Symptoms - Hoarseness

Hoarseness is a term that refers to any weakening or altering of the voice. Hoarseness is a common symptom in lung cancer patients, although it can be caused by other conditions as well. Speech originates from the voice box, or larynx, which is located in the throat. The larynx can become inflamed (laryngitis) due to infections or overusing the voice (for example, prolonged shouting, speaking or singing).

Lung cancer patients may experience an infection as a side effect of chemotherapy. Hoarseness can also occur due to cancer in the larynx (larynx cancer, different than lung cancer), which is most often caused by tobacco use.

What causes hoarseness?

The majority of hoarseness experienced by lung cancer patients is the result of recurrent laryngeal nerve palsy (paralysis or weakness in that nerve). The recurrent laryngeal nerve controls the action of the larynx and is split into a left and right nerve. The recurrent laryngeal nerve has an indirect route through the body, with the left passing through the chest cavity close to the left lung. Tumors in the left lung can press on the nerve, causing hoarseness, or recurrent laryngeal nerve palsy. Although less common, right lung tumors can also cause recurrent laryngeal nerve palsy.^1,2

There are several factors that increase the risk of developing hoarseness in the general public, including:

• Tobacco smoking
• Gastroesophageal reflux (GERD)
• The use of the voice in certain professions such as teachers, actors, and singers
• Environmental issues, such as poor acoustics (necessitating shouting), atmospheric irritants (pollution), and low humidity^3,4

In lung cancer patients, hoarseness is more common in those with tumors to the left lung (due to the location of the left recurrent laryngeal nerve) and those who also have larynx cancer.^1,2

Evaluating voice hoarseness

Hoarseness can be evaluated using a nasopharyngolaryngoscopy (NPL). This procedure involves threading a thin tube into the throat allowing the doctor to view the larynx. Local anesthetic is used to numb the area.¹

How to manage voice hoarseness

Treating hoarseness involves treating the underlying cause of the symptom. In cases of infection, the bacteria or fungus can generally be treated with medications. If hoarseness is due to a tumor in the lung pressing on the recurrent laryngeal nerve, cancer treatment that targets the tumor can help. In addition, there are several surgical procedures that can be used to counter the effects of the recurrent laryngeal nerve palsy.¹

Recurrent laryngeal nerve palsy causes dysfunction in the vocal cords, interrupting their ability to completely close and create proper sounds. An ENT specialist (ear, nose, throat specialist) can insert an implant into the larynx to help push the dysfunctional cords back together. Different materials may be used for this procedure, such as fat, collagen, or a gel.¹

In addition to hoarseness, other symptoms of lung cancer include:

• Persistent coughing
• Wheezing
• Shortness of breath
• Chest pain
• Weight loss
• Loss of appetite
• Fatigue or feeling weak
• Respiratory infections (like bronchitis or pneumonia) that don’t go away or keep returning⁵