Laryngeal cancer

Disease Description (Causes and Symptoms)

Laryngeal cancer is a malignant tumor formed by the abnormal proliferation of epithelial cells in the larynx (the vocal cords and the surrounding mucosa). It mainly develops in the glottis (vocal cords), supraglottis (upper larynx), or subglottis, and depending on its stage and location, it may metastasize to adjacent tissues and cervical lymph nodes.
Main causes and risk factors:

• Smoking (the strongest risk factor), excessive alcohol consumption (interaction with smoking)
• Human papillomavirus (HPV) infection (associated with some head and neck cancers)
• Chronic irritation·inflammation, leukoplakia, keratosis, radiation exposure, air pollution, nutritional deficiencies (including vitamins)
  Main symptoms:
• Most common: hoarseness (voice changes)
• Difficulty swallowing (dysphagia), odynophagia (pain when swallowing), foreign-body sensation in the throat, persistent sore throat
• Cough, wheezing (noisy breathing), hemoptysis, a neck mass or enlarged lymph nodes, unexplained weight loss
  Signs of progression: As the tumor grows, pain, symptoms of airway obstruction, cervical lymph node metastasis, and bleeding may occur.

Treatment Methods (Standard Treatment · Medications · Procedures/Surgery · Lifestyle Management and Precautions)

Treatment is determined based on the stage (tumor size·invasion of surrounding structures·lymph node metastasis·distant metastasis), the patient’s general condition, and whether laryngeal function can be preserved.

Main treatments

• Surgery
  • Transoral laser excision (early lesions, superficial tumors): short hospital stay, possible laryngeal preservation
  • Partial laryngectomy (superficial/locally advanced lesions): possible partial changes in voice·function
  • Total laryngectomy (extensive invasion): permanent tracheostomy required, voice rehabilitation needed
  • Neck dissection (lymph node removal): performed when there is cervical metastasis
• Radiation therapy
  • Used as primary treatment for early lesions or as adjuvant therapy after surgery. Usually 5 times per week for 5–7 weeks.
  • Side effects: dry mouth due to salivary gland damage (which may be permanent), mucositis, fatigue, etc.
• Chemotherapy
  • Used when surgery is not possible or there is metastasis, or concurrently with radiation (concurrent chemoradiation therapy).
  • Representative medications: concurrent therapy based primarily on the cisplatin class. In cases of recurrence·metastasis, targeted therapy (e.g., EGFR inhibitors) or immune checkpoint inhibitors (e.g., pembrolizumab, nivolumab) may be considered (depending on the indication).
• Tracheostomy (temporary or permanent) and nutritional support
  • A tracheostomy may be necessary to secure the airway immediately after surgery or when airway obstruction is a concern. A nasogastric tube or gastrostomy tube (PEG) may be used after extensive surgery or in cases of dysphagia.
• Rehabilitation
  • Speech rehabilitation (esophageal speech, use of an electrolarynx, etc.), swallowing rehabilitation (swallowing training), physical therapy·nutritional management

Lifestyle management and precautions

• Smoking and alcohol cessation: strongly recommended to improve treatment outcomes and reduce the risk of recurrence
• Dental examination before radiation therapy (treatment of cavities, etc.) is necessary (to reduce the risk of osteonecrosis after radiation)
• Maintain thorough oral hygiene; manage dry mouth after radiation (fluid intake, artificial saliva, etc.)
• Maintain nutritional status (consider nutritional supplementation if weight loss occurs)
• Be aware of complications: aspiration pneumonia (dysphagia), voice changes (which may be permanent), radiation-related dry mouth·tooth loss, postoperative wounds·infection, psychological problems (social effects resulting from loss of voice)

Outpatient Visit Checklist (Items to Bring · Examination History · Symptom Records and Example Questions)

Items and documents to bring

• List of medications·supplements currently being taken (including doses·times of administration)
• History of allergies (medications, anesthesia, etc.)
• Previous examination·imaging·pathology results (CT/MRI, PET, biopsy results, etc.), if available, as printouts or on a CD/USB
• Recent records from other medical care (surgical records, history of radiation/chemotherapy)
• Identification and insurance card

Examination·symptom records (items to organize before consulting the doctor)

• When symptoms began and how they have progressed (duration of hoarseness, onset of difficulty swallowing, etc.)
• Factors that worsen or relieve symptoms (voice use, smoking·alcohol consumption)
• Weight changes (how many kilograms recently, and over what period)
• Presence or absence of fever·night sweats·cough·hemoptysis
• Smoking (duration·amount per day)·alcohol habits (type·frequency)
• Occupation (whether the voice is used) and living environment (exposure to pollution, etc.)

Basic examinations to confirm during an outpatient visit (as determined by the doctor)

• Laryngoscopy/direct laryngoscopy, biopsy (if necessary)
• Imaging tests: neck·chest CT or MRI, PET-CT to check for metastasis, etc.
• Blood tests (general condition), pulmonary/cardiac function tests (for pre-anesthesia evaluation, etc.)

Examples of questions to ask during an outpatient visit (brief)

• “What stage is suspected based on my symptoms? What additional tests are needed?”
• “Is a biopsy necessary? When and how will the biopsy be performed?”

General Example Questions to Ask the Doctor

• What are the standard treatment options for this stage, and why do you recommend them?
• Is laryngeal preservation (voice preservation) possible? If so, which method is most appropriate?
• What side effects and recovery periods can be expected for surgery·radiation·chemotherapy, respectively?
• Is dental treatment necessary before radiation therapy? How should I manage my oral health after radiation?
• What is the outlook for recovery of voice·swallowing function after treatment, and what is the rehabilitation plan?
• Is the goal of treatment cure or symptom relief (palliative treatment)? What is the prognosis?

Disease-Specific Example Questions (1–2 Tailored to the Condition)

• “At the current stage, are laryngeal preservation options (laser excision or concurrent chemoradiation therapy) possible? If so, what are their advantages and disadvantages?”
• “If I need surgery, would total or partial laryngectomy be recommended, and what changes can be expected in voice·swallowing function?”

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Note: The information above is general information, and the final diagnosis·treatment plan is determined based on a specialist’s evaluation (clinical examinations·imaging·pathology results).