What is laryngeal cancer?
Cancer is the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Laryngeal cancer occurs when malignant (cancerous) cells form in the tissues of the larynx, or voice box. The larynx contains a person’s vocal cords. Most laryngeal cancers occur in the squamous cells, which are the thin, flat cells that line the inside of the larynx.

What factors increase the risk of laryngeal cancer?
A person’s risk of developing laryngeal cancer increases substantially with the use of tobacco products. Drinking alcohol, especially in large amounts, also can affect the risk of developing laryngeal cancer. Other risk factors include:

• Age—This form of cancer occurs most often in people over the age of 55.
• Gender—Men are more likely to develop cancer of the larynx.
• A personal history of head and neck cancer—Nearly one in four people who have had head and neck cancer will develop a second primary head and neck cancer.
• Occupation—Workers who are exposed to sulfuric acid mist or nickel have an increased risk of laryngeal cancer. In addition, people who work with asbestos have a greater risk of developing laryngeal cancer. Workers exposed to wood dust, the manufacture of mustard gas, and machinists are at a higher risk of developing laryngeal cancer.

What are the symptoms of laryngeal cancer?
Some of the following symptoms may be signs of laryngeal cancer, or they could be signs of other conditions. Consult with your doctor if you experience any of the following:

• A sore throat or cough that does not go away
• Trouble or pain when swallowing
• Ear pain
• A lump in the neck or throat
• A change or hoarseness in the voice

How is laryngeal cancer diagnosed?
Tests and procedures that may be used to help diagnose laryngeal cancer include:

• Physical exam—A physician will perform an examination of the throat and neck.
• Laryngoscopy—This procedure involves the doctor’s examination of the larynx with a mirror or a thin, lighted tube called a flexible endoscope.
• Biopsy—This procedure involves taking a small piece of the cancer, usually under general anesthesia, so that it can be viewed under a microscope .
• CT or CAT scan (also called computed tomography, computerized tomography, or computerized axial tomography)—A scan that involves taking series of detailed pictures of areas inside the body. The images are created by a computer linked to an x-ray machine.
• MRI (also called magnetic resonance imaging)— A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body.
• PET scan—A PET scan, or Positron Emission Tomography scan, is helpful in diagnosing diseases such as cancer. While techniques such as CT scan or MRI only show organ structure, PET scans shows organ structure and function.

What are the stages of laryngeal cancer?

Stage 0—In this stage, cancer is found only in the cells that line the larynx. Stage 0 cancer is also called carcinoma in situ.

Stage I—In this stage, cancer is still in the area where it started. Stage I laryngeal cancer’s development depends on where cancer is found in the larynx. Cancer can begin in the supraglottis (upper part of the larynx; the area above the vocal cords), glottis (middle part of larynx, where vocal cords are), or subglottis (lowest part of larynx, below vocal cords).

Stage II—Cancer is in the larynx only in this stage, but can be found in the supraglottis, glottis or subglottis.

Stage III—This stage involves cancer’s spread from the supraglottis, glottis or subglottis. Cancer may spread to the tissues next to the larynx or to lymph nodes.

Stage IV—The most advanced stage, indicating either a large tumor of the larynx, multiple lymph nodes involved in the neck, or metastases to other organs of the body such as the lungs.

How is laryngeal cancer treated?
Specialists skilled in the treatment of laryngeal cancer include otolaryngologists (ear nose and throat doctors), radiation oncologists, or medical oncologists (doctors who specializes in diagnosing and treating cancer). Laryngeal cancer treatment may include surgery, radiation therapy, or chemotherapy. Some patients have a combination of treatments. Some types of surgery to treat laryngeal cancer include:

Total laryngectomy – removal of the larynx, including the vocal cords. Stage III and stage IV cancers are usually treated with this procedure, as well as recurrent cancers.

Partial laryngectomy – removal of cancerous tissue while leaving as much of the vocal cords as possible. Smaller tumors are sometimes treated by partial laryngectomy. The goal is to remove the cancer but save as much of the larynx as possible.

Laser excision surgery –Very small tumors or cancer in situ are sometimes successfully treated with laser excision surgery. In this type of surgery, a narrowly-targeted beam of light from a laser is used to remove the cancer.

Neck dissection—This surgery is sometimes required in cases of advanced cancer. The goal of a neck dissection is to remove the lymph nodes and prevent the cancer from spreading. There are several forms of neck dissection. A radical neck dissection is the operation that removes the most tissue, but is rarely used nowadays.

Tracheotomy – making a hole in the neck below the larynx to help breathing. This may be temporarily necessary after surgery, or permanently placed in the case of laryngeal tumors that are too large to be removed. This operation is necessary if the larynx is totally removed

Radiation—The use of radiation can kill cancer cells and reduce the size of tumors. Radiation therapy can be used alone in early stage cancers or in combination with surgery. Sometimes it is tried first with the plan that if it fails to cure the cancer, surgery still remains an option.

Chemotherapy—Chemotherapy to treat laryngeal cancer is sometimes given, but always in combination with radiation therapy.

Laryngeal cancer treatment by stage
Laryngeal cancer is treatable and curable as long as the cancer is located in the larynx and/or the neck lymph nodes. Once the cancer spreads to other parts of the body such as the lungs or lymph nodes of the chest, this no longer is a curable situation. Biopsy of the cancer has never been shown to cause spread to other parts of the body.

Treatment of Stage I laryngeal cancer depends on where cancer is found in the larynx. In cancer of the supraglottis, treatment may include radiation therapy and supraglottic laryngectomy. In cancer of the glottis, treatment may include radiation, a cordectomy (surgery on the vocal cords or on the spinal cord), partial or total laryngectomy, or laser surgery. In cancer of the subglottis, treatment may include radiation therapy with or without surgery or surgery alone.

Stage II laryngeal cancer treatment also depends on where the cancer is found in the larynx. Treatments may include radiation therapy, partial laryngectomy, laser surgery, or total laryngectomy.

Stage III laryngeal cancer treatments can include surgery with or without radiation, radiation with or without surgery, radiation and chemotherapy, or a combination of surgery, radiation, and chemotherapy.

Stage IV laryngeal cancer treatments can include total laryngectomy with radiation therapy, radiation therapy with or without surgery, or chemotherapy plus radiation. If Stage IV laryngeal cancer is in the subglottis area, treatment may include laryngectomy plus total thyroidectomy (surgery to remove all or part of the thyroid) and removal of lymph nodes in the throat, usually with radiation therapy.

What is the prognosis (chance of recovery) for people with laryngeal cancer?
The prognosis differs from person to person and depends on factors including the stage of the disease, the size and location of the tumor, and the patient’s age and general health.

Cancers found in stage 0 and stage 1 have a 75% to 95% cure rate, depending on where the cancer is located. Late stage cancers that have spread to other areas of the body have a very poor survival rate. The survival rates for intermediate stage cases of laryngeal cancers are between the rates for stages I and 0 and those for stages III and IV.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional written health information, please contact the Health Information Center at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771 or visit www.clevelandclinic.org/health/.

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