Laryngeal cancer, risk factors, symptoms and treatment

Citation: Boçi B, Çuko A (2020) Laryngeal cancer, risk factors, symptoms and treatment. Arch Otolaryngol Rhinol 6(2): 021-028. DOI: https://dx.doi.org/10.17352/2455-1759.000116 The objective of this study is to identify trends in demographics, symptoms and treatment of laryngeal cancer and to analyze risk factors contributing to the emergence of this cancer. Review of 679 cases with laryngeal cancer diagnosed between the years 2002 and 2011 in ENT SERVICE in University Hospital Center “Mother Teresa“. Analysis of these case records addressed demographics, risk factors and treatment for cases according to stage, site and TNM classifi cations. In all cases, their diagnosis has been confi rmed by histopathological studies.

The British Cancer Research Center reports in 2011, following a detailed study, that in the United Kingdom the percentage of males diagnosed with laryngeal cancer is 82% and women 18%. So there is a big difference in the distribution of tumor to females in Britain and Albania. This can be explained by the fact that the beginning of smoking in UK women is earlier than ours Table 3, Graph 3.
Distribution village/ town: From the tables we see that those who live in the city are more affected than those living in the village. Village percentage ratio: city is 44.5%: 55.5%. This report may not be very real, in the context of the major demographic changes that followed the 90s Table 4, Graph 4.

Distribution by profession:
We have regrouped professions based on professional exposures, seeking to make a connection between the exposure and the prevalence of the disease
Alcohol: The major risk factors for SCC of the larynx are long-term tobacco exposure and alcohol abuse and have been long -established [18,19]. According to a European study and presented by Talamini, 58% of cases suffering from laryngeal cancer consume alcohol and 75% of cases are both tobacco and alcohol consumers. For alcohol consumption these data are not consistent with our study [10,12,17] Table 9, Graph 9.
Other risk factors: These data match Muscat, Wynder, or Zheng's studies that show that there is a connection between laryngeal cancer and various occupational professions related to the textile industry, chemical industries dealing with wood processing [11,20]. A small proportion of carcinomas appears to be related to transcriptionally active human papillomavirus infection, prognostic signifi cance of this is not known at these sites [21]. In our 679 cases we don't have data that are connected with HPV as a cause of laryngeal cancer Table 10, Graph 10.

Staging.The extent of the tumor at the time of diagnosis
Staging criteria in Table 12, data collected of cancer staging uses the most recent UICC TNM staging (currently 8th version), which refl ects the AJCC cancer staging for all criteria except for T3/T4a subglottic carcinomas. In the AJCC system, T3 carcinomas include those limited to larynx with vocal cord fi xation and/ or invasion of paraglottic space and/or inner cortex of the thyroid cartilage. Normal (T1) or impaired (T2) vocal cord mobility and vocal cord fi xation (T3) may only be determined clinically.
From the above data we see that in most cases of our cases, the laryngeal cancer is diagnosed in advanced stages III / IV. This proves a low level of early diagnosis of the disease, but also a silent tumor, which it might be diagnosed only when it is spread suffi ciently. Perhaps these data point to our Albanian-Balkan character as careless of the disease. According to Jeffrey S.Moyer and Gregory T.Wolf, the third-fourth infi ltration is 40% -50%, so no great compatibility with our study because of the two factors mentioned above Tables 12,13, Graph 12 [25,26].       Graph 9: Alcohol consumption.

Tobacco and alcohol
The importance of smoking exposure in the appearance of laryngeal cancer is a clear case for our study. Also, for alcohol exposure it can be said that there is a clear link. While the relationship between the two factors is commonly our study is not to produce any. The result of the simple fact because it requires more in-depth research [13,14,16,17].

Professions exposed as a result of work in the wood industry, rubber, textile or mineral industries
As in the literature and in our study there are several cases of laryngeal cancer that have worked in these industries.
But despite these we can't judge for the consequent cause connection.

Genetic
There are some cases that people diagnosed with laryngeal cancer have had close affi liation with this type of cancer, but despite that we are unable to say if there is a real cause connection [20,29].

HPV
In our study no case has been discovered that has been affected by HPV, but I believe that there has been 'failure to take this factor seriously' or even because this factor has not been detected as a cause.

Plummer-Vinson
In our study there are several cases with this syndrome but no tangible connection is detected. Graph 11: Signs and symptoms.

Cases
Graph 14: Surgery and its types.

Anemia
There are some cases of anemia, but this can be explained by the malnutrition or the lack of vitamins that potentially are the cause of laryngeal cancer .

Conclusions
Laryngeal cancer occurs with an incidence of 2.27 cases per 10,000 inhabitants and an average of 67.9 new cases per year.
Incidence for male is 4.36 per 100.000 inhabitants, for female is 0.19 per 100.000 inhabitants.The incidence is low according to the changes that occurred in Albania in the 1990s, a large part of the Albanians had the opportunity to move abroad and be treated elsewhere.Also many cases can be treated in private hospitals, which further reduce the incidence.    In addition, we found that there is a link between exposure to wood, dust, or metal working in appearance of the laryngeal cancer. It is a task to detect the quantitative relationship between exposure years and this cancer. Also, the work should be deepened in HPV as a potential causative factor.In Albania Citation: Boçi  we see laryngeal cancer exclusively in smokers and alcohol abusers. We think that as a very important risk factor except smoking is a traditional Albanian alcoholic drink called "Raki".
We conclude from our study that the incidence in women is lower compared to men because smoking is still taboo in Albania. Since primary prevention is not fully feasible then we need to focus more on secondary prevention or early psychology by coordinating activity between family practitioners and those specialists.