Internal Medicine

Vocal cord cancer

definition

Cancer of the vocal cords is a malignant tumor disease of the vocal cords and the most common subtype of larynx cancer (about 2/3).
Synonyms are also glottic carcinoma, vocal cord carcinoma or vocal cord carcinoma. Larynx cancer is one of the most common malignant ear, nose and throat tumors. The disease mostly occurs in men between the ages of 50 and 70 years. However, women are also increasingly affected by increased tobacco consumption.

What are the symptoms of vocal cord cancer?

The main symptom of vocal cord cancer is usually a hoarseness that lasts for weeks and months.
In addition, there may be a scratchy throat, which means that those affected often have to clear their throat. If the tumor gets bigger, it can lead to a permanent sensation of foreign bodies or difficulty swallowing. A chronic cough can also occur.
If the disease is very advanced, breathing difficulties with breathing sounds can also occur. Often the patients even develop shortness of breath (Dyspnea). Swelling of the lymph nodes in the neck area is also possible if the tumor Metastases forms (daughter ulcers). Since the symptoms of this form of larynx cancer usually appear early, the disease can often be detected early.

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Causes of vocal cord cancer

The main cause of all larynx tumors is tobacco consumption, which increases the risk 20 times in men and 5-10 times in women. Larynx cancer is very rare in non-smokers. Alcohol abuse is seen as a further cause. In addition, it seems that increased alcohol consumption, especially in combination with other risk factors (such as smoking), increases the likelihood of developing a malignant tumor of the larynx.

Other causes can include viruses such as HPV (Human papillomavirus). An HPV infection initially leads to a benign tumor disease, the so-called laryngeal papillomatosis, from which a malignant tumor can develop. Exposure to asbestos can also lead to throat cancer. Lastly, working with wood and metal dust as well as paints and varnishes that contain chrome and nickel is a risk factor for the development of vocal cord cancer.

Another risk factor is reflux disease, in which acidic gastric juice from the stomach enters the esophagus and can lead to changes in the tissue there. In addition, chronic inflammation of the larynx (laryngitis) lead to a malignant tumor in this area. A weakened immune system, for example after an HIV infection or the like, can lead to an increased risk of developing this tumor.

The tumor often develops over years. First, so-called Dysplasias, Changes in the tissue that lead to a loss of classical structure and function, or hyperplasia (too many cells). This is called a Precancerous disease, a kind of pre-cancerous stage. A malignant tumor can develop from this over time. The most common preliminary stage of vocal cord cancer is the so-called Vocal fold leukoplakia, a whitish, non-wipeable tissue change. One can only determine under a microscope whether it is a benign precursor or a malignant tumor.

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How is vocal cord cancer diagnosed?

The diagnosis can be made in several ways.
With particularly advanced growth, some of the tumors can already be determined by palpation. Another option is a larynxoscopy (Laryngoscopy). Here, the location and exact size of the tumor can usually be better determined and a tissue sample can be taken in order to confirm the suspected diagnosis histologically (with a microscope by a pathologist in the laboratory).
Further diagnostic methods are the CT (Computed Tomography) or the MRI (Magnetic resonance imaging). These methods can be used to determine particularly well whether the tumor has grown into other tissues in the vicinity or whether metastases can already be found in other organs.

How is vocal cord cancer treated?

The treatment of choice for cancer of the vocal cords is surgery, as only this can lead to a complete cure. As long as the patient is operable, i.e. nothing speaks against an operation, he should also be operated on.
The type of operation depends on how advanced the disease is. However, the operation has many risks. For example, the patient can lose their voice. In order to restore the voice, a speech therapist can alternatively learn an "esophageal voice". There is also the option of inserting a vocal cord prosthesis or using an electronic speaking aid.

Another therapy option is radiation therapy. This can be used as the sole therapy if the tumor has progressed so far that an operation is no longer possible. Usually chemotherapy is also used. In addition, in advanced but still operable stages, radiation therapy can be used in addition to surgery in order to achieve the best possible results and to get rid of the tumor completely.
In the very early stages, radiation therapy from the inside through the esophagus can also be carried out, during which the voice can be preserved.

Another therapy option is targeted therapy with an antibody that is supposed to recognize the cancer cells called cetuximab. This antibody is usually used in very advanced tumor growth with subsidiary ulcers. As a rule, cetuximab is also combined with radiation and chemotherapy.

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How does the operation for vocal cord cancer work?

The operation of the vocal cord tumor is stage-dependent.
There are different types of operations. The first form is used for tumors that were recognized very early and are therefore still localized. Here the tumor is removed endoscopically with the help of a laser, that is, as part of a reflection. Here the larynx can usually be preserved.

In the more advanced stages, only open surgery is possible and the larynx usually has to be completely removed. In rare cases, the tumor can also be partially removed. If the local lymph nodes are also affected, they will also be removed during the operation. All lymph nodes in the neck area are removed.

How long does the therapy last?

The duration of therapy naturally depends on the type of therapy.
The operation itself does not take long, but it depends on whether the patient still needs a voice replacement afterwards and whether complications have occurred. An accompanying radiation or chemotherapy also extends the duration of the therapy. At least one month can be expected here.
Antibody therapy, if it is effective, can last for months or even years, but is available on an outpatient basis, which means that the patient does not have to stay in the hospital permanently.

All in all, therapy can last anywhere from 2 weeks to several years.

What are the chances of recovery and life expectancy for vocal cord cancer?

The 5-year survival rate for patients with vocal cord cancer is 90% if the disease was not very advanced.
This is usually the case, as the tumor is usually recognized very early due to the early symptoms, such as hoarseness. The mortality from the disease is very low. Only about 1-1.5% of cancer deaths can be traced back to the superordinate group of larynx tumors.
However, it must be mentioned that most vocal cord cancers are caused by smoking, which is associated with many other serious diseases of the cardiovascular system and also other tumor diseases. Quitting smoking is therefore the most important basis for extending life.

Metastasis in vocal cord cancer

Carcinoma of the vocal cords usually metastasizes locally in the area of the larynx on both sides.
So not only the vocal folds, but also the areas above and below can be affected. This tumor rarely metastasizes to other areas and organs, as it is usually detected early, before metastases have formed. If metastases do occur, these are mainly found in the lungs and liver.