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Laryngeal Cancer

By Bradley A. Schiff, MD

  • Laryngeal cancer is located in the voice box or surrounding structures.

  • People may be hoarse or have a lump in the neck or difficulty breathing or swallowing.

  • A biopsy is needed for diagnosis.

  • The prognosis depends on how advanced the cancer is.

  • Treatment is usually with surgery and/or radiation therapy, but sometimes chemotherapy is also used.

The larynx is the voice box, which includes the vocal cords. Laryngeal cancers include cancers that occur in the voice box, vocal cords, and the surrounding structures.

Most laryngeal cancers are squamous cell carcinomas, which means the cancer develops in the squamous cells that line the larynx. Laryngeal cancer is a common cancer within the head and neck and is more common among men than women. Most men with laryngeal cancer are over 60 years of age. Smoking is the biggest risk factor, with over 95% of affected people being smokers. Abuse of alcohol also increases risk. The number of men who develop laryngeal cancer is decreasing most likely because of changes in smoking habits.

Cancers of the vocal cords usually cause symptoms earlier, spread less, and are cured more often than cancers of other parts of the larynx.

Did You Know?

  • A person who has been hoarse for more than 2 to 3 weeks should be checked by a doctor.

Symptoms

This cancer commonly originates on the vocal cords or the surrounding structures and often causes hoarseness. A person who has been hoarse for more than 2 to 3 weeks should seek medical attention.

Cancer in other parts of the larynx can cause weight loss, throat pain, ear pain, "hot potato" voice (speaking as if a hot object is being held in the mouth), and difficulty swallowing or breathing or a combination.

Sometimes, however, a lump in the neck resulting from the cancer's spread to a lymph node ( metastasis) may be noticed before any other symptoms.

Diagnosis

  • Laryngoscopy

  • Biopsy

  • Imaging tests for staging

To make the diagnosis, a doctor initially examines the larynx with a thin, flexible viewing tube used for direct viewing of the larynx ( laryngoscope) and removes a tissue sample for examination under a microscope ( biopsy). A biopsy is most often done in the operating room with the person under general anesthesia. If cancer is present, the person also may undergo staging tests, including a chest x-ray, a computed tomography (CT) scan of the neck and chest, and a positron emission tomography (PET) scan, to determine how far the cancer has spread.

Prognosis

The larger the laryngeal cancer is and the more it has spread, the worse the prognosis. If the tumor also has invaded muscle, bone, or cartilage, cure is less likely. About 85 to 95% of people with small vocal cord cancers that have not spread anywhere (metastasized) survive for 5 years, compared with fewer than 50% of those who have laryngeal cancers that have spread to the local lymph nodes. For people who have cancers that have spread beyond the local lymph nodes, the chance of surviving longer than 5 years is about 35%.

Treatment

  • Surgery

  • Radiation therapy

  • Chemotherapy

Treatment of laryngeal cancer depends on the stage and the precise location of the cancer.

Early-stage cancer treatment

For early stage cancer, doctors may use either surgery or radiation therapy. When the vocal cords are affected, doctors may prefer radiation therapy over surgery because it may preserve the person's normal voice. However, for very early-stage laryngeal cancers, doctors may prefer laser microsurgery over radiation therapy, because it can be as effective and, unlike radiation, can be completed in a single treatment. Laser microsurgery uses a high-energy beam of light (a laser beam) as a precision cutting tool. Unlike traditional surgery using a scalpel that can affect the person's voice, laser surgery does not usually harm the person's voice. For larger laryngeal tumors, using a laryngoscope to remove the tumor has gained in popularity and is a viable alternative to radiation. This method reduces swallowing and speech problems compared to surgery done through a neck incision.

Moderate or advanced stage cancer treatment

If the cancer has spread to the bone or cartilage, doctors usually prefer using combination therapy. One combination consists of surgery to remove part or all of the larynx and vocal cords, called a partial or total laryngectomy, followed by radiation therapy. If the cancer has only spread into the bone or cartilage slightly, doctors may use radiation therapy with chemotherapy instead of surgery, which can be as effective while having less of an impact on the person's voice. However, surgery still may be required to remove any cancer that remains after the combined radiation therapy and chemotherapy. If the cancer is too advanced for surgery or radiation therapy, chemotherapy can help reduce the pain and the size of the tumor but is unlikely to provide a cure.

Side effects of treatment

Surgical or nonsurgical treatment almost always has significant side effects. Radiation may cause skin changes (such as inflammation, itching, and loss of hair), scarring, loss of taste, dry mouth, and, occasionally, destruction of normal tissues. People whose teeth will be exposed to the radiation treatments must have dental problems corrected and any unhealthy teeth removed prior to radiation treatment, because radiation makes any subsequent dental work more likely to fail and severe infections of the jawbone may occur. Chemotherapy typically causes a variety of side effects, depending on the drug used. These side effects may include nausea, vomiting, hearing loss, and infections. Treatment often affects swallowing and speaking. In such cases, rehabilitation is necessary. A number of methods have been developed that allow people without vocal cords to speak (see Speech Without Vocal Cords), often with good results. Depending on the specific tissue removed, reconstructive surgery may be done.

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