Laryngeal Cancer

Laryngeal cancer symptoms

Symptoms of laryngeal cancer include:

• Hoarseness or other changes in the voice. This is the most common laryngeal cancer symptom. It occurs when the tumor impacts the vocal cords.
  
• A lump in the neck resulting from swollen lymph nodes
  
• A persistent sore throat
  
• Trouble swallowing
  
• Earaches
  
• Persistent bad breath

These symptoms do not always mean you have cancer. However, it is important to discuss them with your doctor since they may signal other health problems.

Like all cancers, it’s important for laryngeal cancer to be diagnosed as early and accurately as possible. This helps increase your chance for a successful treatment while maintaining your quality of life, including the ability to speak and swallow.

If you have symptoms that may signal laryngeal cancer, your doctor will examine you and ask you questions about your health and lifestyle, including smoking habits, drinking habits and family medical history.

The following tests can be used to diagnose laryngeal cancer and find out if it has spread. Tests also may be used to monitor the disease and how it is responding to treatment.

Fiberoptic Laryngoscopy

A fiberoptic laryngoscopy is often the first test in a laryngeal cancer diagnosis. During this procedure, a doctor passes a small camera through the nose and examines the larynx. This allows the doctor to determine if a biopsy is needed.

Biopsy

In a biopsy, doctors retrieve suspected cancer tissue for study under a microscope. A biopsy is the only way to definitively diagnose throat cancer. Different methods are used to obtain this tissue, depending on where the tumor is located. Common biopsy methods for laryngeal cancer include:

• Fine-needle-aspiration biopsy (FNA): This type of biopsy may be used if you have a lump in your neck that can be felt from the outside. A thin needle is inserted into the area, and cells are withdrawn and examined under a microscope. This is often coupled with an ultrasound to verify the placement of the needle.
  
• Conventional incisional biopsy: The doctor surgically removes part of the tissue where cancer is suspected.
  
• Excisional biopsy: A type of biopsy that removes most or all the suspected cancer tissue. This is frequently done with a tonsillectomy in the operating room.
  
• Endoscopic biopsy: During this procedure, an endoscope (a long, thin tube with a light and lens through which the doctor can view organs and tissue) is inserted through the mouth, nose or an incision. The endoscope has a tool to remove tissue samples.
  

Imaging exams

Imaging exams can help locate the suspected cancer and show whether it has spread. They can also be used to monitor the disease’s progression and how it is responding to treatment.

Throat cancer imaging exams may include:

• CT or CAT (computed axial tomography) scans
  
• PET (positron emission tomography) scans
  
• MRI (magnetic resonance imaging) scans
  
• Ultrasound
  
• Chest and dental X-rays
  

Learn more about imaging exams.

Swallowing tests

Doctors use swallowing tests to understand how the patient’s throat is performing and help them plan treatment. There are different types of swallowing tests.

Barium swallow: The patient drinks liquid barium, which makes certain areas of the body show up more clearly during X-rays. This study evaluates the passage from the throat to the stomach. It is used to look for changes in structure and muscle movement. 

Modified barium swallow: During a modified barium swallow, the patient ingests liquid, pudding and solid food, all containing barium. A speech pathologist and radiologist observe the swallowing in real time using a specialized X-ray exam, called a fluoroscopy. They then evaluate the structures and movements associated with swallowing.

Fiberoptic endoscopic examination of swallowing (FEES): FEES relies on a small, flexible endoscope that is inserted through the nose. It allows the doctor or speech pathologist to examine swallowing.

Staging is a way of determining how much disease is in the body and where it has spread. This information helps your doctors decide the best type of treatment for you and the outlook for your recovery.

Laryngeal cancer stages

Source: National Cancer Institute

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the larynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in the supraglottis, glottis, or subglottis area of the larynx:

• Supraglottis: Cancer is in one area of the supraglottis and the vocal cords work normally.
  
• Glottis: Cancer is in one or both vocal cords and the vocal cords work normally.
  
• Subglottis: Cancer is in the subglottis only.
  

Stage II

In stage II, cancer has formed in the supraglottis, glottis, or subglottis area of the larynx:

• Supraglottis: Cancer is in more than one area of the supraglottis or has spread to the area at the base of the tongue or to tissues near the vocal cords. The vocal cords work normally.
  
• Glottis: Cancer has spread to the supraglottis, subglottis, or both, and/or the vocal cords do not work normally.
  
• Subglottis: Cancer has spread to one or both vocal cords and the vocal cords may not work normally.
  

Stage III

In stage III, cancer has formed in the supraglottis, glottis, or subglottis area of the larynx:

In stage III cancer of the supraglottis:

• cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller; or
  
• cancer is in one area of the supraglottis and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller; or
  
• cancer is in more than one area of the supraglottis or has spread to the area at the base of the tongue or to tissues near the vocal cords. The vocal cords work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller.
  

In stage III cancer of the glottis:

• cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller; or
  
• cancer is in one or both vocal cords and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller; or
  
• cancer has spread to the supraglottis, subglottis, or both, and/or the vocal cords do not work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller.
  

In stage III cancer of the subglottis:

• cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller; or
  
• cancer is in the subglottis only. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller; or
  
• cancer has spread to one or both vocal cords and the vocal cords may not work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller.

Stage IV

Stage IV is divided into stage IVA, stage IVB, and stage IVC. Each substage is the same for cancer in the supraglottis, glottis, or subglottis. 

In stage IVA:

• Cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller; or
  
• Cancer may have spread from the supraglottis, glottis, or subglottis to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. The vocal cords may not work normally. Cancer has spread
• to one lymph node on the same side of the neck as the primary tumor and the lymph node is three centimeters or smaller. Cancer has spread through the outside covering of the lymph node; or
• to one lymph node on the same side of the neck as the primary tumor and the lymph node is larger than three centimeters but not larger than six centimeters. Cancer has not spread through the outside covering of the lymph node; or
• to more than one lymph node on the same side of the neck as the primary tumor and the lymph nodes are not larger than six centimeters. Cancer has not spread through the outside covering of the lymph nodes; or
• to lymph nodes on both sides of the neck or on the side of the neck opposite the primary tumor and the lymph nodes are not larger than six centimeters. Cancer has not spread through the outside covering of the lymph nodes.

In stage IVB:

• Cancer may have spread from the supraglottis, glottis, or subglottis to the space in front of the spine, the area around the carotid artery, or the area between the lungs. The vocal cords may not work normally. Cancer has spread:
• to one lymph node that is larger than six centimeters. Cancer has not spread through the outside covering of the lymph node; or
• to one lymph node on the same side of the neck as the primary tumor and the lymph node is larger than three centimeters. Cancer has spread through the outside covering of the lymph node; or
• to more than one lymph node anywhere in the neck. Cancer has spread through the outside covering of the lymph nodes; or
• to one lymph node of any size on the side of the neck opposite the primary tumor. Cancer has spread through the outside covering of the lymph node; or
• Cancer has spread from the supraglottis, glottis, or subglottis to the space in front of the spine, the area around the carotid artery, or the area between the lungs. Cancer may have also spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size.

In stage IVC, cancer has spread to other parts of the body, such as the lungs, liver, or bone.

MD Anderson customizes your laryngeal cancer treatment to maximize the chances of cure while also paying special attention to your quality of life. Because the oropharynx plays a critical role in speaking, breathing and swallowing, treatment for laryngeal cancer often focuses on preserving these functions along with eliminating the cancer. To achieve these goals, treatment plans are customized to each individual patient.

If the disease is caught early, the patient often receives radiation therapy, sometimes accompanied by chemotherapy. Patients with more advanced diseases may require surgery.

Surgery

Surgery for laryngeal cancer includes:

• Partial laryngectomy: This procedure focuses on removing only the cancerous area of the larynx. The surgeon leaves as much healthy tissue as possible so the larynx still functions. Patients retain the ability to speak normally, but with some hoarseness, after a partial laryngectomy.
  
• Total laryngectomy: All of the larynx is removed, including the vocal cords. Patients require a permanent hole in the neck to breathe through and can no longer speak with their regular voice after this procedure. Speech pathologists can help them learn new ways to talk.
  
• Neck dissection: A neck dissection involves removing lymph nodes from the neck. Lymph nodes are small, bean shaped structures and part of the immune system. They are often the first spot where cancer spreads. Neck dissection is often performed at the same time as a total or partial laryngectomy.
  

Radiation therapy 

Radiation therapy uses powerful, focused beams of energy to kill cancer cells. There are several different radiation therapy techniques. Doctors can use these to accurately target a tumor while minimizing damage to healthy tissue.  

Learn more about radiation therapy. 

The types of radiation therapy used to treat oropharyngeal cancer include:

• Intensity modulated radiation therapy (IMRT): This treatment focuses multiple radiation beams of different intensities directly on the tumor for the highest possible dose. One type of IMRT is Volumetric modulated arc therapy (VMAT), which uses a rotating treatment machine to deliver radiation at multiple angles. 
  
• Proton therapy: Proton therapy is similar to standard radiation therapy, but it uses a different type of particle that may allow doctors to reduce the radiation dose and limit damage to healthy nearby tissue. Learn more about proton therapy. 
  
• MR LINAC radiotherapy: This approach uses a specialized device to adjust treatment on a daily basis. These adjustments can reduce side effects and effectively treat changing tumors.
  
• Stereotactic body radiation therapy (SBRT): SBRT, also known as stereotactic ablative radiotherapy and stereotactic ablative body radiation, precisely targets tumors with very high doses of radiation. SBRT achieves this by using several radiation beams of various intensities aimed at the tumor from different angles. Learn more about SBRT.
  

Chemotherapy

Chemotherapy drugs kill cancer cells, control their growth or relieve disease-related symptoms. Chemotherapy may involve a single drug or a combination of two or more drugs, depending on the type of cancer and how fast it is growing. 

Learn more about chemotherapy. 

Targeted therapy

Targeted therapy drugs are designed to stop or slow the growth or spread of cancer. This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. These molecules are usually made by the genes that cause cancer, as well as the cells themselves. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them.  

Learn more about targeted therapy. 

Immune checkpoint inhibitors 

Immune checkpoint inhibitors are a type of immunotherapy. They stop the immune system from turning off before cancer is completely eliminated. 

For laryngeal cancer, immune checkpoint inhibitors are currently approved only for stage IV cancer. They can be used alone or with other treatments, including surgery, radiation therapy and other cancer drugs.

Learn more about immune checkpoint inhibitors. 

Specialized care for laryngeal cancer patients

Throat cancer and its treatments can impact a person’s ability to eat, drink and speak, as well as their appearance. MD Anderson offers therapies and services to help throat cancer patients adjust to and overcome these challenges as much as possible.

Speech therapy: MD Anderson speech pathologists and audiologists offer patients the most advanced techniques for restoring speech after throat cancer and its treatment.

Swallowing therapy: Experts in MD Anderson’s Speech Pathology and Audiology Section are dedicated to evaluating and treating patients who have difficulty eating, drinking and swallowing after treatment. MD Anderson’s swallowing service is one of the leaders in this field and serves as a model for the management of patients treated for throat cancers. 

Reconstructive surgery: Throat cancer treatment can impact a patient’s appearance. MD Anderson is home to renowned reconstructive surgeons who can perform procedures to help restore appearance. 

Dental care: The teeth and jaw of throat cancer patients can be damaged by the disease and its treatments. MD Anderson dentists specialize in designing implants and performing procedures to help throat cancer patients restore appearance and function. 

Survivorship: MD Anderson has a survivorship clinic dedicated to the needs of head and neck cancer patients.

Regular follow-up and screenings are vital due to the high risk of throat cancer returning to the throat or other areas in the head and neck region. Patients need to see their doctors every three to six months for the first two years after treatment, since most cancers that recur, or come back, do so within that time. 

Throat cancer patients are also strongly urged not to smoke or drink alcohol during and after treatment. Drinking and smoking can make treatments less successful and worsen side effects during treatment. They can also greatly increase the chance of the cancer returning.