Laryngeal Cancer Overview

This manual will examine the subject of laryngeal cancer, including the symptoms, diagnosis, treatment, and what happens after treatment. The purpose of this guide is to educate you and to help you make informed decisions about your treatment.

Cleveland Clinic Head and Neck Institute caregivers work as a team to provide consistent, patient-centered care for patients who have laryngeal cancer.

DEFINITIONS

What is the larynx?

larynx

The larynx, or voice box, is located in the throat. The larynx helps us breathe, speak, and swallow. The vocal cords, which help us speak, are part of the larynx.

The larynx is made up mostly of cartilage, a flexible tissue that forms a framework of support. There are three parts to the larynx:

  • The supraglottis, or upper part.
  • The glottis, the middle part. This is where the vocal cords are located. The vocal cords open and close, and allow you to breathe and speak.
  • The subglottis, the lower part.

The larynx plays a role in several functions:

  • When you breathe, the vocal cords open to allow air to pass through.
  • When you speak, the vocal cords close. The air that passes through the vocal cords makes them vibrate, which helps create the sound of speech.
  • When you swallow, the epiglottis (which is part of the supraglottis) drops down over the larynx and the vocal cords close tight to keep food out of the lungs. (Food goes down the esophagus to the stomach.)

What is laryngeal cancer?

Cancer is an uncontrollable growth of cells that invade and cause damage to the body. In laryngeal cancer, malignant (cancerous) cells form in the larynx. Most laryngeal cancers occur in the squamous cells, which line the inside of the larynx.

About 60% of laryngeal cancers start in the glottis, 35% in the supraglottis, and the rest in the subglottis.

Laryngeal cancer is one of a group of head and neck cancers. In the United States, approximately 13,000 people a year are diagnosed with laryngeal cancer, and about 3,700 die from the disease every year.

What factors increase the risk of laryngeal cancer?

A person has a much greater risk of developing laryngeal cancer if he or she smokes or uses other tobacco products. Drinking alcohol, especially in large amounts, also can increase the risk of developing laryngeal cancer. In fact, using tobacco and alcohol together increases the risk of cancer even more.

Other risk factors include:

  • Age: Laryngeal 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 get it again.
  • Occupation: Workers who are exposed to sulfuric acid mist, wood dust, nickel, or the manufacturing of mustard gas have a greater risk of laryngeal cancer. In addition, machinists and people who work with asbestos are at greater risk.

What are the symptoms of laryngeal cancer?

Some of the following may be symptoms of laryngeal cancer, or they could be symptoms of other conditions:

  • A sore throat or cough that does not go away
  • A change in your voice, such as hoarseness, that does not get better after two weeks
  • Any pain or other trouble when you swallow
  • Ear pain
  • A lump in the neck or throat
  • Dysphonia (problems producing voice sounds)

If you have any of the following symptoms, see your doctor right away:

  • Dyspnea (trouble breathing)
  • Stridor (breathing that is high-pitched and noisy)
  • Globus sensation (a feeling like there is something in the throat)
  • Hemoptysis (coughing up blood)

How is laryngeal cancer diagnosed?

These tests and procedures may be used to help diagnose laryngeal cancer:

  • Physical exam: A physician will examine the throat and neck.
  • Laryngoscopy: The doctor examines the larynx with a mirror or a thin, lighted tube called a flexible endoscope.
  • Biopsy: The doctor removes a small piece of the larynx so that it can be examined under a microscope.
  • CT or CAT scan (also called computed tomography, computerized tomography, or computerized axial tomography): Computed tomography uses X-rays and computers to produce images of a cross-section of the body.
  • MRI (also called magnetic resonance imaging): Magnetic resonance imaging uses a large magnet, radio waves, and a computer to produce clear pictures, or images, of the human body.
  • PET scan: A very small dose of a radioactive chemical, called a radiotracer, is injected into a vein in the arm. The tracer travels through the body and is absorbed by the organs and tissues being studied. A machine called a PET scanner creates three- dimensional pictures from the energy given off by the tracer substance.

What are the stages of laryngeal cancer?

A system known as staging is used to describe how far a tumor has grown, and what parts of the body it has invaded (spread to).

For instance, in laryngeal cancer, the stage will depend on the part of the larynx that is affected, and whether the cancer has invaded other parts of the body, such as the thyroid, esophagus, tongue, lungs, liver, and bones.

Cancer that begins in the larynx can spread to other parts of the body through the blood- stream or the lymph nodes. Lymph is a clear or slightly yellowish watery fluid that removes bacteria and certain kinds of proteins from tis- sues. Lymph nodes are small, bean-shaped structures located throughout the body. Clusters of nodes are found in the neck, armpits, abdomen, and groin. Other nodes are found in the chest, arms, and legs.

The stages of laryngeal cancer are grouped by “early” and “advanced” cancer:

  • In early laryngeal cancer (Stages 0, I, and II), the tumor is small and the cancer remains in the larynx.
  • In advanced laryngeal cancer (Stages III and IV), the tumor is larger and has affected the vocal cords, or has invaded the lymph nodes or other parts of the body.

THE HEALTHCARE TEAM

At Cleveland Clinic, laryngeal cancer is treated by a team of specialists, including:

  • Head and neck surgeons: Physicians who provide surgical care for patients with head and neck tumors.
  • Radiation oncologists: Physicians who use radiation therapy to treat cancer.
  • Medical oncologists: Physicians who evaluate and treat malignant (cancerous) tumors with medications.
  • Dentists: Dentists and oral surgeons offer a wide range of services, from dental cleaning exams and X-rays to advanced treatments for oral cancer.
  • Speech-language pathologists: Offer comprehensive evaluation and treatment for all speech, language, voice, cognitive (mental/intellectual), and swallowing disorders.
  • Registered dietitians: Help provide for the nutrition needs of patients, based on the patients’ nutritional status, condition, illness, or injury.
  • Social workers: Address concerns and informational needs of patients and families, and provide individual, family, and group counseling, referrals to local community and national organizations and support groups, and financial assistance information.
  • Primary care providers: This is usually an internist or family physician who oversees the patient’s medical care.

Treatments

How is laryngeal cancer treated?

Laryngeal cancer is treated with radiation therapy, chemotherapy, or surgery. Sometimes, it is treated with a combination of these methods.

Radiation therapy

Radiation therapy delivers high energy x-rays to the tumor to kill cancer cells. By focusing the radiation on the cancer cells, the damage to normal structures can be minimized.

Chemotherapy

Chemotherapy is the use of medications to kill or to slow the growth of rapidly multiplying cancer cells. These medications are often given intravenously (through a needle into a blood vessel) and can have major side effects.

Surgery

Surgery for early laryngeal cancer is done to allow the patient to keep the major functions of the larynx, including speaking and swallowing. The goal is to take out the cancer without having to remove the entire larynx. In cases of advanced laryngeal cancer, a laryngectomy (complete removal of the larynx) is often performed.

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