Although smoking appears to be decreasing, especially with recent efforts to curb smoke in public places, the rates of cancer of the larynx have not changed dramatically with over 12,000 new cases annually. Smoking and excess alcohol intake is the primary etiologic factor. Early voice changes, ear pain, dysphagia, throat clearing, and sore throat are typical signs. Unfortunately, these signs can mimic other diseases of the head and neck and diagnosis is often delayed. Time from first symptom to actual diagnosis is rarely less than 4-6 months. Any patient who smokes and has symptoms of hoarseness, voice changes, throat discomfort, otalgia (referred pain) and dysphagia should see a laryngologist immediately. Early detection with early treatment can lead to cure rates in excess of 95%.
Symptoms
- Hoarseness
- Otalgia
- Sore Throat
- Cough
- Dysphagia
- Throat Clearing
Diagnosis
Laryngeal Digital Video-Stroboscopy is the gold standard tool to diagnose any voice disorder. Cancers often cause very subtle changes in the vocal fold vibration pattern which allow for earlier detection.
Treatment
Traditional treatment of vocal fold cancers and pre-malignant lesions include “vocal fold stripping” and radiation therapy. The CO2 laser has been the workhorse tool in removing these lesions by circumferential excision. In recent years, the improvements in microsurgery have led to microflap excision of these lesions with improved vocal results and excellent local control. Metastasis from vocal fold cancer is rare. The trend for treatment is away from radiation therapy for smaller lesions. Equal control rates, better voice results, and the ability to utilize radiation for recurrences or other primary cancers makes microsurgery and laser surgery the preferred option.
The newest tool in the armamentarium against vocal fold cancer includes the use of a specialized angiolytic laser. KTP laser treatment can be performed in the operating room and even the office setting, especially in patients deemed too sick to undergo general anesthesia. Improved voice results and long term cure are the goals of utilizing this newer technology. By ablating the feeding blood supply to the cancerous lesion, regression of the lesion is seen. Improved voice results occur because of less collateral damage to the surrounding normal vocal fold epithelium and underlying superficial lamina propria, responsible for creating normal voice. Additionally, digital scanning technology for the CO2 laser allows for improved resection with minimal collateral damage as well.
Voice therapy is a very important adjunct in the post-treatment period for any modality of treatment utilized. Enhanced vibration and improved muscle strength and support result from specialized techniques of vocal therapy.