Cancer of the Larynx : Symptoms, Diagnosis, Treatment

by National Cancer Institute

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Symptoms

The symptoms of cancer of the larynx depend mainly on the size of the tumor and where it is in the larynx. 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 your throat
• A cough that does not go away
• Problems breathing
• Bad breath
• An earache
• Weight loss

These symptoms may be caused by cancer or by other, less serious problems. Only a doctor can tell for sure.

Diagnosis

If you have symptoms of cancer of the larynx, the doctor may do some or all of the following exams:

Physical exam. The doctor will feel your neck and check your thyroid, larynx, and lymph nodes for abnormal lumps or swelling. To see your throat, the doctor may press down on your tongue.

Indirect laryngoscopy. The doctor looks down your throat using a small, long-handled mirror to check for abnormal areas and to see if your vocal cords move as they should. This test does not hurt. The doctor may spray a local anesthesia in your throat to keep you from gagging. This exam is done in the doctor's office.

Direct laryngoscopy. The doctor inserts a thin, lighted tube called a laryngoscope through your nose or mouth. As the tube goes down your throat, the doctor can look at areas that cannot be seen with a mirror. A local anesthetic eases discomfort and prevents gagging. You may also receive a mild sedative to help you relax. Sometimes the doctor uses general anesthesia to put a person to sleep. This exam may be done in a doctor's office, an outpatient clinic, or a hospital.

CT scan. An x-ray machine linked to a computer takes a series of detailed pictures of the neck area. You may receive an injection of a special dye so your larynx shows up clearly in the pictures. From the CT scan, the doctor may see tumors in your larynx or elsewhere in your neck.

Biopsy. If an exam shows an abnormal area, the doctor may remove a small sample of tissue. Removing tissue to look for cancer cells is called a biopsy. For a biopsy, you receive local or general anesthesia, and the doctor removes tissue samples through a laryngoscope. A pathologist then looks at the tissue under a microscope to check for cancer cells. A biopsy is the only sure way to know if a tumor is cancerous.

If you need a biopsy, you may want to ask the doctor the following questions:

• What kind of biopsy will I have? Why?
• How long will it take? Will I be awake? Will it hurt?
• How soon will I know the results?
• Are there any risks? What are the chances of infection or bleeding after the biopsy?
• If I do have cancer, who will talk with me about treatment? When?

Staging

To plan the best treatment, your doctor needs to know the stage, or extent, of your disease. Staging is a careful attempt to learn whether the cancer has spread and, if so, to what parts of the body. The doctor may use x-rays, CT scans, or magnetic resonance imaging to find out whether the cancer has spread to lymph nodes, other areas in your neck, or distant sites.

Treatment

People with cancer of the larynx often want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. However, shock and stress after a diagnosis of cancer can make it hard to remember what you want to ask the doctor. Here are some ideas that might help:

• Make a list of questions.
• Take notes at the appointment.
• Ask the doctor if you may use a tape recorder during the appointment.
• Ask a family member or friend to come to the appointment with you.

Your doctor may refer you to a specialist who treats cancer of the larynx, such as a surgeon, otolaryngologist (an ear, nose, and throat doctor), radiation oncologist, or medical oncologist. You can also ask your doctor for a referral. Treatment usually begins within a few weeks of the diagnosis. Usually, there is time to talk to your doctor about treatment choices, get a second opinion, and learn more about the disease before making a treatment decision.

Getting a Second Opinion

Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if you or your doctor requests it. There are a number of ways to find a doctor for a second opinion:

• Your doctor may refer you or you may ask for a referral to one or more specialists. At cancer centers, several specialists often work together as a team. The team may include a surgeon, radiation oncologist, medical oncologist, speech pathologist, and nutritionist. At some cancer centers, you may be able to see them all on the same day.

• The Cancer Information Service, at 1-800-4-CANCER, can tell you about treatment centers near you.

• A local medical society, a nearby hospital, or a medical school can often provide the names of specialists in your area.

• The American Board of Medical Specialties (ABMS) has a list of doctors who have met certain education and training requirements and have passed specialty examinations. The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information on the Internet at http://www.abms.org.

Preparing for Treatment

The doctor can describe your treatment choices and the results you can expect for each treatment option. You will want to consider how treatment may change the way you look, breathe, and talk. You and your doctor can work together to develop a treatment plan that meets your needs and personal values.

The choice of treatment depends on a number of factors, including your general health, where in the larynx the cancer began, the size of the tumor, and whether the cancer has spread.

If you smoke, a good way to prepare for treatment is to stop smoking. Studies show that treatment is more likely to be successful for people who don't smoke. Your doctor or the Cancer Information Service (1-800-4-CANCER) may be able to suggest ways to help you stop smoking.

You may want to talk with the doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option. Patients who join trials have the first chance to benefit from new treatments that have shown promise in earlier research.

These are questions you may want to ask your doctor before treatment begins:

• Where is my cancer and has it spread?
• What are my treatment choices? Which do you recommend for me? Why?
• What are the benefits of each treatment?
• What are the risks and possible side effects of each treatment?
• How will I look after treatment?
• How will I speak after treatment? Will I need to work with a speech therapist?
• Will I have problems eating?
• Will I need to change my daily activities?
• When can I return to work?
• What is the treatment likely to cost? Is this treatment covered by my insurance plan?
• Would a clinical trial (research study) be right for me? Can you help me find one?
• How often will I need checkups?

You do not need to ask all your questions or understand all the answers at once. You will have many chances to ask the doctor and the rest of the health care team to explain things that are not clear and to ask for more information.

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