Voice box cancer can settle in one of three parts of the larynx: the supraglottic – just above the vocal cords, the glottis – the true vocal cords, or in the sub-glottis area – just below the vocal cords. Depending on where the cancer manifests itself will determine the treatment of it. It has been found that, without a doubt, exposure to tobacco smoke plays a huge role in this rare form of cancer. Add alcohol use to it, and you might have the perfect recipe for (especially) supraglottic-or glottis cancer! The reason for this is the combined ‘direct contact’ of carcinogenic substances to the larynx. Even if you have quitted smoking – damage to the delicate cells within the larynx might have already been done. Be very aware of the symptoms of voice box cancer.

When experiencing a non-obvious hoarseness in your voice, persisting for 3 weeks or more – go speak to your doctor. A persistent cough – not due to flu or allergies – can also be an indication that something is wrong. If you experience difficulty in swallowing, as if you have a lump in your throat, it might be a warning of the presence of a tumour. This difficulty in swallowing could be accompanied by pain – or not. Because of the slow progress of trouble in swallowing, weight loss might be evident. It has also been found that halitosis (gum disease) and non-specific ear aches can also be a symptom of voice box cancer. The human papilloma virus in the larynx has also been labelled a risk. Being male, and over the age of 50 might increase your risk in getting this form of cancer. To cut the risk in getting voice box cancer, practice caution when working under conditions that entail wood dust, coal dust and paint fumes. These substances are known to damage the lining of the larynx. Be aware that continuous acid reflux causes damage to the oesophagus cells. Speak to your doctor if you have this problem. Processed meats, and other processed foods will also increase your risk, as poor eating habits will increase the risk of many forms of cancer. The anti-oxidants Vitamins A, C and E have shown positive results in the prevention of voice box cancers. No specific gene (causing) voice box cancer has been identified as yet.

Sub-glottic cancers are quite rare, and will be treated first with surgery, followed by radiation. For supraglottic cancer, radiation will be the first choice, sometimes followed by partial removal of the area. Because ‘supraglottic’ cancer is closer to the lymph nodes – metastasis (spreading) to the lymph is a risk. Cancer in the glottis is usually called ‘true cord’ cancer. Radiation therapy/chemotherapy is the first choice, with surgery being the last resort. Surgical removal of two cords or more are done in more aggressive forms of true cord cancer. Removal or partial removal of the voice box/cords is probably the biggest fear of patients with this form of cancer.

There are different degrees of ‘voice losses’ due to voice box surgery. If an endoscope has been performed to remove a small tumour, the patient should only end up with a hoarse voice. After a partial laryngectomy, the patient will be fitted with a tracheotomy (hole in neck for breathing) during the healing period. During this period speaking will be zero, but after healing the patient should be able to speak with a hoarse voice. When a total laryngectomy is performed (removal of voice box), a permanent tracheotomy will be performed for breathing, where after a voice prostheses will be fitted. An advanced speech therapist will work with the patient to improve communication with the voice prostheses, electro larynx (machine) or oesophageal speech. This is usually a very traumatic time for the patient. It is highly recommended that a patient joins a support group during this time, as meeting patients in similar circumstances will surely lighten the burden. In fact, it has been told that many patients actually have fun ‘showing off’ their new voices to their grandchildren!

There are various ways of screening the degree or high risk in voice box cancer. A flexible nasoendoscopy (camera) and mirror will be used to aid a smaller biopsy (although this procedure can be risky for the true vocal cords). This can be done under local anaesthetic. X-rays and ENT by flexible telescope is used to detect tumours. A pan endoscopy (camera with light and eyepiece connected to a telescope) for larger biopsies will be performed under general anaesthetic. If a doctor decides to perform a transnasal oesophagoscopy – a digital camera will be inserted through the nose under local anaesthetic. No biopsy will be performed, but the doctor will get a better picture of tumours in the larynx. Fine needle aspiration will be done to withdraw fluid from a lump in the neck/larynx to examine the cells, and even to detect metastasis to the lymph. These tests accompanied by others, will determine the choice of treatment. CT scans can detect enlargement in the lymph nodes and size of a tumour. MRI scans will be performed if the results need to be more lymph node specific. By undergoing a PET-CT scan, the activity of cells will be clearer. Ultra sounds are mainly used to examine the lymph.

After surgical procedures in the voice box, the patient will be put onto a soft diet (e.g. nutritional shakes) as swallowing can be difficult and ever painful. During the recovery time, full fat dairy products should be used. Sometimes liquid feeds through a tube will be preferable for a while. Patients should take care to have exceptional oral hygiene to combat infections. As the senses of smell-and taste can be affected after larynx surgery – it is advisable to add flavour by using herbs and mild spices to the diet.

Famous people who have suffered from forms of larynx cancers are: George Harrison – lead guitarist of the Beatles, Bruce Paltrow – father of Gwyneth Paltrow, fashion designer Bill Blass, actor Sammy Davis Jr., and Ulysses S. Grant – the 18th US President. If developing this form of cancer is one of your fears – I would strongly suggest you quit smoking a.s.a.p!!