Where is Throat (Larynx)?: It is a structure which has a ring-shaped, solid and round cricoid cartilage. It starts from oral cavity basing vestibule of mouth where our tongue ends (i.e. from the tongue base). This structure consists of vocal cords and the initial portion of vocal cords that are protected by the thyroid eminentia (thyroid cartilage) taking place in front of our neck and referred as “Adam’s apple”. Throat starts right from the base of the tongue, the hyoid bone (commonly referred as “bone of the tongue”) to which the tongue muscles are attached, and the flexible cartridge called epiglottis that takes place right behind the hyoid bone and operates as a cover to prevent the escape of the material inside the mouth to the lungs when we swallow. And it continues until the trachea. Filling 4-8 cm of the front-mid line of our neck, this organ enables us to speak as well as playing a role in respiration (please see the model). Besides, the task of directing the food we eat to the alimentary canal (oesophagus) located right behind the vocal cords pertains to the larynx, which closes along with epiglottis by swelling on our neck during swallowing. Larynx includes the vocal cords.
This organ which plays a role both in respiration and speaking, as well as in alimentation, is controlled by a variety of muscles. The muscles inside the organ makes the vocal cords to operate, and the muscles outside of the organ enables the up and down movement on the neck. Two delicate structures which we called vocal cords provide the basic tone, i.e. the fundamental frequency during speaking and sound making. The pharynx, mouth and nasal cavity located right above the vocal cords are involved in enrichment, enhancement and adornment of the produced sound with harmonics.
What is Cancer?
Cancer is a disease emerging out of the uncontrolled growth and spread of the cells in our body which undergone changes. With the continuous division of the cancerous cells, these cells form a “clot” which is called “tumour” in the language of medicine. The tumour is colloquially referred as the “excrescence”. In order for a cell to lose its regular structure and to undergo an uncontrolled growth, there must be an exposure to a stimulus, an irritant factor for a period of time, or a family history of cancer susceptibility. Regular cells in our body get born, grow, reproduce and die just like our body itself. Once a cell alters its regular structure and becomes cancerous, it acquires some structural features. These are the following:
- Cancer cells acquire immortality, i.e. they continuously proliferate and invade the organ they are in.
- Regular cells stop when they contact different cell group, whereas cancer cells try to destroy any other different cell groups that they get in touch by occupying them.
- Since the cancer cells proliferate continuously and they receive the nutrients they require for this proliferation from the blood, they nourish themselves through the new blood vessels in the available vascular system.
- Merging into these new blood vessels and the lymph fluid, cancer cells are transported to other parts of the body. And they may form new cancer tubers there, which is a process called metastasis.
In our country, the most common cancer types are lung, breast, stomach, colon and bladder cancers. Larynx cancer which emerges less than the aforementioned types, is a cancer type mainly found in men. This cancer type that is linked to tobacco and products of tobacco, detected in men 5-6 times more frequently compared to women. However, with the increased use of tobacco among women, this ratio has decreased down to 4.5, which means that this cancer type has also started to be detected among women more frequently. The amount of cigarettes smoking increases the risk of developing these cancers. One who smokes half a pack a day has 4.4 times higher risk of developing this type of cancer compared to a non-smoker. One the other hand, one who smokes more than two packs a day is 10.4 times more likely to develop this cancer compared to a non-smoker. In addition to cigarette and alcohol consumption, those with high stomach acid reflux and those who work with paint, metal, plastic, and petrochemical products also has the possible risk of getting this cancer.
Which symptoms should cause patients to suspect? Patients with a cancer in this region, apply to health care organizations with complaints including hoarseness, sore throat, and ear pain, painful swallowing, and swallowing difficulties. Cases such non-healing hoarseness (lasting more than 15 days), difficulties in breathing, noisy breathing, speaking with difficulty as if the mouth was full, blood coming out of the mouth with or without saliva should be a concern. In the case of progressive disease, swelling of the neck (metastasis) might be detected.
Diagnosis: In the diagnosis of larynx cancer, having cancer susceptibility has a major importance. Issues such as patient symptoms, duration, whether or not patients had weight loss, smoking and alcohol history, presence of cancer in the family should be carefully examined and a detailed inquiry is to be made. The most prominent determinant of cancer is time.It is compulsory for the physician who first saw the patient to evaluate the findings carefully. Examining and imaging the larynx for every suspicious case, taking biopsy from the areas where the regular structure has been altered, and performing pathological diagnosis are also strictly required.
Treatment: As with all cancer types, the treatment of laryngeal cancer requires a team effort. All departments dealing with head and neck oncology share theresponsibility in the processes such as direct viewing of the disease, the pathological diagnosis by biopsy, determination of the cancerous parts with radiologic techniques, and deciding upon a treatment option. Among the treatment options shared with the patient, the duty of the otorhinolaryngologists (ENTs) is to identify the disease and to inform the patient and her/his relatives, to help the pathological diagnosis by biopsy, to select the surgical treatment in cases that require surgery, and to follow up the patient on a regular basis and keep her/him under medical surveillance for the cases in which rehabilitation and additional treatment are needed after the surgical operation. If the patient’s health status or preference are not suitable for surgery and radiotherapy or other treatments are to be applied, otorhinolaryngologists can examine the patient’s larynx and neck on a regular basis. If surgery for cancer in the larynx is decided, some cases can be cleaned by endolaryngeal surgery, i.e. by entering through the mouth without opening the neck or the larynx, with the help of surgical instruments or lasers. If there are lesions in certain locations or sizes that prevent them from being eliminated by endolaryngeal surgery, or in patients with suspected or diagnosed neck metastasis, larynx and neck dissections are to be performed by approaching from the neck. Depending on the degree of prevalence of the disease, a portion of the larynx is removed by partial laryngectomy, or it is completely removed by total laryngectomy. In order for the patient to breath after total laryngectomy, it is needed to create a permanent hole tracheostoma)in the middle bottom of the neck. This permanent hole, which is the main factor that causes people to desist from the surgery, is not an obstacle to speak after surgery. These patients are able to speak or continue their lives in a normal way thanks to the Esophageal speech that can be learned with a short training, and a small silicone prosthesis that is planted between the esophagus and trachea in the place of the removed larynx.
In the cases of larynx cancers which have relatively early symptoms compared to many other types of cancers in our bodies, quite promising results are being gained with early diagnosis and treatment.