Head and Neck Oncology TOC

Leukoplakia of the larynx

Q: I have been told that I have "leukoplakia, larynx," but I can't find any info about it. Any information you could give me would be appreciated.

A: Leukoplakia is a descriptive term, meaning "white plaque." It is not a diagnosis. This is kind of like going to your doctor because you are having pain (pick a body part), only to be told that you have "neuralgia", which means PAIN. Sounds better than "pain," but there is very little information content in the word "neuralgia."

"Larynx," of course, is the anatomical term for the voice box. "Leukoplakia of the larynx" usually means that you have one or more white patches on your vocal cords. Under the microscope, leukoplakia looks a bit like skin. In response to chronic irritation, the normally-thin mucosa lining the vocal cords gets thicker. Think of it as a callus. To the naked eye, this thick area looks like a white plaque... hence, leukoplakia.

Leukoplakia may or may not indicate cancer of the vocal cords. The only way to know for sure is to have a biopsy of the white plaque, and this can only be done under general anesthesia, by a procedure known as "direct laryngoscopy." Ear, nose and throat doctors (ENTs) are extremely competent in this procedure.

You may have already had such a biopsy. If this biopsy did not demonstrate a cancer, then you can breathe a LITTLE easier. You are still not off the hook. Chances are, you developed leukoplakia because of a lengthy smoking history. Leukoplakia is your larynx’ way of telling you that it is chronically inflamed due to all of the cigarette smoke. Might not be a cancer now, but give it time... In any event, you need to quit smoking, and your ENT needs to examine your vocal cords on a regular basis to monitor you for the development of more serious lesions.

Occasionally, nonsmokers can develop leukoplakia. In these individuals, the leukoplakia is usually related to gastroesophageal reflux disease (GERD). Leukoplakia in GERD patients is much less worrisome than in smokers; nevertheless, your physician must consider carefully whether to recommend a biopsy under general anesthesia, or, instead, to recommend observation (with aggressive treatment of GERD.)

Needless to say, you ought to be asking your doctor these questions. Any doctor worth his/her fee should gladly discuss with you the diagnosis and treatment of this condition. Always remember that your doctor needs you more than you need your doctor (there are plenty of other docs out there!)

This letter originally appeared in Dr. Hoffman's column on allHealth.com.

About GERD (Gastroesophageal Reflux Disease)
Douglas Hoffman, MD, PhD, March 1999

GERD occurs when stomach acid and digestive enzymes travel up your esophagus into your throat. While the stomach lining is adapted to withstand digestive enzymes and acid, the tissues of your throat and larynx (voice box) are not so blessed. Damage to these tissues results in the symptoms of GERD: hoarseness, chronic cough, chronic sore throat, a sensation of mucus or a tickle in the back of the throat, or difficulty swallowing. If you have any of these symptoms, you may have GERD. You may also experience classic heartburn, but many GERD patients do not have heartburn.

Although medication can help control GERD, you will need to make several changes in your daily habits in order to best address this condition. (These can be summarized briefly as: join a monastery or nunnery!)

1. Allow at least 3 hours to pass between your last meal and bedtime. You may drink water before bedtime, but you should not eat or drink anything else.

2. Make your midday meal your "big meal of the day." That way, you should be satisfied with a lighter-than-usual evening meal. Try to make your evening meal as low in fat as possible, and try to reduce the fat in your diet over all.

3. Certain foods and drugs encourage the development of GERD. These should be avoided altogether, or at the very least, you should avoid them in the evening. You should avoid:

Caffeinated drinks (coffee, tea, caffeinated soft drinks)
Chocolate and mints
Alcohol and tobacco

4. If you are overweight, losing weight will reduce or eliminate your problems with GERD.

5. Elevate the head of your bed 4 to 6 inches by placing blocks under the headboard. The idea is to place your head above your stomach (make gravity work for you!) Do not try to do this by sleeping on multiple pillows; this will only flex your neck and will not help your GERD one bit.

6. Take the medicines that you have been prescribed. Do not increase or reduce the dose without discussing this change with your doctor.

7. BE PATIENT. Your problems have developed over weeks, months, perhaps even years. There are no quick fixes for chronic problems. It may take at least two to three months of medication and lifestyle changes to eliminate your symptoms. No one ever said this would be easy.