(See also Overview of Mouth, Nose, and Throat Cancers.)
The larynx is the voice box, which includes the uppermost portion of the windpipe (trachea) and the vocal cords.
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.
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
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
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 of laryngeal cancer depends on the stage and the precise location of the cancer.
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.
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.
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.
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.