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Laryngeal Cancer

By

Bradley A. Schiff

, MD, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine

Last full review/revision Feb 2020| Content last modified Feb 2020
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Laryngeal cancer is cancer originating in the larynx, also known as the voice box.

  • 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 uppermost portion of the windpipe (trachea) and the vocal cords.

Locating the Larynx

Locating the Larynx

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 people 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 people 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

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

Cancers originating in other parts of the larynx develop more slowly and first cause symptoms other than hoarseness, such as

  • Weight loss

  • Throat pain

  • Ear pain

  • "Hot potato" voice (speaking as if a hot object is being held in the mouth)

  • Difficulty swallowing or breathing

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 diagnose laryngeal cancer, 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 to determine how far the cancer has spread, including a

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 45% 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 30%.

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 microsurgery over radiation therapy, because it can be as effective and, unlike radiation, can be completed in a single treatment. Microsurgery uses a laryngoscope (flexible viewing tube) that has either instruments or a high-energy beam of light (a laser beam) attached to it. Unlike traditional surgery using a scalpel that can affect the person's voice, microsurgery causes fewer problems with swallowing and speech.

Moderate-stage cancer treatment

For larger laryngeal tumors that may have spread slightly into nearby tissues, doctors may use radiation therapy combined with chemotherapy (called chemoradiation) 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 chemoradiation therapy.

Advanced-stage cancer treatment

If laryngeal cancer has spread to the bone or cartilage, doctors usually prefer using surgery to remove part or all of the larynx and vocal cords, called a partial or total laryngectomy, followed by radiation therapy and sometimes 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.

Surgery, other treatments, and the tumor itself may affect 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 tissues affected, reconstructive surgery may be done.

Speech Without Vocal Cords

Speech requires a source of sound waves (vibrations) and a means of shaping those vibrations into words. The vocal cords normally provide the vibrations, which are then shaped into words by the tongue, palate, and lips. People whose vocal cords have been removed can regain their voice if a new source of sound vibrations can be provided because their tongue, palate, and lips remain able to shape these new vibrations into words.

There are three ways that people with no larynx can produce sound vibrations. In all three techniques, sound changes into speech through the throat (pharynx), palate, tongue, teeth, and lips.

Esophageal speech

  • No surgery or mechanical accessories required

  • Person taught to swallow air into the esophagus (pathway from the throat to the stomach) and expel the air (as in a belch) to produce a sound

  • Difficult to learn and may be hard for other people to understand

Tracheoesophageal puncture

  • One-way valve inserted in surgically created hole between the windpipe (trachea) and the esophagus

  • Air enters the windpipe (trachea) through an opening in the front of the neck (stoma)

  • Speech produced with air diverted into the esophagus through the valve while the person exhales

  • Requires significant practice and training

  • Often eventually produces easy and fluent speech

  • Valve requires daily cleaning and needs to be replaced after many months

  • With some valves, person must block the opening in the windpipe with a finger to speak

  • Risk of fluids or food accidentally entering the windpipe if the valve malfunctions

Electrolarynx

  • Battery-powered vibrating device that acts as a sound source when held against the neck

  • Produces an artificial, mechanical sound

  • Easier to use and understand than esophageal speech

  • Requires batteries and must be carried with the person

  • Requires little or no training

  • Can carry a great deal of social stigma for many people

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