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Laryngeal cancer

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 20, 2021.

Laryngeal cancer occurs when a tumor grows in the voice box or on the vocal cords. It is treatable, especially if caught early, and there are many surgical procedures that may preserve the patient’s voice.

The larynx, also called the voice box, is located between the pharynx (cavity behind the nose and mouth) and the trachea (tube that leads to the lungs). It contains the vocal cords, also called the glottis, and several other structures called the supraglottis (which includes the epiglottis) and subglottis.

When cells in this part of the body start growing abnormally, they form growths called tumors. These tumors become laryngeal cancer.

Cancers of the larynx make up about one-third of head and neck cancers. About 13,000 cases of laryngeal cancer are diagnosed every year in the United States, according to a 2020 review in StatPearls. These cancers are more common in older males who smoke.

Causes and risk factors of laryngeal cancer

The biggest risk factor for laryngeal cancers is smoking tobacco. Smoking has been associated with the majority of cases of laryngeal cancer (70 percent to 95 percent), according to the StatPearls review.

Other factors that increase the risk of laryngeal cancer include:

  • Alcohol use: Excessive drinking
  • Age: Being older
  • Gender: Being male
  • Race: It’s more common in Black and non-Hispanic white people
  • Poor diet and vitamin deficiencies
  • Excess weight
  • Intense exposure to certain toxins

In addition to lifestyle factors, some genetic syndromes are associated with higher rates of laryngeal cancer. These include Fanconi anemia and dyskeratosis congenita.

Infection with human papillomavirus (HPV) may also be a risk factor for laryngeal cancers, though more research is being done on this connection.

HPV is the most common sexually transmitted disease in the United States, and there are several strains that are at a high risk of leading to cancer, including those of the head and neck. Not all types of HPV cause cancers, and cancers that do develop may happen years down the road from the initial infection, making it difficult to draw clear links between infection and tumors. The HPV vaccine may prevent cancer in some cases.

Having multiple risk factors—for example, smoking and drinking heavily—further increases the risk of developing laryngeal cancer.

Types of laryngeal cancer

Most laryngeal cancers form in the cells lining the larynx, called squamous cells. These are squamous cell carcinomas.

Two other, much-less common types of cancer develop in the larynx. These include:

  • Cancers that arise in the salivary glands, which make mucus and saliva to keep the throat moist
  • Sarcomas, which are cancers of cells in the connective tissue and cartilage that create the structure of the throat and support the tissues and organs of the larynx

Symptoms of laryngeal cancer

Anyone who has some risk factors for laryngeal cancer should be on the lookout for signs that may indicate a tumor on the voice box.

Laryngeal cancer symptoms include:

  • Prolonged cough, sore throat or hoarseness without cause
  • Coughing up blood
  • Problems or pain when swallowing
  • Pain in your ears
  • Lump, pain or swelling in the neck
  • Unexplained weight loss
  • Breathing that sounds high- pitched

Diagnosis of laryngeal cancer

If a patient has some of these symptoms and is in the right demographic, the doctor may be concerned about laryngeal cancer. The doctor may ask questions about symptoms, health history and family history, and perform a physical exam of the neck and mouth.

The patient may also need to see a specialist ear, nose and throat (ENT) doctor for more thorough testing. To get a better look at the larynx, the doctor may use a flexible tube with a lighted camera on the end. This is called an endoscopy or, more specifically, a laryngoscopy.

During this test, a sample of any suspicious growth may be taken. This sample, called a biopsy, is studied under a microscope.

Doctors may also use specialized imaging machines—such as those for magnetic resonance imaging (MRI) scans, computed tomography (CT) scans or positron emission tomography (PET) scans—to look inside the throat and head for signs of cancer.

If doctors find cancer, they’ll do additional testing to determine how advanced it is. These tests help determine the tumor’s size, how far the cancerous cells have spread, and whether the patient’s vocal cords are working. This may include more biopsies or removal of lymph nodes, which are the small balls of tissue that are found all over the body and are home to white blood cells.

Treatment of laryngeal cancer

Treatment of laryngeal cancer typically involves at least one of several approaches. Depending on how advanced the cancer is, treatments may be used in sequence or together. If the patient is actively smoking, quitting will help these treatments work better.

Treatments include:

  • Surgery (removal of cancerous tissue)
  • Radiation (destruction of cancer cells using high-energy waves)
  • Chemotherapy (drugs that slow the growth of or kill fast-growing cells like cancer cells)

Many new types of surgery have been developed that are aimed at keeping vocal function and quality of life and reducing disfigurement.

However, if the tumor is large, doctors may need to remove the vocal cords (in a surgical procedure called a cordectomy) or the voice box (during a laryngectomy). These procedures leave the patient unable to talk normally, and it may take time to learn to communicate vocally in new ways.

If the procedure is a total laryngectomy, the patient will require a tracheostomy, which is a hole created in the neck to facilitate breathing. Other complications of treatment may include difficulties swallowing, damage to the thyroid and pituitary glands, and disfigurement requiring reconstructive surgery.

In addition to surgery, laryngeal cancer may require additional treatment with radiation, chemotherapy or both. In some cases, the patient may be given two or more chemotherapy drugs at once, and also be prescribed radiation therapies.

Commonly used chemotherapies for laryngeal cancer include:

  • Platinol® (cisplatin)
  • Paraplatin® (carboplatin)
  • Adrucil® (5-fluorouracil or 5-FU)
  • Taxotere® (docetaxel)
  • Taxol® (paclitaxel)
  • Trexall® (methotrexate)
  • Xeloda® (capecitabine)

Other treatments that may be used for laryngeal cancers include:

  • Erbitux® (cetuximab) is a targeted therapy, which means it attacks cancer cells directly based on their characteristics.
  • Immune therapies such as Keytruda® (pembrolizumab) and Opdivo® (nivolumab) help prime the body’s immune system to fight cancer, which may help shrink or slow tumor growth.

Survival rates for laryngeal cancer

The outlook for patients with laryngeal cancer depends on how big and advanced the cancer is, as well as how strange the tumor’s cancerous cells look. Age and general health are also taken into consideration.

Cancer survival rates are tracked in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program database. This database categorizes cancers into three stages based on how far they’ve spread:

  • Localized cancers are still in the tissue they originated in
  • Regional cancers have spread to nearby tissues and lymph nodes
  • Distant cancers have spread to other organs

The SEER program also tracks laryngeal cancers based on where in the throat they’ve originated.

A five-year survival rate refers to the percentage of people who are alive five years after a cancer diagnosis. Keep in mind that survival rates are based on older data and past treatments, and the actual rates may have improved.

The five-year survival rates are as follows, according to the SEER Program database.

For the supraglottis, above the vocal cords:

  • Localized: 61 percent
  • Regional: 47 percent
  • Distant: 31 percent
  • Combined (all stages): 46 percent

For the glottis, which includes the vocal cords:

  • Localized: 83 percent
  • Regional: 49 percent
  • Distant: 43 percent
  • Combined (all stages): 76 percent

For the subglottis, below the vocal cords:

  • Localized: 63 percent
  • Regional: 35 percent
  • Distant: 43 percent
  • Combined (all stages): 52 percent

Getting the HPV vaccine, quitting smoking and reducing excessive drinking are all steps that may help decrease the risk of developing laryngeal and other cancers.

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