((Ralna has clearly understood the guidelines, however we suggest that she could have been bit more

elaborate. Please add more points to all the headings/sub-headings. Lets keep an average of 170-200 per topic. Good work otherwise!)) PART 3 SIGNS AND SYMPTOMS Signs or symptoms of laryngeal cancer are dependent on where the cancer is growing (supraglottis, glottis, subglottis). Hoarseness Cancer that grows on the true vocal cords which is known as a glottis cancer causes obstruction to the normal vibrating function of the sound-producing part (vocal cord) of the voice box (larynx) resulting to voice changes or hoarseness. Hoarseness is the most common symptom since it is not only caused by cancer but also by a number of things including infection and smoking. However, a persistent occurrence of more than three weeks of this voice changes should alarm the patient for a possible laryngeal cancer. Difficulty in swallowing Dysphagia is the term for swallowing problem which is commonly observed among persons diagnosed with laryngeal cancer due to the webs of tissue that grow across the upper part of the food pipe (esophagus). Laryngeal cancer provides discomfort and strange feeling of a mass that blocked your throat narrowing the esophagus leading to the inability to swallow food. Pain when swallowing Painful swallowing is known as odynophagia, one of the common symptoms of a laryngeal cancer patient in cases when the cancer has spread to the esophagus (food pipe). Knowing that the larynx is found in front of the esophagus and cancer is an out of control growth of cells - pain in swallowing is indeed evident since the growth of tissue pushed the food pipe. A feeling that there is a lump in your throat This lump in the throat sensation is also known as globus pharyngeus or hystericus. Mostly it is felt when a person needs to swallow two to three times to make sure that the food enters the food pipe. There are several causes of this sensation and one of which is large mass brought about by laryngeal cancer. Patients may feel a lump in the throat because of lesion of the false vocal cord, ventricle, and epiglottis.

Cough

Cough is usually due to cold or allergies that usually go away after proper medication. However when cough become consistent and persistent and doesnt disappear though medicines have been taken, this is due to cancer of the larynx. The tissue of the larynx is sensitive to stomach acid and once these tissues are exposed to it laryngopharyngeal reflux occurs in which the primary sign is cough. Patients with cancer according to studies are more prone to laryngopharyngeal reflux thereby having a constant cough. Shortness of breath Laryngeal cancer especially the subglottic (downward extension from vocal cords) type causes shortness of breath as tumor formation and stenosis (abnormal narrowing of tubular structure) gradually spread. It may appear first as an effort to breath and then after as wheezing which will lead to cyanosis (blue). Airway obstruction One of the key functions of the larynx, especially its seven (out of eight) muscles, is the closure to the opening of the airway. Growth of laryngeal cancer causes airway obstruction in the following sites- above the true cords (supraglottic), true vocal cords (intraglottic) and below the true cords and above the carina (infraglottic). Bad smelling breath (halitosis) Bad breath or halitosis often is caused by volatile sulfur compound producing bacteria in the oral cavity (85%). Though the connection is not still established but foul breath may be a symptom of laryngeal cancer. Researchers are still conducting studies to have a better understanding to the link of bad breath and laryngeal cancer. Weight loss Since laryngeal cancer conveys difficulty and pain in swallowing, a persons eating habit eventually changes. Food intake would be lesser than the usual and this happens with the more advance stage of laryngeal cancer. This is the sole reason why weight loss is a common symptom of cancer of the larynx.
Change in voice The larynx or our voice box is the one responsible for making sound that allow a person to talk. Cancer or tumor usually lies in the lining of the larynx and when this happens, the cancer

attacks the vocal cords thus changing the voice quality. An enlarged lymph node or a lump in the neck Cancer of the larynx has the ability to metastasize (spread) other than its original site. hrough tissue. Cancer invades the surrounding normal tissue. There are three ways for the cancer to spread in the body and one of which is through the lymph system. As the

cancer reached the lymph system, another tumor may form there producing enlargement of the lymph node.

Noisy breathing (stridor) Stridor (noisy type of breathing) is an audible sound that is produced during respiration as the opening between the vocal cords is narrowed by a laryngeal cancer. The location of the obstruction has a corresponding type of stridor. When the site that is blocked is above the level of the true vocal cords, inspiratory stridor occurs. While a biphasic stridor (heard during inspiration and expiration) implies narrowing of the true vocal cords. Ear pain Another common symptom present among laryngeal cancer patients is ear pain. This pain is not actually coming from the ear itself but from the throat specifically the larynx. This is called referred pain. Choking A larger laryngeal cancer may narrow the opening of the esophagus and cause food to get stuck or come back up giving a feeling like choking. Since cancer disrupts the normal functioning of organs, the epiglottis (which is needed to prevent choking when swallowing) is altered and could no longer avoid choking from happening. Fatigue Laryngeal cancer can cause changes to the body that can lead to fatigue. Because some studies pinpoint that this type of cancer release proteins called cytokines, a substance known to be fatigue inducer. Furthermore, the shortness of breathing causes the difficulty of talking and adds up tension to the throat and neck muscles since breathing is from the shoulders or neck area instead of from the lower chest or abdominal area thereby resulting to fatigue.

PART 4 DIAGNOSTIC STEPS Introduction There are more than one hundred types of cancer and it can be in any part of the body. In the survey done by the World Health Organization (WHO), it showed that in the year 2008, 7.6 million died because of cancer comprising about 13% of deaths worldwide. However, having a cancer doesnt end everything since it is also indicated by WHO that more than 30% of cancers could be cured if detected early and treated adequately. Here comes the importance of understanding the diagnostic stage. Whenever a challenge of knowing that you have a laryngeal cancer comes your way, the last thing you should do is to panic and give up. Hearing that you have a laryngeal cancer is indeed a scary reality but this shouldnt stop you from getting help from the people who are well acquainted with it. Ear, nose and throat (ENT) medical practitioners are more than willing to assist you, let you understand what you are going through and how can you combat it, if you will just allow them to do so. The ENT specialist guides you to a proper diagnosis by doing physical examination, laryngoscopy, blood count (anemia), and biopsy. It is always better if you have a good understanding with the condition that you are having since this gives you the sense of control and the ability to choose the best care for you. Visit an ear, nose and throat specialist It is a fact that there are numerous types of sickness occurring in a human body. In order to give the exact and adequate treatment to each disease, medical doctors devoted their life in studying and specializing in a certain field or type of disease so that quality service can be given. As the name suggests, an ear nose and throat specialist deals primarily with problems affecting the ears, the nose, and the throat. These physicians are well trained in treating issues ranging from sleep apnea to hearing loss, allergies, earaches, difficult breathing, excessive snoring, sinus pain, goiter and most especially cancers like for instance laryngeal type. Whenever you feel the above mentioned diseases and also when you have the signs and symptoms, risk factors for laryngeal cancer, do make time to take a visit to an ear, nose and throat specialist clinic.

Do following tests 1. Physical examination The first step in the process of diagnosis after history taking of the physician is physical examination since there features of laryngeal cancer that is observable by our senses. The signs of laryngeal cancer include a breathy, gravelly voice or hoarseness, weight loss, stridor (noisy breathing), masses or leukoplakia of the posterior pharyngeal wall, tonsillar pillars, tonsils and palate, surfaces of the oral tongue, floor of mouth, and base of the tongue and lesions of the vocal cords, and local extension of tumor. In addition are bad smelling breath and enlarged lymph node. 2. Laryngoscopy The doctor can examine the larynx in two ways either by indirect or direct laryngoscopy. In the indirect laryngoscopy, a small, long-handled mirror is used by the physician to look down the throat to inspect if the vocal cords appear normal without lesions and move as they should. Though this is a painless procedure, the doctor sometimes sprays local anesthesia in order to prevent you from gagging. This examination is executed in the doctors clinic. On the other hand, in the direct laryngoscopy, the doctor inserts to your mouth or nose a thin, flexible tube with a light at the end (called laryngoscope) to check the throat and larynx. Before the procedure, the doctor provides a mild anesthetic and mild sedative to help you relax. This technique conveys more areas that cannot be seen with the use of a mirror only. After the procedure, sore throat is a normal consequence but will eventually disappear after a few days. This is done not only in the doctors office but also in an outpatient clinic and hospital. 3. Blood count (Anemia) Physicians sometimes require a blood count to further support their diagnosis and check the patients general health status. Complete blood count is the common blood test that measures the amount of various types of blood cells in a sample of your blood one of which is the red blood cells. Blood cancers may be detected using this test if too few of red blood cells (anemia) are found. 4. Other Test Biopsy If the doctor noticed an abnormal area after the laryngoscopy, he would proceed to biopsy to make sure whether the abnormality seen is cancerous or not. Biopsy is a process of cell removal for examination under a microscope. There are three types of biopsy depending on sample removed and the procedure of how it is obtained. Incisional or core biopsy is the removal only of a sample tissue but when the whole tumor is removed it is now an excisional biopsy while fine-needle biopsy is the removal of tissue and fluid using a needle.