Laryngeal cancer: What you should know

Laryngeal cancer, or larynx cancer, occurs when cancerous cells form in the larynx. The larynx, also known as the voice box, is the part of the throat that controls your vocal cords. Cancer can develop in any of the three major parts of the larynx:

• Glottis: the middle portion that contains the vocal cords
• Supraglottis: the area above the vocal cords
• Subglottis: the area below the vocal cords and above the trachea (windpipe)

We spoke with head and neck surgeon Eduardo Diaz Jr., M.D., to learn more about laryngeal cancer.

How common is laryngeal cancer?

It’s much less common than it used to be because fewer Americans are smoking, which is a risk factor for this type of cancer. That said, laryngeal cancers represent about one-fifth of head and neck cancers.

The most common type of laryngeal cancer is squamous cell carcinoma. Other less common types include:

• verrucous cancer
• adenocarcinoma
• undifferentiated carcinoma of the lymph nodes

What are the symptoms of laryngeal cancer?

Hoarseness is the most common symptom of laryngeal cancer. Other symptoms include:

• trouble swallowing
• shortness of breath
• blood-tinged mucus

“It’s very common to get hoarse when you have a cold or an allergy attack,” says Diaz. “You don’t need to run to the doctor every time that happens. However, your symptoms should improve after about a week.”

If you’ve got hoarseness and/or persistent voice changes for more than a week, or you have hoarseness associated with other symptoms, you should see an ear, nose and throat (ENT) specialist.

How is laryngeal cancer typically diagnosed?

When you visit an ENT, they’ll do a complete head and neck exam.

Your doctor may also perform a fiberoptic laryngoscopy, in which a small scope is placed through the back of your nose so the doctor can get a clear view of your voice box.

“This painless procedure is done in the clinic and gives us an excellent view of your voice box and vocal cords,” says Diaz. “In some cases, we can even perform biopsies in the clinic using one of these scopes.”

If you have a biopsy, a pathologist will examine your cell tissue and then determine if you have cancer.

“In some cases, if we suspect cancer has spread to a lymph node in the neck, we can perform a fine-needle aspiration of the lymph node to confirm our suspicions,” says Diaz.

What are the risk factors for laryngeal cancer?

The biggest risk factor for developing laryngeal cancer is smoking and tobacco use.

Some less common risk factors associated with laryngeal cancer include:

• silent reflux, or heartburn
• drinking alcohol
• the human papillomavirus (HPV)

“Silent reflux is when stomach acid flows up the esophagus and spills over onto your voice box,” explains Diaz. “The acid is an irritant that washes away mucus, a protectant. For example, if you smoke, the mucus protects the carcinogens from reaching the mucosa, but if the reflux washes that away, it increases your chance of developing cancer.”

Alcohol is a solvent that also washes away mucus.

“We’re seeing a lot of tumors in the larynx that look like they’re associated with HPV, so it’s important to get vaccinated for HPV if you’re eligible,” says Diaz.

The HPV vaccine prevents six types of cancer, including throat cancers like laryngeal cancer. Everyone ages 9-26 is encouraged to get the vaccine, and it is most effective when given between ages 11 and 12. Adults ages 27-45 should talk to their doctor about the benefits of getting vaccinated.

How is laryngeal cancer typically treated?

Laryngeal cancer is typically treated with radiation therapy and/or surgery. For lesions that are caught very early, surgery is the best option.

“Once the biopsy confirms it’s cancer, we can use a laser to burn off the cancer,” says Diaz. “This is a very effective option with a high cure rate.”

Radiation therapy is preferred for intermediate-stage cancers.   

“It’s excellent for treating laryngeal cancer, but we don’t use it for all stages because radiation therapy is something you can only use once,” says Diaz. “We don’t want to use it for a small tumor and then have the patient get another type of cancer in the future, and we can’t use radiation because they’ve already used it.”

Most late-stage laryngeal cancers, T3s and some T4s, will be treated with chemotherapy and radiation. The advanced stage T4s are typically treated with surgery first. In T3 laryngeal cancer, the tumor is limited to the larynx while T4 laryngeal cancer means the tumor has spread beyond the larynx.

“For patients with pretty advanced cancer of the larynx, killing the cancer is wonderful, but it doesn’t go back to being a normal larynx because the tissue around the larynx is affected as well,” explains Diaz. “So, if a patient has a really large tumor and their voice box isn’t working well, radiation therapy may not do the patient much good in terms of function. So, we’ll typically go with surgery first, then radiation.”

What lifestyle changes can laryngeal cancer patients expect?    

At MD Anderson, we focus on preserving function when treating laryngeal cancer.

“How do we, one, cure the cancer, and two, preserve function so patients can have a good voice, tolerate a regular diet and avoid having a permanent stoma, or hole in their neck?” says Diaz.

Some patients are not excited by the idea of a total laryngectomy, a procedure to remove the entire voice box through your neck, but Diaz says that this is a great curative option for some extensive cases.

“A total laryngectomy does leave you with a permanent hole in your neck to breathe through, but we’re able to rehabilitate patients, so they can talk hands-free and communicate openly in public,” says Diaz. “We try to introduce them to other laryngeal cancer patients who communicate well and have wonderful lives.”

Diaz recognizes that total laryngectomies can be concerning for some patients, so he does his best to avoid those types of surgeries when possible.

“That’s why we try to diagnose laryngeal cancer early and do simple surgeries,” he says. “Sometimes we can use treatments that don’t involve surgery, like radiation therapy and chemotherapy combined.”

Diaz also performs conservation laryngeal surgery, which often requires only a laser to remove the cancer while preserving enough of the voice box’s functionality, so the patient can still talk and swallow without having a permanent stoma.

What are the latest advances in laryngeal cancer treatment?

We just presented research at the American Society of Clinical Oncology Annual Meeting showing success in treating some patients with only immunochemotherapy.

“We found that we could control the disease with just immunotherapy and chemotherapy in a good portion of patients,” says Diaz. “They never receive radiation therapy or surgery. We’re trying to expand this study nationally to make it available to more patients.”

Request an appointment at MD Anderson online or by calling 1-877-632-6789.