What is laryngeal cancer?

Laryngeal cancer is cancer of the larynx, part of the throat. Cancer happens when specific cells grow uncontrollably. As the cells multiply, they invade and damage the body. In laryngeal cancer, these cancerous (malignant) cells start in the larynx (voice box).

What is the larynx?

The larynx is in your throat. It’s also known as the voice box. The larynx helps us speak, breathe and swallow. Our vocal cords are part of the larynx.

The larynx is mostly made up of cartilage, a flexible tissue that makes a supportive framework. The larynx has three parts:

• Supraglottis (upper part): More than one in three laryngeal cancers (35%) start here.
• Glottis (middle part): More than half of laryngeal cancers (60%) start here, where the vocal cords are.
• Subglottis (lower part): About 5% of laryngeal cancers — 1 in 20 — start here.

What does the larynx do?

The larynx helps us:

• Breathe: The vocal cords open to let air through.
• Speak: The vocal cords close. As air passes through the vocal cords, they vibrate, helping create speech sounds.
• Swallow: The epiglottis (part of the supraglottis) drops down over the larynx. The vocal cords close to keep food out of the lungs.

What are the risk factors for laryngeal cancer?

Smoking or using other tobacco products greatly increases your risk of developing laryngeal cancer. Drinking alcohol, especially a lot of it, also raises your risk. And using alcohol and tobacco together increases the risk even more.

Other risk factors for laryngeal cancer include:

• Age: Laryngeal cancer happens more in people age 55 and older.
• Gender: Men are more likely to develop this cancer, possibly because smoking and heavy alcohol consumption happen more among men.
• History of head and neck cancer: About one in four (25%) people who have had head and neck cancer will get it again.
• Job: People who have exposure to certain substances at work are at higher risk. These substances include sulfuric acid mist, wood dust, nickel, asbestos or manufacturing mustard gas. People who work with machines are also at higher risk.

SYMPTOMS AND CAUSES

What causes laryngeal cancer?

Researchers don’t know what causes laryngeal cancer. But if you have risk factors such as tobacco or alcohol use, you have a much higher chance of developing laryngeal cancer.

Some forms of HPV (human papillomavirus), a sexually transmitted disease, can cause laryngeal cancer.

What are the symptoms of laryngeal cancer?

It’s easy to mistake symptoms of laryngeal cancer for other conditions. If you experience these symptoms, talk to your healthcare provider for an accurate diagnosis:

• Sore throat or cough that doesn’t go away.
• Voice change, such as hoarseness, that doesn’t improve after two weeks.
• Pain or other difficulties when you swallow.
• Lump in the neck or throat.
• Dysphonia, trouble making voice sounds.
• Ear pain.

If you have these symptoms, seek medical attention right away:

• Trouble breathing (dyspnea).
• Stridor, breathing that’s noisy and high-pitched.
• Globus sensation, feeling that something’s in your throat.
• Coughing up blood (hemoptysis).

DIAGNOSIS AND TESTS

How is laryngeal cancer diagnosed?

Your healthcare provider asks you about your symptoms and medical history. They do a physical exam, examining your throat and neck. After the initial exam, you’ll most likely need other tests to confirm a diagnosis.

What other tests help diagnose laryngeal cancer?

Other diagnostic tests include:

• Imaging scans: CT or MRI scans provide detailed images of the body. A chest X-ray can see if cancer has spread to the lungs.
• Laryngoscopy: Your provider uses a thin, lighted tube called an endoscope to examine your larynx.
• PET scan: During a PET scan, a provider injects a small, safe dose of a radioactive substance into your vein. The substance highlights abnormal areas. A PET scanner machine creates 3D pictures from the energy the substance gives off.
• Biopsy: During a biopsy, your provider removes a small piece of any abnormal tissue in the larynx to examine under a microscope.

What are the stages of laryngeal cancer?

Part of diagnosis is staging the cancer. Your care team will figure out how severe the disease is — how far the tumour has grown and if and where it has invaded in the body.

Laryngeal cancer can sometimes invade the thyroid, esophagus, tongue, lungs, liver and bones. Stages of laryngeal cancer include:

• Early laryngeal cancer: In stages 0, 1 and 2, the tumour is small. Cancer has not spread beyond the larynx.
• Advanced laryngeal cancer: In stages 3 and 4, the tumour has grown larger. It’s affected the vocal cords or invaded the lymph nodes or other areas of the body.

MANAGEMENT AND TREATMENT

Who helps diagnose and treat laryngeal cancer?

A laryngeal cancer care team often consists of multiple providers from different fields:

• Head and neck surgeons provide surgical care for tumours.
• Radiation oncologists use radiation therapy to treat cancer.
• Medical oncologists use medication, such as chemotherapy, to treat cancer.
• Otolaryngologists (ear, nose and throat specialists) treat head and neck diseases.
• Dentists and oral surgeons offer services such as X-rays and treat oral cancer.
• Speech-language pathologists evaluate and treat speech, language, voice, cognitive and swallowing disorders.
• Registered dietitians help people find a nutritious diet based on their health, condition, illness or injury.
• Social workers can address concerns and provide information to patients and families. They also offer counseling, referrals to local and national resources, information about support groups and financial assistance information.
• Primary care providers often oversee general medical care during cancer treatment.

What is the treatment for laryngeal cancer?

Treatment for laryngeal cancer includes:

• Radiation therapy: Radiation oncologists deliver high-energy radiation beams to kill cancer cells. The radiation targets only the tumour to minimize damage to the surrounding healthy tissue.
• Chemotherapy: Medical oncologists use medications to kill or slow the growth of cancer cells. People often get chemotherapy intravenously (through a vein). Chemo can cause side effects during treatment.
• Immunotherapy: This treatment uses your immune system, your body’s natural defenses, to help fight cancer. Immunotherapy is also called biologic therapy.
• Surgery: For early laryngeal cancer, surgery can remove the tumour while preserving the larynx (and the ability to speak and swallow). For advanced cancer, surgeons often need to do a laryngectomy, removing the entire larynx.

You may have more than one treatment. For example, people sometimes have chemotherapy or radiation therapy after surgery to destroy any remaining cancer cells.

What laryngeal surgery procedures are available?

Surgery removes cancer. The goal of laryngeal cancer surgery is to remove the tumour while preserving your function. The surgeon may need to remove part or all of the larynx. Surgical procedures include:

• Cordectomy: Removes part or all of a vocal cord, usually through the mouth
• Supraglottic laryngectomy: Removes the supraglottis, either through the neck or through the mouth
• Hemilaryngectomy: Removes half the larynx, preserving your voice.
• Partial laryngectomy: Removes part of the larynx so you retain your ability to talk.
• Total laryngectomy: Removes the entire larynx, through the neck
• Thyroidectomy: Removes all or part of the thyroid gland.
• Laser surgery: Removes a tumour in a bloodless procedure using a laser beam.

How does the care team figure out the best treatment for laryngeal cancer?

For early laryngeal cancer, your care team will likely recommend surgery or radiation therapy. Research has shown that both are effective. Your team will base the decision on several factors, including:

• Treatment that will preserve your voice and swallowing abilities.
• Your preferences, wishes and ability to follow the treatment plan.
• Your age.
• Other conditions you may have.
• Demands on your voice, including for your job.
• How your voice sounds.
• If you smoke or smoked.
• Your ability to breathe.
• Support from your loved ones.

PREVENTION

Can I prevent laryngeal cancer?

You can’t prevent all cancer. But you can lower your risk for developing cancer, including laryngeal cancer, by living a healthy lifestyle:

• Quit smoking and avoid tobacco products.
• Limit alcohol consumption and get treatment for alcohol use disorder or alcoholism.
• Eat a healthy diet.

How do I know if I’m at risk?

If you have any of the risk factors for laryngeal cancer — for example, if you smoke or had head and neck cancer in the past — talk to your healthcare provider. They can help you take steps to lower your risk of developing cancer.

Is there screening for laryngeal cancer?

There’s no regular screening test for laryngeal cancer. But talk to your healthcare provider if you have hoarseness, other voice changes or a persistent cough. Early detection catches cancer early, when it’s easiest to treat.

OUTLOOK / PROGNOSIS

What happens after laryngeal cancer treatment?

After your treatment, you continue to have follow-up appointments with your healthcare provider to make sure you’re recovering well. Your provider will:

• Treat any pain.
• Help you manage swallowing problems or mucositis (ulcers in the digestive tract).
• Discuss your diet to make sure you’re eating and swallowing.
• Prescribe physical therapy for scarring in your neck or trouble opening your mouth.

What’s the outlook for people with laryngeal cancer?

The outlook differs for people, depending on factors such as the cancer’s stage and your age and general health. Generally, early laryngeal cancer has a better cure rate. Advanced cancer that spreads to other areas has a poorer survival rate.

But even advanced laryngeal cancer can be cured. If it comes back, it usually happens within the first two or three years after treatment. After five years, there’s very low risk of cancer returning.

LIVING WITH

How do I take care of myself if I have a total laryngectomy?

If you smoke, it’s important to quit. Don’t smoke before or during treatment, and stay tobacco-free even after you finish treatment. People who smoke after treatment have a higher chance of developing another type of cancer. But patients who stop smoking have a much lower risk of cancer. Smoking also prevents you from healing completely, and it may cause worse side effects from treatment.

Will I have a stoma?

If you have a total laryngectomy, your surgeon will put a new airway in your throat called a stoma. The stoma helps you breathe. It may be permanent or temporary. Take care of your stoma:

• Check it daily to make sure it’s clean and mucus-free.
• Clean mucus from the stoma by coughing it out or using saline spray and cloth.
• Keep it moist with saline spray.
• Clean the stoma area with mild soap and water.
• Don’t submerge the stoma in water.
• Cover the stoma to keep dust out, using a scarf or a special stoma cover. And keep it covered when shaving or in the shower.

Will I be able to use my voice after laryngeal cancer treatment?

If you had a laryngectomy (surgeons removed your larynx), you will need to learn a new way to speak. A speech language pathologist can help.

How can I speak after a laryngectomy?

Healthcare providers use three methods for helping people learn how to speak after a laryngectomy:

• Oesophageal speech: You force air into the oesophagus, the tube that carries food and liquid to the stomach. When you push the air out, it passes through your throat. You use the vibration it creates to say words. Oesophageal speech requires intensive therapy for good results.
• Artificial larynx (electrolarynx): You hold this electronic device against your neck or cheek or put in your mouth to produce sound. The device creates a vibration that you can use to speak words. It doesn’t require surgery, and you can speak right away. But the speech may sound mechanical. A speech pathologist helps you learn how to use it.
• Tracheoesophageal puncture: Your surgeon creates a hole in your throat, between your oesophagus and trachea. They place a prosthesis with a one-way valve in the hole. The valve opens when air passes through. You force air from your lungs into your throat. When the air reaches your oesophagus, it produces vibrations you can use to speak. You need to maintain and replace the prosthesis regularly. But it creates a smoother voice.

How do I breathe after a laryngectomy?

After a laryngectomy, you breathe by taking air in through a stoma, an opening made in your neck. Care for your stoma to keep it moist and free of mucus. Make sure to protect your trachea (windpipe) as well.

After surgery, you’ll be fitted with a stoma cover and filter (HME=heat and moisture exchange). This allows you to breath warmed and moisturized air, using your body’s own power. You’ll find this causes you to have less mucus and debris in the windpipe and minimizes coughing after surgery.

Will I be able to eat after a laryngectomy?

Right after the surgery, you won’t eat or drink anything by mouth. You’ll get your nutrition through a feeding tube. A few days after surgery, your healthcare provider will check to see if you can swallow food and liquid without a problem. Once you can swallow safely, you’ll start eating soft foods (puddings and pureed foods) and progress to a regular diet.

What should I ask my healthcare provider?

If you’ve been diagnosed with laryngeal cancer, ask your provider:

• What stage is the cancer?
• What are my treatment options?
• How will treatment affect my speaking, breathing and swallowing?
• Will I need rehabilitation after treatment?
• Will the cancer come back?
• How can I stay healthy?

Minimally Invasive Procedures for Laryngeal Cancer

Minimally invasive procedures allow doctors to remove laryngeal cancer without making incisions in the neck.

Endoscopic Transoral Resection

In endoscopic transoral resection, a surgeon removes early laryngeal cancer through an endoscope—a thin, lighted tube with a lens at the tip that transmits images to a monitor. Doctors also use a microscope to get a precise view of the anatomy of the area. The procedure may be the only treatment needed for early laryngeal cancer.

During the procedure, the doctor inserts the endoscope through the mouth and into the larynx. He or she places small surgical instruments into the scope to remove the cancer. To spare as much of the vocal cords as possible, doctors may use a laser through the scope to remove or destroy small laryngeal tumours and precancerous tissue, called dysplasia. General anaesthesia is required.

If portions of the larynx need to be removed, they can often be reconstructed to restore your ability to speak.

Open Surgery for Laryngeal Cancer

If laryngeal cancer cannot be easily removed with a minimally invasive procedure, surgeons may perform open surgery, which involves making an incision in the neck. General anaesthesia is used.

Partial Laryngectomy

In a partial laryngectomy, surgeons remove a portion of the larynx while preserving as much of the vocal cords as possible. A partial laryngectomy may be an option in people with early cancer that has not spread.

Total Laryngectomy

For large tumours that affect most or all of the larynx, a total laryngectomy may be necessary. During this procedure, surgeons remove the entire larynx.

The larynx helps you breathe, so surgeons have to create a new pathway for air to flow in and out of the trachea, or windpipe. They connect the trachea to a small, surgically created hole in the neck called a stoma. Air flows in and out of the stoma and into the trachea. Doctors and nurses can help you adapt to using and caring for the stoma.

During or after the laryngectomy, surgeons may insert a small prosthesis connecting the trachea and oesophagus, which is the muscular tube that carries food from the mouth to the stomach, to help restore your voice. Highly trained speech therapists can teach you how to talk using this prosthesis.

The oesophagus is usually not affected by a total laryngectomy, so you can continue to swallow food normally.

Neck Dissection

Laryngeal cancer may spread to the lymph nodes—small organs that make and store lymphocytes, white blood cells that help fight infection—in the neck. If the results of testing show cancer in the lymph nodes, doctors may perform open surgery to remove them, in a procedure called neck dissection.

Doctors may also remove lymph nodes if they appear swollen. They send the nodes to a pathologist, who can determine whether they contain cancer.

Knowing whether the cancer has spread to the lymph nodes and surrounding tissues can help doctors determine whether radiation therapy or a combination of radiation and chemotherapy is necessary after surgery.

Recovery from Surgery for Laryngeal Cancer

Recovery from surgery depends on the type of procedure performed and whether reconstructive surgery is necessary. For example, if surgeons use an endoscopic approach for an early cancer, you may be able to go home the same day. An open surgery to remove large or complex tumours may require a hospital stay of a couple of days so doctors can monitor your recovery and manage any pain and discomfort with medication. If open surgery and reconstruction are necessary, you may remain in the hospital a few days longer.