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The larynx is the voice box. Laryngeal cancers include cancers that occur in the voice box, vocal cords, and the surrounding structures.
Squamous cell carcinoma (see Mouth and Throat Cancer) is the most common cancer of the larynx. Laryngeal cancer, a common area of cancer within the head and neck, is more common among men than women. Most men are over 60 years of age. Smoking is the biggest risk factor. Over 95% of affected people are smokers. Abuse of alcohol also increases risk. The number of people, particularly men, who develop laryngeal cancer is decreasing most likely because of changes in smoking habits.
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 in 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.
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, people also may undergo a computed tomography (CT) scan of the neck and a chest x-ray or CT scan of the chest. A positron emission tomography (PET) scan also may be done. CT and PET are used for staging the cancer (see Symptoms and Diagnosis).
The larger the cancer 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 cancers that have not spread anywhere (metastasized) survive for 5 years, compared with fewer than 50% of those who have cancer that has 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 2 years is poor.
Treatment depends on the stage and the precise location of the cancer within the larynx.
For early-stage cancer, doctors may use either surgery or radiation therapy. When the vocal cords are affected, radiation therapy may be preferred over surgery because it may preserve a more normal voice. However, for very early-stage cancers of the larynx, microsurgery done through a laryngoscope, sometimes using a laser, provides identical cure rates with equal preservation of the voice and can be completed in a single treatment. Using a laryngoscope to remove a laryngeal tumor has gained in popularity and is a viable alternative to radiation for larger tumors as well. Using an endoscope to remove cancer reduces swallowing and speech problems compared to surgery done through a neck incision.
Tumors that have invaded bone or cartilage are usually treated with 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. Radiation therapy is also commonly combined with chemotherapy as the primary treatment for advanced laryngeal cancers. This treatment provides cure rates equivalent to the surgery and radiation combination (provided the tumor has only minimally invaded the cartilage and bone) and preserves the voice in a significant number of people. However, surgery still may be required to remove any cancer that remains after this treatment. 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.
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 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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