The above pictures show cancer of the voice box.  The picture on the left is a cancer of the epiglottis or top of the voice box.  The middle picture is a cancer of the true vocal cords and the picture on the far right is a cancer of the sub-glottis or below the vocal cords.
Search barnesandnoble.com for Quitting Smoking  for larynx Cancer       
Excellent Book: Living With The End In Mind     Search PubMed for Larynx Cancer

Sometimes the cancer requires removing the voice box in a procedure called a laryngectomy. In this procedure the food tube or esophagous is separated from the airway and the wind pipe is brought out through the neck. The patient on the right had a laryngectomy to treat a recurrent cancer after radiation therapy
Mouse over the picture to see his stoma!!!
 
 

Somerset is located in south central Kentucky, in the hills of Appalachia.  Since my practice started in Somerset, I have evaluated 68 patients with invasive cancer (squamous cell carcinoma) of the voice box (larynx).  65 patients smoked.  64 patients had a 20 pack year, or greater, history of smoking (smoking 1/2 pack per day for 40 years).  Two patients had severe GE Reflux and in one patient the cause of the cancer was unknown.

The average age was 64 years.  The average length of smoking was 61 pack years. (A pack year is one pack per day smoked in one year, or one-half pack per day smoked over two years.)  14 patients had quit smoking.  Four patients had quit more than 25 years prior to developing the cancer.  Exposure to the carcinogens in tobacco can cause permanent genetic damage in the cells and tumors can develop years later.  Fifteen of these patients were treated with a total laryngectomy, or had to have their voice box removed. 

The picture on the left shows a T1 squamous cell carcinoma of the vocal cord in a patient who had a 35 pack year history of smoking.  The picture to the far right shows the immediate post-operative appearance of the vocal cords after surgical biopsy and removal of the leukoplakia.  This patient will be treated with full course radiation therapy and should have greater than a 90% chance of cure.    
   
Shown below are the pre and post biopsy views of a patient with two T1 squamous cell carcinomas of the true vocal cords.  The patient was treated with vocal cord stripping and  radiation therapy.
    

 
How Fast Can A Cancer Grow ?? 

If you are hoarse for more than four weeks, you definitely need to have your voice box (larynx) examined by a doctor.  Cancers usually grow slowly, but can sometimes grow fast.  Below are five pictures of a patient who is five years status post-radiation therapy for laryngeal cancer.  The two pictures on the left show an absence of a mass in the voice box.  The three on the right were taken one month later and show that a large tumor has developed, possibly arising from his lower throat (hypopharynx). Click On Pictures To Enlarge
  
          

Distribution of the Number of Pack Years Smoked to the Development of Laryngeal Cancer in 65 Patients, All of Whom Were Smokers.

In the group of smoking patients only one had less than a 20 pack year history of smoking.  This patient had a 5 pack history.  One can achieve a 20 pack year history by smoking 20 packs per day for 40 years.  Thus, if someone smokes more a half a pack per day or more he will have an far greater chance of developing cancer.