Definition

Laryngeal or vocal cord tumors refer to abnormal cell growth in the vocal cord region, which is the part of the airway connecting the nose and mouth to the trachea. Abnormal tissue growth in the larynx can damage the vocal cords and obstruct the airway, leading to breathing difficulties.

Causes

Several types of tumors can develop in the larynx, including papilloma, hemangioma (tumor of blood vessels), fibroma (connective tissue tumor), chondroma (cartilage tumor), and neurofibroma (nerve tumor). One common benign tumor in the larynx is laryngeal papillomatosis. Around 60-80% of laryngeal papillomatosis cases are found in children. Over 60 variants of the Human Papillomavirus (HPV) can cause laryngeal papillomatosis, though the exact mechanism of HPV transmission in humans remains unclear.

Malignant tumors can also occur in the larynx, often developing from papillomas and neurofibromas. The most prevalent malignant tumor is squamous cell carcinoma, which originates in the cells lining the larynx walls. Laryngeal cancer is a frequent type of cancer in the head and neck region.

Risk factor

Several factors can increase the risk of developing laryngeal tumors and cancer:

• Smoking habit is the most significant risk factor (95% of laryngeal cancer cases are smokers).
• Heavy alcohol consumption (especially when combined with smoking).
• Laryngeal cancer is more common in individuals over 55 years old.
• Gender. Men are four times more likely to develop laryngeal cancer than women.
• African Americans have a higher incidence of laryngeal cancer.
• Exposure to carcinogens, such as asbestos.
• Low socioeconomic status.

Symptoms

All types of laryngeal tumors can produce similar symptoms, typically originating from the vocal cords, and can cause rapid onset of hoarseness, the primary symptom of vocal cord tumors. 

Tumors from other laryngeal structures develop more slowly and present different initial symptoms, including:

• Persistent cough
• Breathing difficulties or shortness of breath
• Sensation of a lump in the throat
• "Hot potato" voice (muffled voice, as if there is something hot in the mouth)
• Difficulty or pain while swallowing
• Frequent choking
• Ear pain from nerve irritation extending from the larynx, more common in malignant tumors due to rapid growth
• Voice weakness or changes in the voice
• Coughing up blood (hemoptysis)
• Neck lumps from the spread of cancer cells to lymph nodes, sometimes noticed before other symptoms become apparent
• Weight loss

Diagnosis

In diagnosing laryngeal tumors, the doctor will begin by taking a detailed medical history and inquiring about the symptoms you are experiencing. A comprehensive physical examination, particularly of the head and neck, follows. If a tumor is suspected, a laryngoscopy will be recommended. This procedure involves using a flexible tube with a light and fiber optic camera to visualize the larynx directly. This procedure can also assess the functionality of the larynx and the vocal cord vibrations. During the laryngoscopy, a biopsy sample may be taken to determine if the tissue was tumor cells and the exact type of tumor, or the visible tumor tissues might be removed immediately. This procedure is performed under general anesthesia.

Additionally, a CT scan might be necessary to assess the size, shape, and extent of the tumor growth and its stage. If there is suspicion of tumor metastasis, a PET scan (Positron Emission Tomography) may also be performed. A definitive diagnosis of the laryngeal tumor type can only be made following a laryngoscopy and biopsy.

Vocal cord tumors are typically diagnosed quickly due to the hoarseness they cause, which prompts individuals to seek medical attention. However, tumors located above or below the vocal cords may only be detected in advanced stages, as they often remain asymptomatic for a significant period.

Management

Removing laryngeal tumors can help restore the voice, improve the function of the larynx, and clear the previously obstructed airways.

• For small benign tumors, the tumor tissue can be excised during a laryngoscopy procedure using a CO2 laser under general anesthesia. Larger benign tumors might require more complex surgical interventions. Meanwhile, in patients with laryngeal papillomatosis, HPV immunization may help slow tumor growth by targeting the virus, though this approach remains controversial.
• Treatment for laryngeal cancer depends on the type, location, and stage of the tumor at the time of diagnosis. The primary treatment modalities include surgery, chemotherapy, and/or radiation therapy.
• For tumors in the early stages, surgical procedure to remove the cancer or radiation therapy can usually be performed. Radiation therapy may be preferred to preserve the normal voice if the vocal cords are involved. In very early cancer stages, minor surgery using a laryngoscope might be chosen over radiation therapy for its efficacy. Minor tumor tissue removal with the help of laryngoscope can be done once with minimal side effects on swallowing and speech.
• For moderate stages where the cancer has spread to surrounding tissues, a combination of chemotherapy and radiation therapy (chemoradiation) might be chosen instead of surgical procedure. Chemoradiation can be as effective as surgery but with fewer side effects on the voice. However, if the cancer persists after chemotherapy, surgery may be necessary.
• In advanced stages where the tumor has invaded the bones or cartilage, surgical procedure to remove part of or the whole larynx and vocal cords is usually employed, followed by radiation therapy and sometimes chemotherapy. In very advanced stages of tumor, chemotherapy may be used to reduce pain and tumor size, though the likelihood of recovery is minimal.
• Rehabilitation is often required following both surgical and nonsurgical treatments. In some people, significant swallowing difficulties can occur after surgical procedures, chemotherapy, and radiation therapy, necessitating swallowing therapy or, in severe cases, surgery or the use of a feeding tube. Surgical procedures can also affect speech, making speech therapy necessary to improve communication abilities.

Complications

The complications associated with laryngeal tumors include airway obstruction and vocal cord damage. Meanwhile, malignant tumors can metastasize to lymph nodes and other distant organs. The most common organs are the lungs and liver. Malignant laryngeal tumors outside the vocal cords have a higher chance of spreading and are generally harder to treat. Cancer that invades muscle, bone, or cartilage has a very low cure rate.

Prevention

To reduce the risk of developing laryngeal tumors, it is advisable to adopt a healthy lifestyle, such as:

• Avoiding smoking
• Limit alcohol consumption
• Use personal protective equipment when exposed to asbestos or other toxic substances in work environment
• Eat a healthy diet rich in antioxidants

When to see a doctor?

Consult a doctor if you experience chronic and persistent symptoms of a laryngeal tumor. Since laryngeal tumor often originates from the vocal cords and quickly cause hoarseness, seek medical advice if hoarseness lasts more than 2-3 weeks.

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