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 DEFINITION
The larynx cancer is an appearance of (malignant) cancerous cells in the larynx. The larynx, where the vocal cords are, is a short passage in the shape of triangle, which is just under the pharynx in the neck.
GENERALITIES
The pharynx is a hollow pipe, of approximately 8 cm. of length, which begins behind the nose and goes down to the neck to turn partly of the esophagus (the pipe that goes to the stomach). The food happens for the pharynx in his trip towards the esophagus.
The air, in his trip towards the trachea and the lungs, happens first for the pharynx and then for the larynx. The larynx has above a small piece of textile, called the epiglottis, to prevent the food that go down for the pharynx from getting in the larynx or in the places of step of the air.
The larynx contains the vocal cords, which vibrate and produce sounds when air goes against them. The sound produces an echo in the pharynx, the mouth and the nose to form the voice.
The larynx is composed of three principal parts: the glottis (the part comes up of the larynx where the vocal cords are), the region supraglótica (the textile over the glottis) and the subglottal region (the textile below the glottis).
The subglottal region gets connected to the trachea, which takes air to the lungs.
SYMPTOMS
The larynx cancer is almost exclusively in persons who smoke. As most of cancers, the cancer of larynx talks each other better when it is diagnosed soon.
For it, it must be consulted with the doctor if it is had:
- annoyance of the gullet that it does not eliminate
- pain on having swallowed
- a change in the tone of voice or frank hoarseness
- pain in an ear
- a mass in the neck.
DIAGNOSIS
The specialist will slide the gullet a pipe that has a special light in an end and will observe the larynx (laringoscopia). If abnormal textile is, it will have to extract a piece (biopsy) and to observe it across the microscope in order to determine the presence of cancerous cells. Also he will feel the gullet in search of masses.
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| Exploration of larynx and vision of the same one with the mouth ropes in the sides of the cavity. |
The possibilities of recovery (prognosis) depend:
- of the place in which the cancer is in the larynx
- if the cancer is only in the larynx or (stage) has been spread
- of the general health state.
STAGES (STADIUMS) OF THE CANCER OF LARYNX
Once a larynx cancer is diagnosed, more tests will be done to determine if the cancerous cells have been spread to other parts of the body. This process is known as a classification for stages ("stadiums). Necessary knowledge is the stage of the illness to plan the suitable treatment.
- Stage I. The cancer only is in the area where it began and has not been spread to the lymphatic ganglions of the area or to other parts of the body (the lymphatic ganglions are small structures in the shape of string bean that are in the whole body and which function is to produce and to store cells that fight the infections).
The exact definition of the stage I will depend where from the cancer originated: region supraglótica, glottis or subglottal region. In any case, the vocal cords can move still normally. - Stage II The cancer only is in the larynx and has not been spread to the lymphatic ganglions in the area or to other parts of the body. The exact definition of the stage II will depend also where from the cancer began: region supraglótica, glottis or subglottal region. In any case, in the stadium II can exist local invasion of the nearby region of the larynx, but never out of her.
- Stage III. Any of these situations III define a stadium:
- The cancer has not been spread on the outside of the larynx, but the vocal cords cannot already move normally; or
- The cancer has already been spread to textiles next to the larynx, ó
- The cancer has been spread to a lymphatic ganglion in the same side of the neck, and the lymphatic ganglion measures not more than 3 cm.
- Stage IV. Any of these situations IV define a stadium:
- The cancer has been spread to textiles about the larynx, like the pharynx or the textiles in the neck. The lymphatic ganglions in the area can or have no cancer.
- The cancer has been spread to more than one lymphatic ganglion in the same side of the neck as the cancer, to lymphatic ganglions in one or both sides of the neck, or to any lymphatic ganglion that measures more than 6 cm.
- The cancer has been spread to other parts of the body.
- Appellant. When the illness is an appellant, it means that the cancer has been reproduced after having being treated. It can be reproduced in the larynx or in another part of the body.
TREATMENT OF THE CANCER OF LARYNX
Treatments exist for all the patients with larynx cancer. Three classes of treatment are used:
- Radiotherapy (use of x-rays in high doses or other beams of high energy to eliminate the cancerous cells)
- Surgery (eradication of the cancer)
- Chemotherapy (use of medicines to eliminate the cancerous cells).
1. Radiotherapy. It consists of the use of x-rays of tall energa to destroy the cancerous cells and to reduce the tumors. The radiation can come from a placed machine out of the body (external radiotherapy) or of materials that produce radiations (radioisotopes) put in the area where there are the cancerous cells (internal radiotherapy), by means of thin plastic pipes. The administration of medicines is evaluated together with radiotherapy so that the cancerous cells are more sensitive to the radiation (radiosensibilización).
The external radiation in the neck can alter the functioning of the gland thyroid gland. The function of the thyroid gland is examined usually since earlier and after the radiotherapy.
2. Surgery. The cancer can be eliminated, together with part of the larynx, one of the following operaciónes:
- Cordectomía, in which only the vocal chord is extracted.
- Laringectomia supraglótica, in which the region is extirpated only supraglótica.
- Hemilaringectomia or laringectomia partial, in that part of the larynx is extirpated only.
- Entire Laringectomia, in which the whole larynx is extirpated.
During this operation, it is necessary to do an orifice ahead in the neck (traqueostomía) so that one could breathe without larynx. If the cancer has been spread to the lymphatic ganglions, there will be extirpated the lymphatic ganglions (dissection of lymphatic ganglions).
The surgery is evaluated in clinical essays with laser for very precocious larynx cancers. The surgery with laser uses a concentrated bundle of intense light to destroy selectively the cancer.
3. Chemotherapy. It consists of the use of medicines to destroy the cancerous cells. It can take in oral form, or can be administered by intravenous or intramuscular route. The medicines interfere to the blood stream, travel across the body and can destroy cancerous cells in any area of the body.
The persons with larynx cancer have a major risk of contracting other cancers in the field of the head and the neck. Quimioprevención therapies are evaluated in clinical essays with certain drugs, which might prepare the development of secondary cancers in the mouth, the gullet, the trachea, the nose, or the esophagus.
As the larynx is necessary to breathe and to speak, the larynx produced one is going to need special help to fit to the side effects of the cancer and his treatment. He might need a special device that he helps him to speak, or learn a new speech habit. Different specialists can help him to recover from the treatment and to fit to new ways of eating and of speaking.
TREATMENT FOR STAGES OR STADIUMS
The treatment of the cancer of larynx goes to depend on the location of the cancer in the larynx, of the stage of the illness, of the age of the patient and of his general state of health.
A patient with larynx cancer has the option to receive a "standard" treatment - in accordance with his efficacy in a certain number of patients in previous studies - or to choose to take part in a clinical essay. The clinical tests are designed to find better methods for the patients' treatment with cancer, and are based on the most updated information.
In all the stages of the cancer of larynx, the individualized treatment will depend on the location of the cancer inside the larynx.
STAGE I - Region supraglótica:
- Radiotherapy with external bundle.
- Surgery (Laringectomia supraglótica, or whole).
- Glottis:
- Radiotherapy.
- Surgery to remove a vocal chord (cordectomia).
- Surgery to remove everything or part of the larynx.
- Surgery laser.
- Subglottal region: His treatment probably consists of radiotherapy. In some cases, it can become a hemilaringectomia (surgery to remove part of the larynx).
STAGE II - Region supraglótica:
- Radiotherapy with external bundle.
- Surgery (Laringectomia supraglótica, or whole).
- Surgery + later Radiotherapy.
- Hyperby installments radiotherapy (several small radiation doses a day)
- Quimioprevención therapy to prepare the second cancer in the mouth, the gullet, the trachea, the nose or the esophagus.
- Glottis:
- Radiotherapy.
- Surgery to remove everything or part of the larynx.
- Hyperby installments radiotherapy
- Quimioprevención therapy.
- Subglottal region: His treatment probably consists of radiotherapy. In some cases, it can become a hemilaringectomia (surgery to remove part of the larynx) or an entire laringectomia. There is evaluated in clinical tests the use of hyperby installments radiotherapy and therapies of quimioprevención.
STAGE III
- Region supraglótica:
- Surgery to eliminate the cancer with or without radiotherapy.
- Radiotherapy. The surgery can be necessary (laringectomia) later if the cancer does not diminish after the radiation. Therapy of hyperby installments radiation.
- Chemotherapy followed by radiotherapy.
- The surgery can be necessary (laringectomia) later if the cancer does not diminish after the chemotherapy and the radiation.
- Clinical chemotherapy essays: Use of medicines to do the cancerous cells most sensitive to the radiation (radiosensibilizadores) or new forms of radiation.
- Quimioprevención therapy to prepare the second cancer in the mouth, the gullet, the trachea, the nose or the esophagus.
- Glottis:
- Surgery with or without radiotherapy
- Radiotherapy. The surgery can be necessary to eliminate the larynx (laringectomia) if the cancer does not diminish after the radiation. Hyperby installments radiotherapy.
- Chemotherapy followed by radiotherapy. The surgery can be necessary to eliminate the larynx (laringectomia) if the cancer does not diminish after the chemotherapy and the radiation.
- Clinical chemotherapy essays: Use of medicines to do the cells cáncerosas more sensitive to the radiation (radiosensibilizadores) or new forms of radiation.
- Therapy of quimioprevención of the second cancer in the mouth, the gullet, the trachea, the nose or the esophagus.
- Subglottal region:
Surgery with entire eradication of the larynx, part of the textile of around, the gland thyroid gland - preserving the glands parathyroids regulatory of the calcium - and the lymphatic ganglions in the neck. The surgery follows generally with radiotherapy.
If the surgery is impossible, conventional or hyper-by installments radiotherapy, chemotherapy usually happens with radiosensibilizadores or new forms of radiation.
Quimioprevención therapy can be used.
STAGE IV
- Region supraglótica and/or glottis:
- Entire surgery of larynx followed by radiotherapy.
- Hyperby installments radiotherapy
- Chemotherapy followed by radiotherapy.
- Chemotherapy with radiosensibilizadores and/or new forms of radiation.
- Quimioprevención therapy.
- Subglottal region:
Just as for the stadium III: Surgery with entire eradication of the larynx, part of the textile of around, the gland thyroid gland - preserving the glands parathyroids regulatory of the calcium - and the lymphatic ganglions in the neck. The surgery follows generally with radiotherapy.
If the surgery is impossible, conventional or hyper-by installments radiotherapy, chemotherapy usually happens with radiosensibilizadores or new forms of radiation.
Quimioprevención therapy can be used.
APPELLANT His treatment will depend on the class of treatment received at first, always combining of individualized form the possibilities of surgery, radiotherapy and/or chemotherapy.
To know more on the larynx cancer, it can get in touch with the Spanish Association of Struggle against the Cancer or other organisms, like the Service of Attention to the Patient of the hospitals, where it is possible to find information about the treatments for the cancer and of the services that him can be useful.
WHAT DOCTOR CAN TREAT ME?
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DEFINITION 
