Laryngeal cancer is a rare cancer in which malignant cells grow in the larynx, or voice box. Smoking tobacco and drinking alcohol are the main risk factors for laryngeal cancer.

The American Cancer Society predict that there will be 12,410 new cases of laryngeal cancer and 3,760 deaths in the United States in 2019.

They also note that the number of people with laryngeal cancer is falling by 2 percent to 3 percent each year, probably because fewer people are smoking.

In this article, we look at the symptoms, causes, and treatment of laryngeal cancer.

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A persistent cough and sore throat are symptoms of laryngeal cancer.

Laryngeal cancer occurs in the larynx, or voice box.

The larynx is a short, triangular passageway just below the pharynx in the neck. It is about 2 inches wide.

The larynx has three main parts:

  • the glottis is the middle part of the larynx that contains the vocal cords
  • the supraglottis is the tissue above the glottis
  • the subglottis is the tissue below the glottis that connects to the trachea, which takes air to the lungs

Cancer can develop in any part of the larynx but usually begins in the glottis. Most laryngeal cancers start in the flat, scale-like squamous cells that line the inner walls of the larynx.

If laryngeal cancer spreads, it often reaches nearby lymph nodes in the neck. The cells can also spread to the back of the tongue, other sections of the throat and neck, the lungs, and other parts of the body.

When this happens, and a tumor forms at the new site, it will contain the same kind of abnormal cells as the original tumor in the larynx. A doctor would diagnose this as metastatic laryngeal cancer.

The symptoms of laryngeal cancer include:

  • a persistent cough
  • hoarseness
  • a sore throat
  • an abnormal lump in the throat or neck
  • difficulty or pain when swallowing
  • frequently choking on food
  • difficult or noisy breathing
  • persistent ear pain or an unusual sensation in and around the skin of the ear
  • unplanned, significant weight loss
  • persistent bad breath

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Smoking and exposure to hazardous chemicals in the workplace can increase the risk of laryngeal cancer.

Smoking is the most significant risk factor for laryngeal cancer.

Death from laryngeal cancer is much more common among people who smoke than those who do not. Second-hand smoking may also be a risk factor for laryngeal cancer.

Moderate or heavy consumption of alcohol is also a risk factor. The American Cancer Society suggest that those who consume one or more alcoholic drink every day, especially if they smoke as well, may be at greater risk of developing this type of cancer.

Other risk factors include:

  • poor nutrition and vitamin deficiency
  • human papillomavirus (HPV)
  • being male, as men are four times more likely to develop laryngeal cancer than women
  • being over 40 years of age
  • a previous history of head or neck cancer
  • exposure to certain chemicals in the workplace, such as paint fumes and some chemicals in metalworking
  • low immunity

Genetic factors may also play a role in the development of laryngeal cancer.

People with Fanconi anemia, which is a condition that causes blood issues from a young age, and dyskeratosis congenita , which is a syndrome that affects the skin, nails, and blood, might be at higher risk of developing many types of head and neck cancer.

Cancer of the larynx may present as a visible lump on the outside of the neck. In these instances, the doctor will recommend a biopsy to help make the final diagnosis.

If a person's symptoms suggest a laryngeal or other head and neck tumor, a doctor may use a laryngoscope to help with diagnosis. A laryngoscope is a small camera with a light on the end that allows a doctor to look into the mouth and down the throat.

Fiber-optic nasal endoscopy involves a thin, flexible scope that the doctor inserts into the nostril. It allows doctors to see the entire pharynx and larynx. This procedure typically takes place in a clinic while the individual is under local anesthetic.

A doctor may suggest a CT scan of the neck or head, or an MRI to see the extent or size of the tumor. This can help the doctor determine if the cancer has spread to lymph nodes in the neck.

If the lesion appears to be small and limited to one area, the surgeon may do an excisional biopsy, in an attempt to completely remove the tumor and send it to pathology for review.

Scientists or technicians will carry out a pathological analysis of any tumors or tissues that appear abnormal to confirm the diagnosis of cancer.

If the lab tests confirm laryngeal cancer, doctors may order additional tests to find out if the cancer has spread to other parts of the body.

Early diagnosis can help support the successful treatment of laryngeal cancer. Based on 2008–2014 data from the National Cancer Institute, the 5-year survival rate for this type of cancer is just under 61 percent.

Treatment depends on the stage of the cancer .

Conventional treatment for early-stage laryngeal cancer includes surgery or radiation therapy.

At the later stages, an individual may need either a combination of radiation and chemotherapy or surgery followed by radiation.

Surgery

Surgery involves removing the cancerous tumor and nearby tissue. The surgeon may carry out a neck dissection to remove any cancerous lymph nodes in the neck.

Surgeries for laryngeal cancer include endoscopic resection, partial laryngectomy, and total laryngectomy.

Depending on the type of surgery they have, some individuals may need a temporary or permanent tracheostomy. This is a hole, or stoma, in the neck that promotes healing after surgery.

Some people will need a permanent stoma that allows them to breathe. These indivduals will also require an assistive device to allow speech.

Radiation therapy

Radiation therapy kills cancer cells and shrinks tumors. In external beam radiation therapy, the doctor directs a beam of radiation at the tumor in the neck.

The beam is powerful and can burn the skin alongside any cancer cells, which can be painful.

Chemotherapy

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Chemotherapy can be a highly effective treatment, but side effects, such as hair loss and nausea, may be severe.

Chemotherapy uses a combination of drugs to kill cancer cells and to enhance the effects of radiation therapy.

A medical team may use chemotherapy to reduce the size of a large tumor before surgery. This can help improve the surgical and cosmetic outcomes.

The doctor either gives these drugs in pill form or an infusion. The chemotherapy enters the bloodstream and travels through the body, killing any rapidly growing cells, which may include both cancerous and healthy cells.

Chemotherapy can lead to potent side effects, such as nausea, weight loss, and hair loss.

Prevention

The best way to avoid cancer of the larynx is to avoid smoking or drinking excessive amounts of alcohol. Both have strong links to the disease.

Q:

Can I still get laryngeal cancer if I do not smoke?

A:

Yes. Although smoking is the most significant risk factor for laryngeal cancer, other factors, such as excessive alcohol and some genetic conditions, can lead to laryngeal cancer. However, this is rare.

In some cases, a person with a diagnosis of laryngeal cancer may have no known risk factors.

Yamini Ranchod, PhD, MS Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.