smoking and excessive alcohol consumption, which are the most common risk factors, cause damage to the DNA of the cells in the larynx, paving the way for cancer development. Tobacco smoke and alcohol contain carcinogenic substances that can damage the genetic material of cells, causing mutations. These mutations cause cells to grow and divide uncontrollably and abnormally, leading to tumor formation. Exposure to asbestos and other environmental toxins can similarly contribute to DNA damage and abnormal growth of cells. Additionally, some genetic predispositions and gene mutations may increase individuals' risk of developing laryngeal cancer. For example, infection with Human Papillomavirus (HPV), especially high-risk HPV types, has been associated with the development of laryngeal cancer. As a result of these interactions, laryngeal cells multiply abnormally and form a cancerous tumor. This complex process is an ever-evolving topic of research in cancer biology, and deepening this understanding can contribute to the development of more effective treatment and prevention strategies.

WHAT ARE THE SYMPTOMS?

Laryngeal cancer is a type of cancer that affects the voice box and surrounding areas and can present with various symptoms.

Common findings of this cancer include:

Hoarseness: One of the most common symptoms, especially when cancer affects the vocal cords. Hoarseness can last a long time, unlike an untreated infection or cold.

Sore throat: There may be persistent or recurring sore throat.

Difficulty in Swallowing: Difficulty swallowing food may occur.

Shortness of breath: When the tumor narrows the trachea, breathing difficulties may occur.

Cough: Continuous cough with bloody sputum may be detected.

Mass or Swelling in the Neck Area: There may be mass or swelling in the neck area, especially in the lymph nodes.

Earache: Earache may occur as a result of the tumor affecting the nerves.

Weight Loss and Loss of Appetite: It is especially seen in advanced stage cancers.

Bad Breath Odor: It may occur due to infection arising from the tumor.

Voice Changes: Changes in tone of voice and weakening of the voice may occur.

Any one or more of these symptoms may be signs of laryngeal cancer. But not all of these symptoms are specific to cancer and can also be caused by other, less serious health problems. If any of these symptoms persist for a long time or worsen, it is important to see a physician. Early diagnosis is an important factor in the treatment of laryngeal cancer and can significantly increase treatment success.

HOW IS IT DIAGNOSED?

Laryngeal cancer is diagnosed by a combination of the patient's symptoms, medical history, and various medical tests. Usually, the process begins with an ear, nose, and throat (ENT) specialist assessing the patient's symptoms and performing a physical examination. This examination uses laryngoscopy for direct visualization of the larynx. Laryngoscopy is an instrument used to examine the inside of the larynx and can help determine the presence, size and location of a tumor. If a suspicious lesion is detected, a biopsy is performed to make a definitive diagnosis; That is, a sample of the suspicious tissue is taken and examined under a microscope. To support the diagnosis, imaging tests such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET) may be performed. These tests help evaluate the size of the cancer, its spread, and whether it has spread to lymph nodes or other organs. This type of comprehensive evaluation enables an accurate diagnosis of laryngeal cancer.to be placed and allows the determination of the appropriate treatment plan.

WHAT ARE THE PATHOLOGICAL TYPES?

Larynx Cancer can be classified according to its main pathological types, and these types are based on the microscopic structure and cellular characteristics of the cancer. The most common pathological types of laryngeal cancer are:

Squamous Cell Carcinoma: It constitutes the majority of laryngeal cancers. This type arises from squamous (flat) cells lining the inner surface of the larynx. Squamous cell carcinoma can present itself in more or less differentiated forms, that is, it is classified according to the degree to which the cells resemble normal cells.

Basaloid Carcinoma: It is a more aggressive form of squamous cell carcinoma and shows basal cell features.

Adenocarcinoma: It is a much rarer type in the larynx and originates from the mucous glands.

Adenoid Cystic Carcinoma: It is also a rare type, originating from the glandular structures of the larynx, and is generally a slow-growing disease with a tendency to relapse.

Neuroendocrine Carcinoma: This rare type has characteristics of nerve and endocrine cells and can be divided into several subtypes.

Each pathological type can affect the course of the disease, its response to treatment, and its overall prognosis. Therefore, accurate pathological diagnosis of laryngeal cancer is critical in creating an effective treatment plan. Treatment approaches may vary depending on the type of cancer and are taken into consideration by oncology specialists.Larynx It is important to examine some molecular receptors and biological markers in the diagnosis and treatment of cancer. These receptors and markers are used to understand the biological characteristics of the tumor and identify potential treatment targets. In particular, Epidermal Growth Factor Receptor (EGFR) is often found at high levels in laryngeal cancer cells and Its overexpression has been associated with disease prognosis and response to targeted therapies. In addition, mutations of tumor suppressor genes such as P53 and expression of oncogenes can also affect the behavior of cancer and its response to treatment. Immunohistochemical analyzes are standard methods used to detect these receptors and genetic markers. These molecular profiling are becoming increasingly important, especially in the selection of targeted therapies and immunotherapies. These receptors and molecular markers in laryngeal cancer cells play a critical role in understanding cancer biology and treatment strategies, and ongoing research in this field contributes to the development of treatment approaches.

Image 2: For the diagnosis of laryngeal cancer, video examination can be performed with a camera.

HOW IS TUMOR STAGING DONE?

Tumor staging in laryngeal cancer is a system used to determine the severity of diseases spread. This system evaluates the size of the tumor, its spread to nearby lymph nodes, and its metastasis to other parts of the body. It is done according to the TNM (Tumor, Nodule, Metastasis) classification system accepted by the Union for International Cancer Control (UICC) and the American Cancer Society (ACS):

T (Tumor) Category: It is rated from T0 to T4. This shows how much the tumor has grown and spread in the larynx. T0 indicates absence of tumor; T1-T4 indicates the size of the tumor and how far it has spread in the larynx.

N (Lymph Nodule) Category: It is rated from N0 to N3. This shows whether the cancer has spread to nearby lymph nodes and the extent of spread.

M (Metastasis) Category: M0 means no distant metastasis; M1 indicates metastasis to distant organs.

As a result of these evaluations, laryngeal cancer is classified from Stage I to Stage IV:

Stage I: It is usually a small tumor and there is no spread to the lymph nodes.

Stage II: A larger tumor, but there is no or minimal spread to the lymph nodes.

Stage III: There is spread to larger tumors or lymph nodes.

Stage IV: A widely spread tumor involves large involvement in lymph nodes or distant metastasis.

Physical examination, laryngoscopy, biopsy, and various imaging methods (e.g., MRI, CT, PET scans) are used for staging. This detailed evaluation plays an important role in determining treatment options and predicting the patient's prognosis.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Treatment of laryngeal cancer varies depending on the stage of the disease. Treatment approaches for each stage are as follows:

Stage I and II (Early Stage)

Surgery: In some cases, small tumors can be removed surgically. Minimally invasive methods such as laser surgery may be preferred.

Radiotherapy: Early-stage laryngeal cancer is usually treated with radiotherapy. Cancer cells are targeted and destroyed using high-energy rays.

Stage III and IVa (Locally Advanced Stage)

Combined Radio-Chemotherapy: In these stages, chemotherapy is usually applied together with radiotherapy. Chemotherapy can increase the effectiveness of radiotherapy and help prevent the spread of cancer.

Surgery: If the tumor size and location are appropriate, all or part of the larynx may need to be removed. This surgery can affect the function of the larynx and cause voice changes.

Stage IVb (Metastatic)

Systemic Chemotherapy: If there is distant metastasis, systemic chemotherapy may be administered to control the cancer and relieve symptoms.

Palliative Care: At this stage, palliative care becomes important to improve the patient's quality of life and relieve symptoms.

Targeted Therapy and Immunotherapy: In some cases, drugs with molecular targets or immunotherapy can be used.

General Approach

Regular Monitoring and Support: At all stages, regular monitoring and psychological or social support should be provided when necessary.

Clinical Trials: In addition to existing treatments, some patients may choose to participate in clinical trials that test new treatment approaches.

In the treatment of laryngeal cancer, a personalized treatment plan is created by taking into account factors such as the patient's general health condition, the characteristics of the cancer and the patient's preferences. A team effort consisting of oncologists, radiation oncologists, surgeons and other physicians is important in determining the treatment plan.

Image 3: Laryngeal cancer can cause complaints such as hoarseness, sore throat and bleeding from the mouth.

WHAT ARE THE SYSTEMIC DRUGS USED IN TREATMENT?

Larynx Treatment methods used in cancer include chemotherapy, targeted therapies (smart drugs) and immunotherapies.

Some examples of these treatments:

Chemotherapy pills

Cisplatin: It is the most commonly used chemotherapy drug and is often combined with radiotherapy.

Carboplatin: Used similarly to cisplatin and often combined with radiotherapy.

5-Fluorouracil (5-FU): Mostly used in combination with cisplatin or carboplatin.

Docetaxel: In some cases, it may be added to other chemotherapy drugs.

Paclitaxel: Can be used as part of chemotherapy.

Targeted Therapies (Smart Drugs)

Epidermal Growth Factor Receptor (EGFR) Inhibitors: For example, drugs such as cetuximab can inhibit the growth of cancer cells by targeting EGFR.

Immunotherapies

PD-1/PD-L1 Inhibitors: For example, drugs such as Pembrolizumab and Nivolumab can increase the effectiveness of the immune system against tumor cells by targeting the PD-1 or PD-L1 pathway.

General Approach

Combination Therapies: Chemotherapy, targeted therapies and immunotherapies are often used in combination with other treatment methods.

Personalized Treatment: Treatment options are personalized based on factors such as the patient's general health status, characteristics of the cancer, and genetic profiling.

In the treatment of laryngeal cancer, these drugs and treatment methods are used to control the disease and improve the patient's quality of life. A team effort consisting of oncologists, radiation oncologists and other physicians is important in determining the treatment plan. Because treatment options and combinations are constantly evolving, it is important to stay in touch with physicians for the most up-to-date information.

HOW SHOULD FOLLOW-UP BE CARRIED OUT AFTER RECOVERY?

Follow-up after treatment for laryngeal cancer is vital to detect early recurrence of the disease and manage possible side effects. Post-recovery follow-up usually begins after surgery or radiotherapy and continues for several years. This process is often customized based on the patient's symptoms, the characteristics of the cancer being treated, and their overall health. Follow-up includes regular examination of the patient by an ear, nose and throat (ENT) specialist. In these examinations, a detailed examination of the larynx is performed using methods such as laryngoscopy. Patients are also encouraged to report any new symptoms or changes to their doctor. Imaging tests (for example, MRI or CT scans) and blood tests may be performed from time to time to detect signs of recurrence or metastasis. Patients may also receive speech and swallowing therapy, nutritional counseling, and psychological support when necessary to cope with the long-term side effects of treatment. Preventive measures, such as smoking cessation and healthy lifestyle changes, also play an important role in reducing the risk of relapse and improving overall health.