Vocal cord carcinoma

Synonyms

Vocal cord carcinoma, glottic carcinoma, vocal cord cancer

Occurrence and risk factors

The vocal cord carcinoma is a malignant (tumor) cancerous tumor located in the region of the vocal folds in the larynx. So it belongs to the group of laryngeal cancer ( laryngeal carcinoma ).

Most commonly, this cancer is found in men over the age of 70 years. The most important risk factor for the development of a vocal cord carcinoma is the long-term cigarette abuse. The nicotine and other harmful substances found in cigarette smoke have a destructive effect on the mucous membrane of the larynx.
It is estimated that people who smoke at least 20 cigarettes per day have a 6% higher risk of having a vocal cord cancer than the normal population.

In addition, however, there are also a large number of other risk factors:

  • Noxae such as asbestos (laryngeal carcinoma is recognized as a recognized Berkuf disease in the workplace), benzene, chromates, nickel, aromatic hydrocarbons, soot, tar, cement dust or textile dust, sulfuric acid, gasoline or diesel fumes;
  • a long-standing gastroesophageal reflux ( GERD ), which manifests as heartburn;
  • ionizing radiation, provided that it was very intense (for example, during the irradiation of this area in the context of tumor therapy) or over a very long period of time took place.

The precursors of vocal cord carcinoma include certain forms of laryngitis (chronic hyperplastic larnygitis), leukoplakia, and laryngeal papillomas, but not the benign vocal cord polyps, cysts, or nodules.

Classification of the vocal cord carcinoma

Like most solid tumors, vocal cord cancer is also described using the UICC classification, where the T stands for tumor, and the higher the stage the worse the prognosis:

  • a T1 tumor is restricted to the vocal cords,
  • a T2 tumor is spread upward ( supraglottis ) and / or below ( subglottis ) and is associated with impaired mobility of the vocal folds,
  • a T3 tumor is even larger, but still limited to the larynx, the vocal folds are completely immobile here,
  • In a T4 tumor, the thyroid cartilage and other organs besides the larynx are affected.

This classification is important for choosing an appropriate therapy.

symptoms

The key symptom of a vocal cord carcinoma is hoarseness.

Of course, this can also have a variety of other causes, but if hoarseness persists for more than three weeks (most inflammatory hoarseness usually disappears within two weeks), then you should definitely visit an ear, nose and throat doctor,

Other symptoms include irritable coughing or in advanced stages also a breathlessness or difficulty swallowing. The carcinoma of the vocal cord forms very rarely and if, then late metastases (secondary tumors), since this area is only very poorly supplied with lymphatic vessels, which can delay the tumor cells. Should a metastasis take place, it usually takes place regionally (ie in the immediate vicinity of the vocal folds) or in the liver or lungs.

More commonly, about 20-30% of those affected, so-called secondary cancers occur, usually in the upper respiratory tract or the lungs. Secondary tumors as well as metastases may have additional symptoms depending on their localization.

diagnostics

If there is a suspicion of vocal cord cancer, the ear, nose and throat specialist carries out a direct or indirect laryngoscopy, with which the larynx and the vocal folds can be well evaluated.

In an existing carcinoma, the affected vocal cord is typically reddened and thickened, sometimes also a defect of the mucous membrane ( ulceration ) or a whitish fibrin coating can be seen .
At a later stage of the disease, it can happen that the carcinoma grows into the arytenoid cartilage . In such patients, the mobility of the vocal folds is limited and they are no longer in their typical position. To get a more accurate idea, the vocal fold vibration can be checked using stroboscopy.

To confirm the diagnosis, a small piece of the suspicious tissue in the larynx is extracted during laryngoscopy under local anesthesia (by means of a trial excision = PE or fine needle puncture), which is then sent for microscopic examination ( histology ).

In order to better assess how far and how deep a carcinoma has already grown, a computed tomography ( CT ) or magnetic resonance imaging ( MRI ) can be performed. In order to search for any existing metastases, an ultrasound examination ( sonography ) is also recommended, which is also suitable for follow-up.

therapy

If the carcinoma is still at an early stage of diagnosis (T1), laser ablation is nowadays usually performed ( endolaryngeal surgery ).

Alternatives are the somewhat obsolete conventional choroidectomy, in which the vocal cord, including the vocal muscle, is removed by an external access (for which the thyroid cartilage must be split), and the radiation of the tumor area from the outside.
However, the radiation has the decisive disadvantage that no tissue examination can take place.

In more advanced tumor stages, the procedure of choice depending on the spread of the carcinoma is either partial or complete resection of the larynx ( laryngectomy ). If tumor tissue has been detected in the surrounding cervical lymph nodes, they will also be removed (neck dissection).

forecast

The prognosis of a vocal cord carcinoma is considered good with a 5-year survival rate of approximately 90%.
This has different reasons:

  • On the one hand, because of the symptoms that can be detected early, a diagnosis can often be made early and therapy can be initiated, which is why, at the time of detection, in most cases no spread ( metastasis ) has taken place.
  • In addition, there are now good and modern treatment options, with which one can record high success rates.


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