Overview

Subglottic Cancer is a relatively uncommon form of laryngeal (voice box) cancer that occurs in the subglottis, which is the lower portion of the larynx, found below the vocal cords and above the trachea. It accounts for a minority of cases of laryngeal cancer. Because lesions in the subglottis rarely present with clinical symptoms until the latter stages, they tend to be identified much later than glottic cancers. Early detection, diagnosis, and treatment are imperative for favorable results.

What is Subglottic Cancer?

Subglottic Cancer is a malignant growth originating in the mucous membrane of the subglottis. Most subglottic tumors are squamous cell carcinomas (SCCs), but other types of neoplasms may also occur.

The subglottis consists of the area from slightly below the vocal cords to the superior edge of the trachea. It functions as an important passage through which air moves to and fro between the lungs and the upper respiratory tract.

This cancer in particular has a tendency to compress the airway over time, thereby making breathing more and more difficult.

Where is the Subglottis Situated?

The larynx consists of three parts from an anatomical point of view:

• Supraglottis - above the vocal cords
• Glottis - containing the true vocal cords
• Subglottis - extending from below the vocal cords up to the top of the trachea

Since the subglottis is situated below the vocal cords, early tumor formation does not cause any changes in the voice initially, which can allow the condition to progress unnoticed.

What are the Causes of Subglottic Cancer?

There are several factors that raise the risk of having subglottic cancer.

Risk factors include:

• Active cigarette smoking
• Tobacco chewing
• Excessive drinking of alcoholic beverages
• Combination of tobacco and alcohol use
• Older age
• Male sex (although women can have this condition too)
• Industrial chemicals, wood dust, or asbestos inhalation at work
• History of head and neck radiation
• History of head and neck cancer

Smoking is the greatest preventable risk factor.

What are the Symptoms of Subglottic Cancer?

These become noticeable once the tumor increases in size.

These symptoms include:

• Persistent breathing problems
• Noisy breathing (stridor)
• Dry cough
• Hoarseness due to involvement of the vocal cords
• Difficulty swallowing
• Persistent throat irritation
• Sputum with blood
• Shortness of breath upon exertion
• Swelling in the neck area if the cancer is present in the lymph nodes
• Loss of weight without any reason, if in the advanced stage

Difficulty in breathing and changes in the voice warrant prompt consultation with an ENT doctor.

How is Subglottic Cancer Diagnosed?

Diagnosis requires clinical examination, endoscopy, and imaging.

Clinical Examination

The ENT performs an examination of the following areas:

• The breathing mechanism
• The patient's voice
• Neck lymph nodes
• Stability of the airways

Flexible Laryngoscopy

The treatment is done using a thin, flexible tube to visualize the larynx and any apparent anomalies in the subglottic area, when present.

Direct Laryngoscopy with Biopsy

An anesthesiologist performs this procedure, whereby the tumor can be biopsied under general anesthesia.

Imaging Studies

Imaging tests include:

• Contrast-enhanced CT scan
• MRI scan
• PET-CT scan (in case of advanced disease)
• Chest CT scan, where indicated

Such tests help determine the size of the tumor, the degree of cartilage invasion, airway narrowing, lymph node involvement, and distant metastasis.

What Is the Stage of Subglottic Carcinoma?

Subglottic carcinoma staging is done based on the TNM (Tumor, Node, Metastasis) system.

Stage I

The tumor is confined to the subglottis.
Normal mobility of vocal cords
No lymph node involvement

Stage II

The tumor involves the vocal cords, but with normal or reduced mobility.
No lymph node involvement

Stage III

Fixation of the vocal cords or extralaryngeal spread
One lymph node is involved in the vicinity.

Stage IV

The tumor extends to adjacent organs, such as the thyroid gland, trachea, esophagus, or soft tissues of the neck.
Several lymph nodes or distant metastases may be present.

How Is Subglottic Carcinoma Treated?

The treatment is determined by:

• The stage of the disease
• Tumor size
• Involved airway
• Lymph nodes involvement
• General health of the patient

Surgery

Surgery remains one of the leading approaches.

The types of surgical procedures include:

• Partial laryngectomy (in early stages, in selected cases)
• Total laryngectomy
• Dissection of surrounding tissue (if affected)
• Reconstruction surgery (if necessary)

In case of severe airway obstruction, tracheostomy will be necessary.

Neck Dissection

Neck dissection may be performed in the case of spreading of the cancer to neck lymph nodes or the high likelihood of lymph node involvement.

Radiation Therapy

Radiotherapy may be applied:

• As the sole treatment option in selected cases
• After the surgery to prevent recurrence
• To those patients who are not eligible for surgery

Chemotherapy

Chemotherapy usually goes along with radiation therapy in more advanced stages of cancer.

Patients with recurrent, metastatic, or unresectable cancer may also be given targeted or immunotherapy depending on the patient's condition.

Is It Possible for Subglottic Cancer to Metastasize?

Yes.

Subglottic cancer may metastasize to:

• Neck lymph nodes
• Thyroid gland
• Trachea
• Lungs
• Bones
• Liver

Due to the late detection of the disease compared with glottic cancer, there might be more advanced cases among patients.

What is the Prognosis?

It depends on:

• Stage of diagnosis
• Size of the tumor
• Airway involvement
• Spread to lymph nodes.
• Response to treatment
• General well-being

Subglottic cancer detected early can be effectively treated, while the advanced stage of the illness requires combined surgical, radiation, and chemotherapy treatments.

What Happens After Treatment?

Follow-up is necessary.

The patient will be checked for:

• Recurrence of cancer
• Function of the airways
• Voice condition
• Swallowing ability
• Nutrition
• Breathing problems
• Assistance in quitting smoking

Speech and swallowing therapy may be prescribed, especially if there was extended surgery.

Prevention

Even though all cases cannot be prevented, the following strategies can decrease the risk of subglottic carcinoma:

• Avoidance of smoking in all its forms
• Limiting the intake of alcohol
• Wearing protective clothing during exposure to industrial chemicals and dust
• Good oral hygiene
• Timely visits to a doctor for difficulty breathing or hoarseness.

Treatment is more effective with early diagnosis.

Frequently Asked Questions (FAQ)

Is Subglottic Cancer common?

No. It is the rarest form of laryngeal cancer; it accounts for a minority of cases.

Why does it tend to be diagnosed late?

In the early stages, cancer usually causes few symptoms because it develops below the vocal cords and does not affect the voice.

What is the first symptom?

Difficulty breathing or noisy breathing (stridor) can be one of the earliest signs, though some people might initially experience hoarseness if the tumor grows into the vocal cords.

Is Subglottic Cancer Curable?

Yes, in the early stages, it can be successfully treated with surgery, radiation, or a combination of both. In advanced stages, multimodality therapy might be needed.

Do I have to undergo a tracheostomy procedure permanently?

No. The tracheostomy procedure is needed only in certain cases, such as airway obstruction or extensive surgery.

Does smoking affect the risk?

Yes. Smoking is the main preventable cause of subglottic cancer. Stopping smoking can reduce the chance of developing other cancers.

Why chooseTender Palm Super-Speciality Hospital for Subglottic Cancer Treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Subglottic Cancer treatment in Lucknow, India, at an affordable cost. We have a team of experienced head and neck surgeons and oncology specialists who provide accurate diagnosis and both non-surgical and surgical treatment options including surgical resection, radiation therapy, and chemotherapy. Our Head and Neck Surgery and Oncology team has decades of experience in successfully treating Subglottic Cancer in Lucknow, India.

To seek an Expert consultation for Subglottic Cancer Treatment in Lucknow, India:

Call us at +91-9076972161
Email at care@tenderpalm.com

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