Vocal Cord Cancer: Treatment, Cost and Side Effects

Vocal cord cancer mainly occurs in the larynx, the area of the throat responsible for breathing, swallowing and talking. It is mostly concentrated in the lower part of the throat and is also termed as laryngeal cancer. In order to understand laryngeal cancer, it’s important to elaborate on larynx which is the voice box in the body. It is located at the base of the tongue and the trachea (windpipe) and contains the vocal cords that help in producing sound when air is directed against them. The larynx is divided into three parts- supraglottis which lies above the vocal cords. It also contains the epiglottis which is a flap that closes off the larynx when you swallow food. This sends food down the esophagus (the tube that connects to the stomach) and keeps food and fluids from going into your lungs. The second part is the glottis which contains the vocal cords and the third part is the subglottis which lies below the vocal cords.

Most vocal cords cancer are squamous cell carcinomas. This type of carcinomas begins in the epithelium which is the innermost lining or layer of the larynx. The cancer may spread to other parts of the body or nearby tissues and organs like the thyroid, trachea and esophagus. However, most squamous cell carcinomas starts as a pre-cancer condition called dysplasia. These types of cells look abnormal under a microscope but they are not cancer. They usually go away on their own.

Sometimes dysplasia turns into carcinoma in situ which is the earliest form of cancer. It is only restricted to the inner lining of the larynx and has not spread to other body parts or tissues. This is often signified as stage 0. In stage I the cancer tumour is small and is limited to your throat. In stage II the cancer tumour has grown in size but is still limited to your throat. In stage three and four, the cancer tumour has grown in size and has also spread to nearby tissues, lymph nodes and organs.

Laryngeal cancer can be diagnosed by an oncologist by doing a physical examination of the throat and neck and various tests that will consist of biopsy (laryngoscopy and endoscopy) and a CT scan. Additional test may include MRI, PET and Bone scan. These tests are done to check whether the cancer has spread to other organs and tissues (metastasis).

Treatment of laryngeal cancer depends on the stage of the cancer, the location of the tumour and the patient’s age, health and other factors. Generally a combination of radiation therapy, chemotherapy and surgery is used to treat laryngeal cancer. If you are diagnosed with CIS (carcinoma in situ), then the cancer is restricted to the vocal cords and treatment is either endoscopic surgery or radiation therapy. The cancer at this stage is curable with lesser chance of reoccurrence. In stage II and III, the cancer is either located in the glottis or supraglottis depending on which the treatment is done. However, cancer in the supraglottis has a tendency to spread to surrounding tissues or organs. The standard treatment is either radiation or partial laryngectomy (removes part of the larynx). However, if your cancer is restricted to the glottis, then treatment may also include cordectomy (removal of the vocal cords) or laser surgery. On the other hand if you have cancer in the supraglottis which have spread to the surrounding tissues, then supraglottic laryngectomy (removal of the supraglottis) is done along with radiation. It should be noted that if there are signs of reoccurrence, then chemoradiation may be needed to treat the remaining cancer tumours.

Stage III and IV is characterized by the presence of cancer either in the supraglottis or glottis or subglottis. Stage III is mainly defined by the area of metastasis which is restricted to surrounding tissues or organs and stage IV is defined by complete metastasis to other body parts like the trachea, esophagus or the spinal cord. The standard treatment is surgery or chemotherapy. If treatment is surgical then it is either total larygectomy (complete removal of the larynx and a hole is made in the neck to help the patient breath) or partial laryngectomy (that restores some form speaking ability). An oncologist will either go for surgery followed by radiation and chemotherapy or radiation and chemotherapy followed by surgery. The goal of the treatment for stage III and IV is to stop the growth of cancer as long as possible and to help in relieving the symptoms.

Laryngeal cancers generally occur in the vocal cords and are characterized by sudden hoarseness or change in voice. If you have changes in your voice like hoarseness for more than two weeks, then you should go to a doctor right away.

Laryngeal cancers that do not start in the vocal cords but occur either in the supraglottis or subglottis may develop hoarseness at a later period when the cancer has reached a certain stage. Therefore, you should go to a doctor if you experience these symptoms like constant coughing, pain when swallowing, trouble swallowing, ear pain, trouble breathing, weight loss and a lump or mass in the neck or throat.

People experiencing similar symptoms from other disease or conditions like cold and cough or difficulty in swallowing is not eligible for cancer treatment.

As with most cancer treatments that includes radiation therapy, chemotherapy and surgery, people suffering from laryngeal cancer also experience major side effects of these procedures. Radiation side effects may range from skin problems such as redness, blistering or peeling, dry mouth, worsening of hoarseness, trouble swallowing, and loss of taste, breathing trouble, tiredness and hearing problems. If you undergo chemotherapy, then you may experience side effects such as fatigue, hair loss, easy bruising and bleeding, infection, anemia, nausea and vomiting, appetite changes and constipation. A person undergoing a combination of radiation and chemotherapy may experience various side effects which are subjected to a person’s health and his or her response to these treatments.

However, if you are having a laryngectomy (partial or total), then you may experience side effects like losing your ability to talk, dry mouth, changes in smell and taste of food, mouth ulcers and other difficulties.

Cancer treatment can be emotionally and physically exhausting for the family and the patient undergoing the treatment. Therefore, after-treatment care will be palliative in nature with regular or monthly follow-up with your doctor to check for reoccurrence and treating any side effects that may experience as a result of the treatment.

If you had a total or partial laryngectomy, then your doctor will sign you up with a speech or voice therapist to help you get back to normal daily life. Some ways you can incorporate to help you speak are trachea-esophageal puncture which can be done during the actual surgery where a connection is made between the windpipe and esophagus through a small hole at the stoma site. Speech can also be induced using an eclectrolarynx where a battery-operated device is placed at the corner of your mouth or against the skin of your neck which makes a vibrating sound. The other method used to help with a person’s voice or speech is esophageal training where a person learns to swallow air into their esophagus and force it out through their mouth.

The other problems that you may face like swallowing difficulty and loss of smell is also treated by nutritionists and other doctors. Loss of smell is generally treated through olfactory rehabilitation that may consist of either nasal airflow-inducing maneuver (NAIM) and polite yawning.

The period of recovery is ususally long and includes treatment and post-treatment therapy time as well. It can take anywhere between 6 months to a year for a person to fully recover.

Cancer treatment in general is a costly affair in India which starts at Rs.50,000. However, with vocal cord cancer which may need laryngectomy surgery, the cost may increase to Rs.2,00,000.

Cancer is a type of disease that has a high recurrence rate. Therefore, even if you have stage 0 or I or II cancer which is cured by radiation, chemotherapy and surgery, it can come back after a period of time. The rate of recurrence increases with excessive smoking and drinking alcohol. However, with stage 0 or I or II, people have a higher chance of survival rate compared to stage III and IV.

Newer treatments are being tested and researched by doctors which are being used on a clinical trial basis. These includes targeted therapy and radiosensitizers.