The larynx, or larynx, with its medical name, is an organ between the root of the tongue, which we call the pharynx, and the trachea, which we call the trachea, the outer part of our neck in the form of an Adam's apple under the chin, the outer part of the cartilage, the inner part of the leaf-shaped soft cartilage covering the esophagus at the top, and the false and true vocal cords below. Our voice comes out through the vocal cords in the larynx. The larynx separates the esophagus and the trachea from each other, preventing food from escaping into the trachea during eating. The larynx sends the air we take to the lungs, while exhaling, the lung air comes out of the larynx, we speak while exhaling, and a speech sound is formed thanks to the vocal cords in the larynx.
Smoking is the most important factor in the development of laryngeal cancer. Smoking more than 10 times a day is effective for cancer, the rate of cancer in smokers is 20 times higher, and the effect lasts for 20 years in the body after quitting smoking. A person who smokes 25 cigarettes a day for 30 years is 40 times more likely to develop laryngeal cancer than a non-smoker. The second reason is alcohol. In particular, taking cigarettes and alcohol together has a synergistic effect, that is, it is more harmful than using them separately. The third reason is HPV (human papilloma virus). HPV, which causes diseases in the genital system in women, has become a risk factor in laryngeal cancers after oral cancers in recent years. The fourth factor is asbestos, wood dust, nickel compounds, coal dust, paint fumes, formaldehyde, polycyclic aromatic hydrocarbon, long-term exposure to toxic substances such as mineral oils, isopropyl alcohol used as a cleaning solvent. In recent years, it has been shown that long-term laryngeal reflux can cause laryngeal cancer. nutrition style; Red and fried meats, vitamin A and E deficiency can also be counted among the factors. As a result, it is necessary to stay away from the harmful substances mentioned above, to have a vegetable-based diet, and to pay attention to oral hygiene.
Laryngeal cancer is the most common cancer of the head and neck region in the world. Every year, 156.000 new cases of laryngeal cancer are seen in the world and 83,000 deaths occur. It is more common in men than in women, 138,000 of these cases are men and 18,000 are women. In recent years, the incidence of cancer has increased with the increase in the rate of smoking in women. According to the statistics of the Ministry of Health in 2013, laryngeal cancer ranks sixth in men with 7%. Laryngeal cancer is more common between the ages of 40-60. As with all cancers, familial genetic factors play a role. Especially P53 gene mutation has been detected in people with laryngeal cancer.
The most important symptom is hoarseness. In smokers, the possibility of cancer should be considered in hoarseness that does not persist for more than 15 days despite treatment. The patient's voice is hoarse, tired, stressed and wheezing, and there is a weak voice. If the cancer has developed in the vocal cords, the first symptom is hoarseness and thus it is detected early. If it develops in an area above the vocal cords, it does not cause hoarseness at first, more difficulty in swallowing, a feeling of hot potato in the throat, a feeling of lump. If the cancer has developed in the larynx area under the vocal cords, they first have complaints such as shortness of breath, wheezing and coughing. For these reasons, tumors that develop from regions other than the vocal cords can be noticed in more advanced stages, and pain in the ear occurs.
For diagnosis, a particularly detailed ENT examination should be performed. By performing an indirect larynx examination with an angled rigid endoscope, the inside of the larynx is seen in detail from the entrance to the vocal cords, and the movements of the vocal cords are evaluated. With stroboscopy, the tumor can be detected at an earlier stage with the enlarged image and slowed movements of the vocal cords. As a more comfortable and detailed examination in patients with gurg reflex, a flexible laryngopharyngoscopy with a chip camera is entered through the nose and recorded. The patient's neck is examined by palpation to see if there is an enlarged lymph node. If a tumor in the larynx is suspected, radiological examination is performed. First of all, larynx-neck CT, if necessary, neck MRI and PET may be requested.
There are 4 stages of laryngeal cancer. The first and second stages (T1, T2) are early stages and the success rate in treatment is higher. . Third stage (T3) laryngeal cancers are cancers that are limited in the larynx and have decreased vocal cord movement. In fourth stage (T4) cancers, the vocal cords are fixed, spread to the upper and lower regions of the vocal cords, and protrude beyond the larynx. The third and fourth stages are advanced stages, the success rate of treatment is low. In these stages, there may be spread to the neck lymph nodes, which we call metastasis in the neck, or spread to other organs such as the lung. In advanced laryngeal cancers, there is usually no movement in one or both vocal cords, it is fixed.
Advanced cancers can spread to other areas. In the third stage, metastases are seen in the neck, while in the fourth stage, metastases to distant organs such as the lung, digestive system and brain may occur. Surgical treatment is not considered in patients with distant metastases, and the success rate in treatment is very low.
There is a cure for laryngeal cancer. Especially with treatment in the early stage, the disease completely disappears and the recurrence rate is very low. There are three options for treatment: surgery, radiotherapy, chemotherapy and the combined form of these treatments.
In the first and second early stages of cancer, treatment with surgery and radiotherapy has the same success rate of 90-95%. Radiotherapy may be preferred in terms of protecting the voice, especially in cancers developed from the vocal cord. However, in advanced laryngeal cancers such as the third and fourth stage, surgery should be preferred together with the larynx and neck, radiotherapy may be required to prevent recurrence after surgery. Chemotherapy may be needed to shrink the tumor and make it operable in very advanced cancers that cannot be operated.
In early stage cancers, the entire larynx is not removed, a part of the vocal cord or a vocal cord is completely removed, in these cases the patient's voice does not disappear and its quality decreases. No hole is made in the trachea, or it is temporarily opened, after a certain period of time it is closed and breathing normally through the nose. In patients treated with radiotherapy, the larynx is completely preserved, but the sound quality may deteriorate somewhat. In advanced stage cancers, especially in the fourth stage, since the entire larynx will be removed, the patient does not have a voice and a permanent hole is made in the trachea, and the patient breathes through this hole. However, with developing technologies, speech can be provided by attaching a small invisible voice prosthesis between the patient's trachea and pharynx and closing the opened hole with a valve cover. By applying speech therapy from the esophagus, the patient can be taught to make sounds and speak without wearing a prosthesis. In advanced stage cancers, patients avoid surgery and lose their chance of treatment because they will have a hole in their neck. This inconspicuous hole under the neck can be closed with valve cannulas or a scarf. Refusing the treatment because of a minor defect while alive causes the patient to lose his/her life.
