Laryngeal Squamous Cell Carcinoma

Laryngeal squamous cell carcinoma is the most common type of cancer affecting the voice box, accounting for the vast majority of laryngeal cancers. This disease develops when thin, flat cells lining the inside of the larynx begin to grow uncontrollably, potentially affecting your ability to speak, breathe, and swallow.

Table of contents

• What is laryngeal squamous cell carcinoma?
• Understanding the larynx
• What causes this cancer?
• Signs and symptoms
• How is it diagnosed?
• Treatment options
• Outlook and survival

What is laryngeal squamous cell carcinoma?

Laryngeal squamous cell carcinoma is a cancer that forms in the tissues of the larynx, commonly called the voice box. Most laryngeal cancers are squamous cell carcinomas, which means they begin in flat, thin cells called squamous cells that cover the inside of the larynx^[1][2]. These cells are part of the lining that protects the larynx.

squamous cell carcinoma of the larynx, laryngeal cancer

When cancer develops, cells in the larynx start to grow uncontrollably. As these cancerous cells multiply, they invade nearby tissues and can damage your body^[1]. Laryngeal cancer is part of a larger group of head and neck cancers^[1].

In the United States, approximately 12,500 to 13,000 people are diagnosed with laryngeal cancer each year, with about 3,900 to 4,000 deaths annually^[1][7]. This represents about one-third of all head and neck cancers^[4]. Men are about five times more likely to develop this cancer than women, possibly because smoking and heavy alcohol use are more common among men^[1].

Understanding the larynx

• Larynx (voice box)
• Vocal cords
• Epiglottis
• Trachea (windpipe)
• Pharynx (throat)

The larynx is part of your respiratory system and sits in your throat, between the base of your tongue and the windpipe. It is about 5 centimeters (2 inches) long and helps you breathe, swallow, and speak^[3]. The larynx contains the vocal cords, which are two bands of muscle that vibrate to make sound when air passes through them^[1].

The larynx is divided into three main parts, and cancer can develop in any of these areas^[1][3]:

• Supraglottis (upper part): The area above the vocal cords, including the epiglottis, a flap of cartilage that protects the opening to the windpipe. About 35% of laryngeal cancers start here^[1].
• Glottis (middle part): The area where the vocal cords are located. More than half of laryngeal cancers, about 60%, start here^[1].
• Subglottis (lower part): The area below the vocal cords, between the vocal cords and the windpipe. Only about 5% of laryngeal cancers start in this location^[1].

The supraglottic area has many lymphatic vessels, which are part of the body’s drainage system. Because of this, cancers starting in the supraglottis commonly spread to lymph nodes in the neck. About 25% to 50% of people with supraglottic cancer have lymph node involvement when they are diagnosed^[7].

In contrast, the true vocal cords have no lymphatic vessels. This means that cancer confined to the vocal cords rarely spreads to lymph nodes^[7]. However, if the cancer extends above or below the vocal cords, lymph node involvement becomes more likely.

What causes this cancer?

Some forms of HPV (human papillomavirus), a sexually transmitted infection, can cause laryngeal cancer^[1]. However, the most important risk factors are tobacco use and alcohol consumption.

There is a clear link between smoking, excessive alcohol use, and the development of squamous cell cancers in the upper parts of the breathing and swallowing passages^[7]. Smoking or using other tobacco products greatly increases your risk of developing laryngeal cancer. Drinking alcohol, especially more than one drink daily, also raises your risk. Using both alcohol and tobacco together increases your risk even more^[1].

For people who smoke, the risk of laryngeal cancer decreases after they stop smoking, but it remains higher than in people who never smoked, even years later^[7].

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

• Age: Laryngeal cancer is more common in people age 55 and older.
• History of head and neck cancer: About 1 in 4 people who have had head and neck cancer will develop it again.
• Occupational exposure: People exposed to certain substances at work are at higher risk. These include sulfuric acid mist, wood dust, nickel, asbestos, or chemicals used in manufacturing mustard gas. People who work with machines are also at increased risk.

Signs and symptoms

It is easy to mistake the first signs of laryngeal cancer for other conditions, like a cold or throat infection. The most common symptom is hoarseness or voice changes that don’t improve after a few weeks^[1].

The symptoms you experience depend on where the cancer is located. Cancers in the supraglottis typically cause sore throat, painful swallowing, ear pain that seems to come from inside the ear, changes in voice quality, or swollen lymph nodes in the neck. Early cancers in the vocal cords are usually detected because of hoarseness. Cancers in the subglottis are rare, and by the time they are found, they commonly involve the vocal cords^[7].

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

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

Some symptoms require immediate medical attention^[1]:

• Trouble breathing
• Noisy, high-pitched breathing
• The feeling that something is stuck in your throat
• Coughing up blood

How is it diagnosed?

A healthcare provider will ask you about your symptoms and medical history. They will examine your throat and neck, feeling for any unusual lumps or swelling^[1]. After the initial exam, you will most likely need additional tests to confirm a diagnosis.

Diagnostic tests may include^[1]:

• Imaging scans: CT (computed tomography) or MRI (magnetic resonance imaging) scans provide detailed pictures of the inside of your body. These tests help doctors see the size and location of the cancer and whether it has spread.
• Laryngoscopy: A procedure where a doctor uses a special tube with a light and camera to look at your larynx. This can be done through your mouth or through a small cut in your neck.
• Biopsy: During a laryngoscopy, the doctor may take a small sample of tissue from the larynx. This tissue is examined under a microscope to check for cancer cells. A biopsy is the only way to confirm that cancer is present.
• Fine-needle aspiration: If you have swollen lymph nodes in your neck, the doctor may use a thin needle to remove cells from the node. These cells are examined to see if the cancer has spread.

Once laryngeal cancer is diagnosed, doctors will determine the stage of the cancer. Staging describes how much cancer is in the body and where it is located. The stage affects your treatment options and outlook. Doctors use the results of exams, imaging tests, and biopsies to stage the cancer^[7].

Treatment options

Treatment for laryngeal squamous cell carcinoma depends on several factors, including the size and location of the cancer, whether it has spread, and your general health^[8][13]. The main goals of treatment are to remove or destroy the cancer while preserving as much of your ability to speak, swallow, and breathe as possible.

The specialist care team looking after you will explain the different treatment options, their benefits, and possible side effects. They will work with you to create a treatment plan that is best for you^[8]. Your team may include surgeons, oncologists who specialize in radiation or chemotherapy, speech and language therapists, dietitians, and specialized nurses.

Surgery

Surgery is often the main treatment for laryngeal cancer, especially if the cancer is found early^[8]. There are several types of surgery^[10]:

• Transoral surgery: Surgery performed through the mouth to reach and remove the cancer. This may include using a laser to remove small tumors.
• Partial laryngectomy: Removal of only part of the larynx. This may preserve some ability to speak normally.
• Total laryngectomy: Removal of the entire larynx. After this surgery, you will need a permanent opening in your neck called a stoma to breathe through^[8].
• Neck dissection: Removal of lymph nodes in the neck if the cancer has spread.

If you have part or all of your larynx removed, recovery can take a long time. You will receive support from your healthcare team, including help learning to speak or communicate after surgery^[8].

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It may be used to treat early-stage cancer, either alone or combined with chemotherapy. Radiation therapy can also be used after surgery to help prevent the cancer from coming back, or to help control symptoms in advanced cancer^[8][10].

Chemotherapy

Chemotherapy uses medicines to kill cancer cells. For laryngeal cancer, chemotherapy is often given along with radiation therapy, a combination called chemoradiotherapy. This approach may be used as the main treatment to try to preserve the larynx, or it may be given before surgery to shrink the tumor^[8][10].

Targeted therapy and immunotherapy

Targeted medicines are drugs that attack specific features of cancer cells. Immunotherapy helps your immune system recognize and attack cancer cells^[8]. These treatments may be used if the cancer has spread to other parts of the body, if the cancer cannot be cured, or to lower the risk of the cancer coming back after surgery^[10].

Treatment by stage

Early-stage laryngeal cancer (stages I and II) is usually highly curable with either surgery or radiation therapy alone. These treatments often preserve the larynx^[4]. Cure rates for small cancers that have not spread to lymph nodes are very good, ranging from 75% to 95%^[7].

Late-stage disease (stages III and IV) requires more intensive treatment, often combining surgery, radiation, and chemotherapy. These cancers are associated with worse outcomes and may require removal of the larynx^[4].

Outlook and survival

The outlook for people with laryngeal squamous cell carcinoma depends on several factors. The most important are the stage of the cancer when it is diagnosed and whether it has spread to lymph nodes^[7]. Other factors that may affect prognosis include your age, overall health, and certain features of the tumor^[7].

Survival statistics from England for people diagnosed between 2014 and 2016 show^[17]:

• Stage 1: Almost 90 out of 100 people (almost 90%) survive for 5 years or more. At this stage, the cancer is only in one part of the larynx.
• Stage 2: Around 70 out of 100 people (around 70%) survive for 5 years or more. The cancer has spread to another part of the larynx but not to lymph nodes or other organs.
• Stage 3: Almost 55 out of 100 people (almost 55%) survive for 5 years or more. The cancer has grown throughout the larynx or has spread to a nearby lymph node.
• Stage 4: Almost 35 out of 100 people (almost 35%) survive for 5 years or more. The cancer may have spread outside the larynx to nearby tissues, larger or more distant lymph nodes, or other parts of the body.

If you continue to smoke and drink alcohol after being diagnosed with laryngeal cancer, your chances of being cured are reduced, and your risk of developing a second cancer is increased^[7]. Many people with this cancer also have other health problems related to smoking and alcohol use, and some die from these other conditions rather than from the cancer itself^[7].

You will have regular check-ups during and after treatment, which may include physical exams and imaging tests. If you have any symptoms or side effects that worry you, talk to your healthcare team. You do not need to wait for your next scheduled check-up^[8].

If the cancer is advanced and cannot be cured, treatment aims to slow the cancer’s growth, control symptoms, and help you live longer. You may be referred to a palliative care team or symptom control team, who specialize in helping manage symptoms and providing support for you and your loved ones^[8].