The biological event which is necessary for reproduction in monocellular organisms, regeneration of tissues in multicellular organisms and for the organism to grow and develop is called as cellular division. This division occurs consistently in some tissues and periodically in some other tissues. Healthy cells except for muscle and nerve cells in the human body can also divide.
Cell division is controlled by a mechanism formed by groups of molecules that work cyclically in the cell and coordinating events occurring in the cell. In case that there is no need for new cells, i.e. division; sometimes, cells continue to divide and multiply uncontrollably due to some damage to the DNA. These unnecessary cells accumulate in mass and form tumors. Malignant tumors caused by the mass which occurs by dividing and multiplying cells in tissues or organs out of the control of the control mechanism are called as cancer. These malignant tumors can squeeze, infiltrate, or damage normal tissue to make room for themselves. Furthermore, cancer cells can leave the tumor in which they have accumulated and reach other tissues and organs through blood, spread rapidly (metastasis) throughout the body, move on their irregular and uncontrolled division and form new tumors there.
Malignant tumors that are formed by irregular and uncontrolled division of some tissues and cells located on the vocal cords or coming from another part of the body are called as Vocal Cord Cancer or Vocal Cord Carcinoma. The vocal cords are also called as Glottis Carcinoma since they form the section of the larynx known as the glottis. They begin to appear as white (leukoplakia) or red (erythroplakia) plaque on the vocal cords. Since the formations that occur in the vocal cords such as nodules, polyps, cysts or precancerous cells cause hoarseness first; they can be detected and diagnosed rapidly. In the first phase, vocal cord cancer can be cured if it is diagnosed before spreading to the larynx. Most cancer cases occurring in the larynx cause cancers covering the surface, skin cancer and squamous cancer in the vocal cords.
Cartilage and sparsely-textured lymphs around the voice box in the larynx prevent cancer cells that may form in the vocal cords from spreading rapidly and invading another organ. Thus, vocal cord cancer remains in its own region for 6-9 months without spreading. In case it is detected that cancer has spread during the diagnosis, the cancer is considered to be in the late stage.
Smoking and excessive alcohol consumption are the most important factors predisposing to formation of vocal cord cancer. Even though it is common in women being at different ages and smoking, it is generally seen among men between the ages of 50-70 years. The incidence of vocal cord cancer in individuals who do not smoke is very low.
In addition to this, exposure to genetic structure, viruses and bacteria, asbestos (amiant) minerals, using paint and varnish containing excessive amounts of wood and metal powder, chromium and nickel, or presence in the environment where these are used, poor diet, reflux and laryngitis diseases, and weak immune system can cause vocal cord cancer.
The first and most distinct symptom of formations such as nodules, polyps, cysts or cancer precancerous cells in the vocal cords is the hoarseness which lasts for more than two weeks. Changes in voice, difficulty in breathing, chronic sore throat, ear pain, bloody cough, difficulty in swallowing, lumps/masses in the neck area, weight loss along with or independently of hoarseness are among the symptoms.
With the prevalence or increase of symptoms, the patient should be examined in detail by an ear, nose and throat specialist. The vocal cords are examined first using endoscopic devices. The most commonly used endoscopic imaging tools are either laryngoscopy consisting of a light, camera and a narrow tunnel, or videostroboscopy, a telescope camera that uses an intermittent light source, which are used by entering through the nose. In case any cancerous cells are encountered in this examination, tissue samples are taken (biopsy) and examined pathologically. If deemed necessary, the doctor may also ask x-ray, ultrasonography, computed tomography (CT), and magnetic resonance (MR) examinations. Subsequently, it is diagnosed and the appropriate treatment is decided among chemotherapy in which chemical drugs are used, radiation therapy made with radioactive rays/radiotherapy or endoscopic surgery. The patient’s condition and age, the stage and the place of the cancer are important factors to make a decision.
Chemotherapy can be used alone in some cases, and sometimes before, during or after radiotherapy and surgical interventions. Chemotherapy, which is primarily used to shrink the tumor or prevent its growth, can be applied as a protective protocol together with other methods or as being preventive for the spread of the tumor. It is generally used in advanced-stage cancers.
Radiation therapy is administered in cases where spread is detected in cancer cells. The aim is to destroy cancerous cells by giving a certain dose of radioactive ray from the neck every day. After radiation treatments, side effects can be seen, for example, painful wounds may occur in the mouth and throat area that prevent feeding, thus naturally, excess weight loss may occur. Furthermore, even if the wounds heal over time, permanent problems in swallowing may occur. Radiation therapy can be applied to the same area only once. In addition to this, problems arising from this treatment are experienced about 10 years after radiation treatment. Thus, endoscopic surgery methods are preferred in cases where recovery can be seen as they involve less risk. It is evaluated that it will be more effective to apply the surgical operation method especially to people between the ages of 30-70 years.
In the treatment of vocal cord cancer in a small area, endoscopic surgery is operated, the tumor is cut or scraped from the area or burned with a laser.
It is important to know the stage of the cancer so as to apply the best treatment when diagnosed with Vocal Cord Cancer. Staging is a detailed examination work to determine whether the cancer has spread or to which parts it has spread. Knowing the stage of the cancer helps the doctor to predict the course of the disease and to understand if there is a chance of recovery.
Different staging systems are used throughout the world. The most common staging system is the Tumor-Node-Metastasis (TNM) System developed jointly by the American Joint Committee on Cancer (AJCC) and The International Union for Cancer Control (UICC). TNM staging system classifies cancers based on the size and extension of the first diagnosed tumor (T), regional lymph node involvement (N), and whether there is distant metastasis (M). Accordingly, there are 4 stages of vocal cord cancer except Carcinoma in situ:
Stage 0 (Carcinoma in Situ): There may be precancerous cells on the surface of the vocal cord(s), which pose risk of transforming into cancer and spreading to tissues in the close area.
Stage 1 (Locally): The cancerous tissue may be in one or both of the vocal cords. Functionality of the vocal cords is regular and both cords can move.
Stage 2 (Early Locally Advanced): Cancerous tissue has spread to one or both of the upper larynx (supraglottis) and lower larynx (subglottis). Functionality of the vocal cords is irregular, they cannot move as expected.
Stage 3 (Late Locally Advanced): This is about whether the cancerous tissue has spread or not.
Cancer is only in the larynx and the vocal cords are unable to move or the cancer is in the tissues around the larynx. Cancer may have spread to a lymph node of 3 cm or smaller.
Cancer is in one or both of the vocal cords and may have spread to a lymph node of 3 cm or smaller. The vocal cords can move regularly.
Cancer has spread to one or both of the upper larynx (supraglottis) and lower larynx (subglottis), and may have spread to a lymph node of 3 cm or smaller. The vocal cords cannot move regularly.
Stage 4 (Metastasized): This is about whether the cancerous tissue has spread outside the neck area. This stage is divided into 3 sections.
Stage 4A: The cancer has spread from the thyroid cartilage to outside the neck, and may have spread to a lymph node of 3 to 6 cm. The vocal cords may not move regularly.
Stage 4B: Cancer may have spread to anterior to the spinal cavity and encircled the carotid artery (artery on both sides of the neck), or may have spread to the chest parts, as well as to one or more lymph nodes of any size. The vocal cords may not move regularly.
Stage 4C: Cancer has spread to other organs and systems such as lungs, liver, and bones.
Vocal Cord Surgery is usually applied in the 1st and 2nd stages of cancer. The aim is to destroy the tumor by preserving the normal non-cancerous tissue. This can be done from the mouth or in rare cases, from the neck.
Depending on the location and condition of the tumor, most of the voice box can be removed with endoscopic surgical equipment; the voice box can be recovered; the tumor can be removed through cutting or scraping; or it can be destroyed by laser application. In some cases, it is also possible to completely remove the larynx or the lymph nodes.
Surgical interventions do not take long. However, recovery time varies according to the method applied and the operation performed. It is also decided whether to apply radiotherapy or chemotherapy after surgery. Taking into account all of these, it should be known that the treatment may span from a few weeks to a few years.
Vocal cord cancer allows early diagnosis generally as it shows symptoms with hoarseness. Thus, the treatment success is quite high.
If you also have problems such as hoarseness and difficulty in breathing, you can reach us via our contact information, and get more information and receive treatment in our health center that uses state-of-the-art technology tools and equipment for diagnosis and treatment of vocal cord disorders and priorities your special demands and needs.