'The phlegm I wanted to get out of my throat was a laryngeal tumor'

‘The phlegm I wanted to get out of my throat was a laryngeal tumor’

A smoker for three decades, Vera Lúcia Cavalcanti de Sá, 67, had abandoned the habit six years ago when she was diagnosed with laryngeal cancer — smoking increases the risk of developing the disease by 10 times. With symptoms such as hoarseness and throat clearing, the pensioner’s condition was treated with reflux, but a few months later she received the correct diagnosis and treatment. Next, she tells her story:

“I smoked from 20 to 50, on average I smoked a pack a day, some days less, some days more — mostly on weekends or when I was stressed. At 50, I made a promise and quit the habit after one of my daughters-in-law went through a health problem.

Six years later, I presented the first symptoms of the disease, which appeared gradually. One of them was hoarseness, I noticed that my voice was getting hoarser than it already was.

I also started to have a constant feeling of throat clearing, it felt like there was slime, secretion, phlegm in my throat. I kept forcing myself to cough to try to get it out, but it didn’t come out, it was unpleasant and bothered me a lot. Also, I had four episodes of gagging.

I sought help from an otolaryngologist to see the issue of throat clearing, I did some tests, he said it was reflux, sinusitis, he recommended a medicine that I used for eight months, but I continued with the symptoms.

In February 2012, I was at a family gathering when I coughed and a phlegm of blood came out. At the time I despaired and remembered my father who died of lung cancer and had the same symptom.

I went to the nearest hospital, had several tests, including laryngoscopy, but the larynx was very obstructed. The doctor suspected the possibility of being a cancer of the larynx and wanted to admit me to do a more in-depth investigation, but I preferred to stay in another hospital that I already used to attend. There, I had a biopsy and the suspicion was confirmed: I had a stage 3 laryngeal carcinoma.

I was distressed, but at the same time I had the intuition that I was not going to die, I was sure that I was going to be cured.

Image: Personal archive

My whole family was in despair, but I told them not to cower, for them to be calm that I was going to be fine.

The next day, I was discharged and went to an oncology clinic to begin treatment. The doctor explained that the cause of my cancer was most likely because I had smoked cigarettes for many years. He said that my case was surgical, that I would have to remove the larynx and pharynx, a procedure called a total pharyngolaryngectomy.

I made the decision that my heart asked for and said I would not operate – I was 56 years old at the time, I didn’t want to mutilate myself or use a tracheostomy my whole life. My sons and daughters-in-law cried because they wanted me to operate, but they respected my choice.

A few days later, I started chemotherapy, I was hospitalized after each of the five sessions I did. Even though I felt really bad, I didn’t see chemo as something bad, on the contrary, I saw it as my cocktail of light, my cure.

Of course I was sad when my hair fell out, but I went bald, donated the wigs I got and wore scarves when I had a special appointment to complete my look.

The second stage was to perform 31 radiotherapy sessions. On the 22nd, my throat started to burn, I ran out of saliva, I had to have a gastrostomy to be able to feed by tube, but I removed it when the sessions were over.

My treatment lasted eight months, I had difficult times, but it took it lightly and today I am cured.

Vera Lúcia - Personal archive - Personal archive

Vera Lúcia with her family: in the background, with glasses and bald head during treatment

Image: Personal archive

Since I was widowed at age 41 and had to raise my three children, I have positioned myself as a warrior, brave and optimistic woman to face any adversity. The support network I had from my family and the team that took care of me was also very important.

Cancer was a desert that brought me learning and made me a better person. Tobacco is the main cause of laryngeal cancer, I knew about the harm when I smoked, but we never imagine that the worst will happen, one day the bill arrives.

I encourage people to kick this habit, to seek professional help if needed, and to have good habits. Health is our greatest treasure.”

What is laryngeal cancer

Laryngeal cancer is a disease that arises from the abnormal growth of cells in the larynx — the organ of the throat that produces the voice —, in a disorganized or accelerated way. The tumor can develop in one of three areas of the organ: supraglottis, glottis, and subglottis.

There are an estimated 184,600 new cases of laryngeal cancer annually in the world and 99,800 deaths, according to the Global Cancer observatory. In Brazil, according to Inca (National Cancer Institute), 7,650 new cases of laryngeal cancer are expected annually.

Smoking and excessive consumption of alcoholic beverages are the main risk factors for the disease. But others may be associated, such as HPV infections and gastroesophageal reflux.

Cigarette, tobacco, smoker - VioletaStoimenova/iStock - VioletaStoimenova/iStock

Smoking is one of the main risk factors for laryngeal cancer.

Image: VioletaStoimenova/iStock

The main symptoms of laryngeal cancer are sore throat, persistent hoarseness, change in voice quality, slight difficulty in swallowing and a feeling of “lump” in the throat. In advanced vocal cord injuries, even more severe difficulty swallowing, breathing, or shortness of breath may occur.

Some of these symptoms can cause confusion and lead the doctor to think that it may be laryngitis, pharyngitis and/or tonsillitis. If the symptoms persist for more than three weeks, it is essential that they are investigated, as they can be due to infections and inflammation, but they can also be from cancer.

About 30% of laryngeal cancer cases could be avoided with some behavioral changes, such as maintaining adequate body weight; do not smoke any kind of cigarette such as pipe, cigar, hookah electronic cigarette, straw cigarette; avoid the consumption of alcoholic beverages; treat gastroesophageal reflux and be up to date with the HPV vaccination.

Treatment depends on the stage (stage) of the tumor, that is, how advanced it is. In early cases, it can be treated with radiation therapy or local surgery. In more advanced cases, there are situations in which the larynx can be preserved and the patient undergoes radiotherapy along with chemotherapy. In other cases, it is not possible and may be necessary to have a total laryngectomy — which is the complete removal of the organ.

The earlier the diagnosis, the greater the chance of cure. When the disease is located in the larynx, the chance that the patient will be alive five years after treatment exceeds 80%. This rate drops to around 30% when there is distant metastasis — that is, the cancer cells have already reached other organs.

Source: Aline Lauda Chavesclinical oncologist at the Brazilian Head and Neck Cancer Group.

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