Laryngeal Cancer

Laryngeal cancer is a disease where cancer cells grow uncontrollably in the larynx, the voice box in your throat that helps you speak, breathe, and swallow. While symptoms like hoarseness can be easy to mistake for a common cold, understanding the signs and treatment options is crucial for early detection and better outcomes.

Table of contents

• What is laryngeal cancer?
• The larynx and its parts
• How common is laryngeal cancer?
• Symptoms of laryngeal cancer
• Causes and risk factors
• How laryngeal cancer is diagnosed
• Treatment options
• Living with laryngeal cancer

What is laryngeal cancer?

Laryngeal cancer is a disease where malignant (cancerous) cells form in the tissues of the larynx, which is part of your throat^[1]. The larynx is your voice box, and it helps you speak, breathe, and swallow. It contains your vocal cords, which vibrate and make sound when air passes through them^[3].

Cancer affecting your larynx happens when cells grow uncontrollably in this area. As these cancerous cells multiply, they invade nearby tissues and can damage your body. The cancer can spread to nearby areas such as the thyroid, windpipe (trachea), or food pipe (esophagus), and can also spread to lymph nodes in the neck or to other parts of the body^[1][3].

Most laryngeal cancers form in squamous cells, which are the thin, flat cells that line the inside of the larynx^[3]. Laryngeal cancer is part of a group of head and neck cancers^[2].

• Larynx (voice box)
• Throat
• Vocal cords
• Trachea (windpipe)

The larynx and its parts

The larynx is a tube-shaped structure in your throat that sits between the base of your tongue and your windpipe. It is about 5 centimeters (2 inches) long and is made up of cartilage, connective tissue, and muscles^[7].

Laryngeal cancer can form in any of the three main parts of the larynx^[1]:

• Supraglottis (upper part): This is the upper part of the larynx above the vocal cords, including a flap of movable cartilage called the epiglottis. More than one in three laryngeal cancers (35%) start here^[1][3].
• Glottis (middle part): This is the middle part of the larynx where your vocal cords are located. More than half of laryngeal cancers (60%) start here. The vocal cords are two bands of muscle on each side of the opening to the windpipe^[1][7].
• Subglottis (lower part): This is the lower part of the larynx between the vocal cords and the windpipe. About 5% of laryngeal cancers — 1 in 20 — start here^[1].

The larynx plays an important role when you breathe, swallow, and speak. It helps keep food and fluids from entering the windpipe^[7].

How common is laryngeal cancer?

Laryngeal cancer is part of a group of head and neck cancers. It accounts for one-third of all head and neck cancers and poses a significant global health concern^[2].

Every year, approximately 12,500 people in the United States are diagnosed with laryngeal cancer. About 4,000 people die from it each year^[1].

Symptoms of laryngeal cancer

It’s easy to mistake the first signs of laryngeal cancer for other conditions like a cold. The most common symptom is hoarseness that doesn’t improve after a few weeks^[1].

If you experience the following symptoms, talk to a healthcare provider for an accurate diagnosis^[1][3]:

• Sore throat or cough that doesn’t improve or go away
• Voice changes, such as hoarseness, that don’t improve after two weeks
• Pain or other difficulties when you swallow
• Lump in your neck or throat
• Trouble making voice sounds
• Ear pain

If you have these symptoms, seek medical attention right away^[1]:

• Trouble breathing
• Breathing that’s noisy and high-pitched (called stridor)
• The feeling that something’s in your throat
• Coughing up blood

Causes and risk factors

Some forms of HPV (human papillomavirus), a sexually transmitted infection, can cause laryngeal cancer^[1].

Smoking or using other tobacco products greatly increases your risk of developing laryngeal cancer. Drinking alcohol, especially a lot of it (more than one drink daily), also raises your risk. Using alcohol and tobacco together increases your risk even more^[1][3].

Other risk factors for laryngeal cancer include^[1]:

• Age: Laryngeal cancer happens more often in people age 55 and older
• Sex: Men are about five times more likely to develop this cancer, possibly because smoking and heavy alcohol use happen more among this group
• History of head and neck cancer: About 1 in 4 (25%) people who have had head and neck cancer will get it again
• Job exposures: People exposed to certain substances at work are at higher risk. These substances include sulfuric acid mist, wood dust, nickel, asbestos, or chemicals from manufacturing mustard gas. People who work with machines are also at higher risk

How laryngeal cancer is diagnosed

A healthcare provider will ask you about your symptoms and medical history. They’ll do a physical exam, examining your throat and neck. After the initial exam, you’ll most likely need other tests to confirm a diagnosis^[1].

Tests that examine the throat and neck are used to help diagnose and stage laryngeal cancer. Your doctor may perform the following tests^[3]:

• Physical exam of the throat and neck: The doctor will feel the inside of your mouth with a gloved finger and examine your mouth and throat with a small long-handled mirror and light. The neck will be felt for swollen areas
• Imaging scans: CT or MRI scans provide detailed images of the inside of your body^[1]
• Laryngoscopy: A procedure to look at your larynx using a special instrument. This may be done with a mirror or with a thin tube with a light and lens^[2]
• Biopsy: A procedure where a small sample of tissue is removed and examined under a microscope to check for cancer cells^[2]

Treatment options

The treatment you have will depend on the size and type of laryngeal cancer, where it is located, if it has spread, and your general health^[9]. Laryngeal cancer is often treatable, especially when found early^[2].

A team of doctors and other health professionals will discuss the best treatment and care for you. This team is called a multidisciplinary team (MDT)^[14].

Treatment may include one or more of the following^[9]:

Surgery

Surgery is often the main treatment for laryngeal cancer, especially if the cancer is found early^[9][2]. There are several types of surgery used to treat laryngeal cancer, depending on how far it has spread.

Surgery might include removing all or part of your voice box using different techniques. One type is called transoral surgery, which means surgery through the mouth to reach the cancer. Another type is open surgery, which means you have a cut in your neck or jaw^[14].

You may need to have some lymph nodes removed, which are small glands that are part of the body’s immune system^[9].

If you have part or all of your larynx removed, recovery can take a long time. You may need a hole in your neck called a stoma, which you will breathe through^[9]. You’ll be supported through surgery and recovery by your specialist treatment team, and you’ll have support to help you speak or communicate after surgery.

Radiotherapy

Radiotherapy uses high-energy rays of radiation to kill cancer cells^[9]. You may have radiotherapy for laryngeal cancer to treat early cancer, usually with chemotherapy, or to help control and improve the symptoms of advanced cancer.

Chemotherapy

Chemotherapy uses medicines to kill cancer cells^[9]. You may have chemotherapy for laryngeal cancer with radiotherapy (called chemoradiotherapy) as the main treatment, before surgery to help make the cancer smaller, after surgery to help stop the cancer from coming back, or if the cancer is advanced, has come back, or has spread to other parts of your body.

Targeted medicines and immunotherapy

Targeted medicines and immunotherapy aim to stop the cancer from growing and help your immune system attack the cancer^[9]. You might have treatment with targeted medicines or immunotherapy if the cancer has spread to another part of the body, if the cancer cannot be cured, or to lower the risk of the cancer coming back after surgery.

Advanced cancer

If you’ve been diagnosed with advanced laryngeal cancer, it may be hard to treat and not possible to cure. The aim of treatment will be to slow down the growth and spread of the cancer, to help with the symptoms, and help you live longer^[9].

You’ll be referred to a team of doctors and nurses called a symptom control team or palliative care team. They will help you to manage your symptoms and make you feel more comfortable^[9].

Living with laryngeal cancer

Living with laryngeal cancer and adjusting to life after treatment is different for each person, depending on the stage of the cancer, the type of treatment, and many other factors^[19].

Living with a tracheostomy

After surgery, some people will have a tracheostomy, which is an opening (stoma) created in the windpipe through the front of the neck. After this procedure, people breathe through the opening in the neck^[19].

People who have a partial removal of the larynx may have a temporary tracheostomy. People who have a total removal of the larynx will have a permanent tracheostomy^[19].

Living with a tracheostomy may be frightening at first. However, most people adapt to it and live normally with it. It takes time and patience to learn the new skills needed to care for the tracheostomy. Specially trained healthcare professionals teach people how to care for it after surgery^[19].

Speech problems

Surgery or radiation therapy for laryngeal cancer can cause problems with speech. People who have a partial removal of the larynx or radiation therapy may experience hoarseness or weakness of voice. People who have a total removal of the larynx cannot speak using their vocal cords and must learn new ways of speaking^[19].

A speech therapist (also called a speech-language pathologist) can help you deal with changes in your voice and learn to speak again^[19].

Swallowing problems

Surgery or radiation therapy for laryngeal cancer can cause problems with swallowing. A speech therapist can help you with swallowing problems^[19].

Self-esteem and body image

How a person feels about themselves is called self-esteem. Body image is how a person sees their own body. Laryngeal cancer and its treatments can affect a person’s self-esteem and body image^[19].

This is often because cancer or cancer treatments may result in body changes, such as voice changes, a tracheostomy tube, loss of the ability to speak and communicate as before, skin changes, scars, or hair loss. Some of these changes can be temporary. Others will last for a long time or be permanent^[19].

Some people who have a total removal of the larynx may feel embarrassed about the stoma, which can affect self-confidence and cause emotional distress. The doctor, nurse, and speech therapist can give information and support^[19].

Coping with emotions

Coping with laryngeal cancer and the changes caused by treatment can be difficult. You might have a number of different feelings when you’re told you have cancer, including shock, upset, fear, confusion, anger, sadness, or feeling numb^[23].

You may have some or all of these feelings. Or you might feel totally different. You may feel them a few at a time or altogether. Everyone reacts in their own way. You need to do what’s right for you to help you cope^[23].

Talking to your friends and relatives about your cancer can help and support you. You might also find it easier to talk to someone other than your own friends and family, such as a specialist nurse or counsellor^[23].

You’ll have regular check-ups during and after any treatments. You may also have tests and scans. If you have any symptoms or side effects that you’re worried about, talk to your specialists. You do not need to wait for your next check-up^[9].