Don't be careless if your voice is hoarse, beware of laryngeal cancer

Author: Li Ruichen, Department of Eye, Ear, Nose and Throat Hospital, Fudan University

Reviewer: Wang Xiaoshen, Chief Physician, Eye, Ear, Nose and Throat Hospital, Fudan University

The larynx is an extremely important and magical organ. It not only gives us functions such as vocalization, breathing and swallowing, but also undertakes important tasks such as protecting the airway, filtering air and helping digest food.

Take a look at the appearance of the larynx. Do you think it looks like a magnificent palace? When eating, the "roof" formed by the epiglottis can automatically close to prevent foreign objects from entering the trachea. The solid thyroid cartilage and cricoid cartilage form a stable and strong wall, providing support and protection for the vocal cords. The vocal cords are the most important "device". The vocal cords on both sides form a "glottis" that connects to the trachea at the bottom. When we speak or sing, the air flows from the lungs through the trachea into the larynx, vibrates under the action of the vocal cords, and forms a pleasant sound through the resonance of the laryngeal cavity.

Figure 1 Copyright image, no permission to reprint

In daily life, people are aware of the existence and function of the larynx. However, most people have limited knowledge of the larynx and usually ignore its maintenance. It is not until a lesion occurs or even laryngeal cancer occurs that they realize the importance of protecting it, which is a bit too late.

Symptoms of Laryngeal Cancer

Laryngeal cancer is a common malignant tumor of the head and neck, mostly occurring in men over 40 years old. Laryngeal cancer can be divided into supraglottic, glottic, subglottic and mixed types according to anatomy. Most laryngeal cancers (over 60%) are of the glottic type, and early patients often experience voice changes. With the continuous advancement of medical technology and treatment methods, significant progress has been made in the radical cure of laryngeal cancer and the protection of voice function.

This is a sign of throat cancer.

Mr. Zhang, 48, is a middle school Chinese teacher. He has many students all over the world, especially his proud voice that has recited beautiful poems for many students. In his spare time, smoking seems to be the only source of inspiration for him. Recently, he felt hoarse, but he didn't care at first, thinking it was caused by talking too much in class. However, after several weeks of talking less, the hoarseness did not improve, but gradually worsened. He noticed his health problems and began to smoke less consciously, but still thought it was caused by excessive use of his voice and a recent cold. It was not until one day that Mr. Zhang found blood in his sputum that he realized the seriousness of the problem. At the urging of his family, he underwent a laryngoscopy at a local hospital and found extensive neoplasms on both vocal cords. The biopsy pathology was "laryngeal squamous cell carcinoma (glottic type)".

Typical symptoms of glottic laryngeal cancer include hoarseness in the early stages. However, most patients believe that it is caused by a cold or throat inflammation, especially those in special occupations such as teachers. If long-term improper use of the voice leads to vocal cord polyps or vocal cord nodules, hoarseness or vocal fatigue may also occur. However, unlike benign diseases, hoarseness caused by laryngeal cancer cannot be relieved by vocal rest or anti-infection treatment. It will gradually worsen, and the voice will become more and more hoarse and heavy, making it difficult for others to hear the patient's words. In severe cases, loss of voice may occur. As the disease progresses, laryngeal cancer patients will also experience blood in their sputum and difficulty breathing.

Who are the high-risk groups for laryngeal cancer?

1. People who smoke and drink for a long time. Data released by the CA-A Cancer Journal for Clinicians in the United States in 2017 showed that the risk of laryngeal cancer in long-term smokers is 10 to 15 times that of non-smokers, and the risk of severe smokers is even up to 30 times; the incidence rate of people who smoke at an earlier age, for a longer duration, in larger quantities, and more frequently smoke rough cigarettes increases significantly; long-term drinking is also related to laryngeal cancer, and alcohol and tobacco have a synergistic carcinogenic effect.

2. History of adult laryngeal papilloma and vocal cord leukoplakia. These two diseases are precancerous lesions of laryngeal cancer, which are prone to recurrence after treatment and may become cancerous.

Figure 2 Copyright image, no permission to reprint

Figure 3 Copyright image, no permission to reprint

3. People who have long-term exposure to dust, organic compounds, and radioactive isotopes. From a gender perspective, laryngeal cancer is more common in men; from an age perspective, laryngeal cancer mostly occurs in people aged 40 and above. Therefore, people over 40 years old, who have long-term hoarseness and have the above high-risk factors, especially men, should go to the hospital for further examination as soon as possible.

Revealing the true form of laryngeal cancer

1. Endoscopic examination: The fiber laryngoscope has a slender, soft and flexible body, high brightness and a certain magnification function. This feature enables it to clearly observe the laryngeal cavity and its surrounding structures, and helps to detect tumors early and perform biopsies. Endoscopy combined with narrow band imaging technology (NBI) has greatly improved the detection rate of early laryngeal cancer and precancerous lesions.

2. Imaging examination: CT and MRI examinations of the larynx are helpful in determining the extent of tumor invasion and whether there is cervical lymph node metastasis, which is crucial for subsequent treatment.

3. Pathological examination: The "gold standard" for the diagnosis of laryngeal cancer is biopsy of the tissue. The specimen is collected under laryngoscope.

Early-stage laryngeal cancer — can you have your cake and eat it too (curing the tumor)?

Early detection, early diagnosis and standardized treatment can achieve good results. Many laryngeal cancer patients worry that treatment will affect their voice or even make them lose the ability to speak. In fact, with the continuous advancement of treatment technology and equipment, laryngeal function-preserving treatment has become very mature in the treatment of early laryngeal cancer.

Laser surgery: For superficial tumors without deep infiltration, laser surgery can be the first choice if there are no contraindications. Laser surgery has the advantages of minimally invasive, less bleeding, low tumor spread rate, and good preservation of voice function.

Figure 4 Copyright image, no permission to reprint

Radiotherapy: The guidelines released by the National Comprehensive Cancer Network (NCCN) in 2024 recommend radiotherapy as equal to surgical treatment, and the 5-year survival rate of radiotherapy patients exceeds 90%. Radiotherapy has shown good results in preserving voice function, without the need for surgery or tracheotomy, without causing mechanical damage to the vocal cords, and preserving the integrity of the larynx as much as possible.

Figure 5 Copyright image, no permission to reprint