Vocal Fold Cancer

Vocal Fold Cancer: Approach, Diagnosis, and Treatment

Vocal fold cancer, also known as glottic cancer, is a type of laryngeal cancer that originates in the vocal folds (vocal cords) within the larynx (voice box). As a critical structure in speech production, the vocal folds are responsible for generating sound by vibrating as air passes through them. The development of cancer in this area can significantly affect a person's ability to speak, breathe, and swallow.

In this detailed page, you will be able to read about the epidemiology, approach, diagnosis, and treatment of vocal fold cancer. Our aim is to provide you with a thorough understanding of this condition, the steps involved in its detection, and the various treatment options available.

Vocal fold cancer is one of the more prevalent cancers within the head and neck region. Laryngeal cancer, including vocal fold cancer, accounts for about 1-2% of all cancers worldwide. The incidence varies by geographic region, with higher rates observed in countries where tobacco use and alcohol consumption are more prevalent.

Risk Factors

The development of vocal fold cancer is closely linked to several risk factors, most notably:

Tobacco Use: Smoking is the most significant risk factor for vocal fold cancer. The chemicals in tobacco smoke can cause mutations in the cells of the vocal folds, leading to the development of cancer. Both active smoking and exposure to secondhand smoke increase the risk.

Alcohol Consumption: Heavy alcohol use, especially when combined with smoking, greatly increases the risk of developing vocal fold cancer. Alcohol acts as an irritant and can make the cells of the vocal folds more susceptible to the harmful effects of tobacco.

Human Papillomavirus (HPV): Infection with certain strains of HPV, particularly HPV-16, has been linked to an increased risk of developing cancers in the head and neck region, including vocal fold cancer.

Chronic Irritation: Long-term exposure to irritants, such as industrial chemicals, dust, or laryngopharyngeal reflux (LPR), can contribute to the development of cancer in the vocal folds.

Age and Gender: Vocal fold cancer is more common in older adults, typically affecting individuals over the age of 55. It is also more prevalent in men than in women, likely due to higher rates of smoking and alcohol use among men.

Prevention

Given the strong association between vocal fold cancer and modifiable risk factors such as smoking and alcohol use, prevention strategies play a critical role in reducing the incidence of this disease. Key prevention measures include:

Smoking Cessation: Quitting smoking is the most effective way to reduce the risk of developing vocal fold cancer. Even individuals who have smoked for many years can significantly lower their risk by quitting.

Reducing Alcohol Consumption: Limiting alcohol intake, particularly when combined with smoking cessation, can further reduce the risk of vocal fold cancer.

HPV Vaccination: Vaccination against HPV can prevent infections that are linked to the development of cancers in the head and neck region, including the vocal folds.

Avoiding Chronic Irritation: Reducing exposure to occupational irritants and managing conditions like Laryngopharyngeal Reflux can help protect the vocal folds from chronic inflammation and potential cancer development.

Early Detection and Screening

Early detection of vocal fold cancer is crucial for improving outcomes, as cancers detected at an early stage are more likely to be treatable and have a better prognosis. Although there is no routine screening program for vocal fold cancer, individuals at high risk, such as long-term smokers or those with persistent voice changes, should undergo regular evaluation by a voice doctor (phoniatrician – laryngologist).

Key signs and symptoms that may indicate the presence of vocal fold cancer include:

Persistent Hoarseness: Hoarseness lasting more than two weeks, especially in smokers or individuals with a history of alcohol use, should be evaluated by a voice doctor.

Voice Changes: Any unexplained changes in the voice, such as a raspy or weak voice, should be investigated.

Throat Pain or Discomfort: Persistent throat pain, difficulty swallowing, or the sensation of a lump in the throat can be warning signs of vocal fold cancer.

Chronic Cough: A chronic cough, especially if accompanied by blood-tinged sputum, may be a symptom of vocal fold cancer.

However, one should also keep in mind that all of the above mentioned symptoms are nonspecific. They may be related with a vocal fold cancer, yes, but may also be secondary to an upper respiratory tract infection or just reflux laryngitis. So, the best practice would be to visit your doctor and be assured about the cause of your symptoms.

Diagnosis of Vocal Fold Cancer

Diagnosing vocal fold cancer involves a series of steps, beginning with a thorough clinical evaluation and often followed by imaging and biopsy procedures.

Clinical Evaluation: The first step in diagnosing vocal fold cancer is a detailed medical history and physical examination. Your doctor will ask about your symptoms, risk factors, and any previous medical conditions. During the physical examination, the provider will pay special attention to the neck and throat, looking for any abnormalities.

Laryngoscopy: Laryngoscopy is a key diagnostic tool for vocal fold cancer. This procedure allows your doctor to visualize the vocal folds and assess their movement and appearance. This procedure provides a detailed view of the vocal folds and is usually performed at the office without any sedation. A flexible or rigid laryngoscope is inserted through the nose or mouth to examine the vocal folds closely. During laryngoscopy, the doctor notices the irregularities in the appearance of the vocal folds, such as white patches (leukoplakia), ulcers, or masses. These findings may prompt further investigation.

Imaging Studies: Imaging studies play a crucial role in evaluating the extent of vocal fold cancer and determining whether it has spread to surrounding tissues or lymph nodes. Common imaging techniques include:

CT (Computed Tomography) Scan: A CT scan provides detailed cross-sectional images of the larynx, neck, and surrounding structures. It helps to assess the size and location of the tumor, as well as any involvement of nearby lymph nodes.

MRI (Magnetic Resonance Imaging): MRI offers superior soft tissue contrast and is particularly useful for evaluating the spread of cancer to nearby tissues or the base of the tongue.

PET (Positron Emission Tomography) Scan: A PET scan is used to detect areas of increased metabolic activity, which may indicate the presence of cancer cells. It is particularly useful for identifying metastatic disease.

Biopsy

A biopsy is the definitive method for diagnosing vocal fold cancer. During a biopsy, a small sample of tissue is removed from the suspicious area and examined under a microscope by a pathologist.

Treatment of Vocal Fold Cancer

The treatment of vocal fold cancer depends on several factors, including the stage of the cancer, the areas of the vocal folds or the larynx involved, the patient's overall health, and the impact on laryngeal functions (voice, swallowing, breathing and airway protection). Treatment options may include surgery, radiation therapy, chemotherapy, or a combination of these approaches.

Surgery is often the primary treatment for early-stage vocal fold cancer. The goal of surgery is to remove the cancerous tissue while preserving as much of the vocal fold function as possible.