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Larynx (voice box)

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Larynx anatomy: supraglottis, glottis, subglottis

The larynx, often called the voice box, contains the vocal cords used in speech, but also acts as a valve that closes with swallowing, so that food and liquid pass to the hypopharynx and esophagus. The glottis consists of the vocal cords and their moveable attachments, the arytenoids. The supraglottis is above the glottis, including the false vocal cords, the epiglottis, and the aryarytenoid folds. The subglottis is the segment of the larynx below the glottis. The epiglottis is a flap of cartilage that covers the laryngeal airway during swallows.

evaluation of larynx cancer

Evaluating larynx cancer begins with a history and physical exam, including evaluation of the airway, swallowing, and the lymph nodes of the neck. Further evaluation commonly includes the following:

• Laryngoscopy in the office: Link to a page on the American Cancer Society site describing use of a scope in the office to examine the throat. This procedure is done to look at both the larynx and pharynx (laryngoscopy and pharyngoscopy, respectively) and it takes about 30-60 seconds, typically.

• CT scan with iodine contrast: This imaging study done in radiology utilizing intravenous dye provides additional anatomic detail. In individuals allergic to iodine contrast, medications may be used to curb any reacti0n, or another study may be undertaken, such as CT scan without contrast or MRI scan with gadolinium contrast.

• PET-CT scan: The combination of a Positron Emission Tomogram (PET) with a non-contrast CT scan is commonly utilized for more advanced cancers or situations in which the above studies are inconclusive. The CT component of this study provides good anatomic detail, while the PET component provides information on the metabolic activity of a tissue, which is useful in identifying probable extent of cancer.

larynx cancer and the airway

Over time, as a larynx cancer grows, the airway gets narrower. This may have minimal effect early-on, but once the airway gets small, every additional millimeter of diameter lost can have a major effect on the ability to breathe. For this reason, when a person’s larynx cancer is causing noticeable challenge in breathing, such as with taking longer to catch one’s breath, becoming unable to breathe in certain positions, or having noisy breathing, their doctor should be notified immediately and tracheostomy should be considered.

In addition, tumors of the throat tend to have bacterial infection on their surfaces. Larynx tumors impair the normal mechanism by which food and liquid are routed to the esophagus instead of to the windpipe (trachea). Combined, larynx cancers tend to soil the lungs with bacteria, leading to infection that further limits breathing.

Swallowing

Swallowing well is essential for maintaining nutrition as well as keeping the lungs free of infection. A decision faced commonly in the treatment of larynx cancer (especially advanced stages of larynx cancer) is whether to place a gastric feeding tube (G tube).

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