CANCER OF LARYNX
( By JASCAP )

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Symptoms & diagnosis

Symptoms of laryngeal cancer

Most cancers of the larynx begin on, or close to, one of the vocal cords. Even a small tumour can stop the two vocal cords meeting together and vibrating properly, and so a change in voice is usually an early symptom. Hoarseness is often the first sign of cancer of the larynx. If you have had hoarseness for longer than four weeks, you should ask your GP to refer you to an ear, nose and throat (ENT) specialist.

Less commonly, cancer can start in a part of the larynx that is not close to the vocal cords. In this case the voice may not change. The first symptom may then be a lump in the throat or neck, or discomfort or pain when swallowing. Occasionally, the first sign is ongoing earache or breathlessness.

If you have any of the above symptoms itís important to let your doctor know. However, the symptoms are more likely to be due to conditions other than cancer. For example, laryngitis (inflammation of the larynx), often occurs due to ordinary viral infections and causes a hoarse voice. Most people with the above symptoms will not have cancer.

How laryngeal cancer is diagnosed

Usually you begin by seeing your GP (family doctor) who will examine you and may arrange for some tests or x-rays. Your GP may then refer you to an ear, nose and throat (ENT) specialist at a hospital.

The ENT doctor will take your full medical history and examine you. The doctor will feel for enlarged glands in your neck. They will examine the back of your mouth and throat
(including the larynx) using a small mirror, like the one a dentist uses when checking your teeth. The specialist may want to look at the larynx with a thin, flexible tube with a light on the end (a nasendoscope). The nasendoscope is passed up your nose and into the throat. This may be a bit uncomfortable, but your throat can be sprayed first to numb the area.

If anything abnormal or unusual is seen in your throat, or if the doctor canít see your larynx clearly with the mirror or nasendoscope, you will need to be admitted to hospital to have an examination of your larynx under general anaesthetic. While you are under the anaesthetic, the doctor can usually see all parts of the larynx very well. Using an endoscope (a thin tube with a light on the end) the doctor will take a closer look at the larynx. If any areas look abnormal a very small sample of tissue is removed and examined under a microscope. This is called a biopsy.

You may have an overnight stay in hospital because this examination is done under general anaesthetic. However, some people can go home on the same day once theyíve recovered from the procedure. Your doctor or specialist nurse will give you more information about this.

Further tests for laryngeal cancer

Blood tests

There isnít a specific blood test that can detect laryngeal cancer, but blood tests may be taken to check your general health.

X-rays

You may have a chest x-ray to check your general health and to see if the cancer has spread to the lungs (which is uncommon).

CT scan

A CT (computerised tomography) scan takes a series of x-rays, which are fed into a computer to give a detailed picture of the throat and neck. Itís used to check whether there has been any spread of the cancer to other parts of your throat and neck.

Once youíre lying comfortably on the couch the scan can be taken. The scan itself is painless but it will mean lying still for around 10Ė20 minutes. To give more detail, a dye may be injected into a vein in your arm. This may make you feel hot all over, but the feeling wonít last long.

Most people are able to go home as soon as their scan is over.


A CT scan

MRI scan

An MRI (magnetic resonance imaging) scan is similar to a CT scan, but uses magnetic fields instead of x-rays to build up a series of cross-sectional pictures of the body.

During the test you will be asked to lie very still on a couch inside a metal cylinder that is open at both ends. The whole test may take up to an hour and is painless Ė although the machine is very noisy. You will be given earplugs or headphones to wear.

The cylinder is a very powerful magnet, so before going into the room you should remove all metal belongings. You should also tell your doctor if you have ever worked with metal or in the metal industry or if you have any metal inside your body (for example, a cardiac monitor, pacemaker, surgical clips, or bone pins). You may not be able to have an MRI because of the magnetic fields.

Some people are given an injection of dye into a vein in the arm, but this usually does not cause any discomfort.

You may feel claustrophobic inside the cylinder, but you may be able to take someone with you into the room to keep you company. It can help to mention to the staff beforehand if you do not like enclosed spaces. They can then offer extra support during your test.

PET-CT scan

A PET (positron emitted tomography) scan uses low dose radiation to measure the activity of cells in different parts of the body. This is combined with a CT scan. This gives more detailed information about the part of the body being scanned. PET-CT scans are a new type of scan and you may have to travel to a specialist centre to have one.

You will be asked not to eat for six hours before the scan, although you may be able to drink. You will be given an injection of a mildly radioactive substance into a vein, usually in your arm.

The radiation dose used is very small. You will then have to wait at least an hour after the injection until you have the scan. The scan itself usually takes between 30 and 90 minutes. You should be able to go home after the scan is over.

Waiting for your test results

You may have to wait several days for the results, and this may be a very anxious time for you. You may wish to contact our cancer support specialists or another support organisation for emotional support.

Staging and grading of laryngeal cancer

The stage of a cancer is a term used to describe the size of the cancer and whether it has spread beyond where it started in the body. The grade of a cancer refers to how abnormal the cancer cells look under the microscope. The grade gives an idea of how quickly the cancer may develop.

Knowing the stage and grade of your cancer is very important. Your doctors can decide what treatment will be best for you with this information. The stage and grade of a cancer can help doctors to predict how that cancer might behave, how it might respond to treatment, and what the chance of cure might be.

Staging

A staging system is a way of reporting the size of a tumour and how far it has grown. The most commonly used staging system for cancer of the larynx is the TNM staging system. TNM stands for tumour, node and metastases.

T describes the size of the tumour
N describes whether the cancer has spread to the lymph nodes and
M describes whether the cancer has spread to another part of the body (secondary or metastatic cancer)

The exact TNM system for laryngeal cancer will depend on which part of the larynx the cancer is affected. Your doctor or specialist nurse can give you more details about the stage of your cancer. If you want more information on the TNM staging system for cancer of the larynx contact our cancer support specialists.

Grading

There are three grades of laryngeal cancer:

Grade 1 (well differentiated or low grade). The cancer cells look very like the normal cells of the larynx.
Grade 2 (moderately differentiated or intermediate grade). The cancer cells look less like the normal cells of the larynx.
Grade 3 (poorly differentiated or high grade). The cancers cells look abnormal and different from normal cells in the larynx.

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