16611 Laryngeal Cancer

Overview

Laryngeal cancer is a type of cancer that starts in the larynx, also called the voice box. The larynx is a tube-shaped organ in your neck that helps you breathe, speak, and swallow. Cancer begins when cells in the larynx grow out of control and form a tumor.

Laryngeal cancer is not very common compared with other cancers, but it is one of the more frequently diagnosed cancers of the head and neck. In the UK, it accounts for a small percentage of all new cancer cases, with several thousand people diagnosed each year.

Laryngeal cancer is about four times more common in men than in women. It usually affects people over the age of 60. People who smoke, drink large amounts of alcohol, or have a history of human papillomavirus (HPV) infection are at higher risk.

Symptoms

Common symptoms

• A hoarse voice or voice change that lasts more than three weeks
• A persistent sore throat that does not go away
• Ear pain (often only on one side)
• Pain or difficulty when swallowing
• A lump in the neck
• A persistent cough that is not due to a cold or other infection
• Shortness of breath or noisy breathing

Causes

Main causes

• Most laryngeal cancers are caused by genetic changes in the cells of the larynx, which make them multiply abnormally.
• Long-term exposure to tobacco smoke (including secondhand smoke) damages the cells lining the larynx, which can lead to cancer.
• Heavy alcohol use irritates the larynx and increases the harmful effects of tobacco.
• Infection with high-risk types of human papillomavirus (HPV) is linked to some cancers of the larynx and other head and neck areas.

Risk factors

• Smoking cigarettes, cigars, or pipes, or using chewing tobacco
• Drinking large amounts of alcohol over many years
• Using both tobacco and alcohol together (this greatly increases risk)
• Being exposed to certain workplace substances such as asbestos, wood dust, paint fumes, or certain chemicals
• Having gastroesophageal reflux disease (GERD), where stomach acid regularly travels back up into the throat
• A diet low in fruits and vegetables
• Being male and over the age of 60
• Having a family history of head and neck cancer

When to see a doctor

See a doctor urgently if:

• You have had a hoarse voice or any voice change for more than three weeks.
• You have a sore throat that has lasted for more than three weeks, especially if you also have ear pain.
• You notice difficulty or pain when swallowing that is not going away.
• You have a new lump in your neck that persists for more than a couple of weeks.

Book a routine appointment if:

• You have a persistent cough or a change in your breathing that is not explained by other conditions.
• You are concerned about any voice problem, even if it has not lasted three weeks yet.
• You have risk factors like smoking or heavy drinking and want to discuss your cancer risk.

Diagnosis

If you visit a general practitioner with symptoms, they will ask about your medical history and examine your neck and throat. If they suspect laryngeal cancer, they will refer you to an ear, nose, and throat (ENT) specialist for more detailed tests.

Tests that may be done

• Laryngoscopy: a test using a thin, flexible tube with a light and camera (nasendoscope) passed through your nose to look at the larynx.
• Biopsy: a small sample of tissue is taken from the larynx during laryngoscopy and examined under a microscope for cancer cells.
• Imaging scans: CT, MRI, or PET scans may be used to see the size of the tumor and whether it has spread.
• Panendoscopy: a more detailed examination of the throat, voice box, and food pipe under general anaesthetic.

What to expect at your appointment

The ENT specialist will perform an examination and likely a laryngoscopy, which is not usually painful but may be slightly uncomfortable. If a biopsy is needed, it is often done under local or general anaesthetic. After tests, you will be told the results at a follow-up appointment. If cancer is confirmed, a team of specialists (called a multidisciplinary team) will plan your treatment and talk you through all your options.

Treatment

Treatment for laryngeal cancer depends on the size and stage of the tumor, its exact position, your overall health, and your personal preferences. The main approaches are surgery, radiotherapy, chemotherapy, targeted therapy, or a combination of these. You will have a care plan tailored to you, and your team will explain the benefits and side effects of each option.

Self-care at home

• Stop smoking as soon as you can — this helps treatment work better and lowers the chance of cancer coming back.
• Reduce or stop drinking alcohol, especially during treatment.
• Follow your doctor's advice about resting your voice, especially after surgery.
• Keep all follow-up appointments and tell your team about any new symptoms.
• Ask for help from a speech and language therapist if you have trouble swallowing or speaking.

Medical treatments

Radiotherapy uses high-energy rays to kill cancer cells and can be used as the main treatment for early-stage laryngeal cancer. Chemotherapy uses medicines to kill cancer cells, but it is not a specific drug recommendation here — your team will choose the right regimen for you. Chemotherapy is often given alongside radiotherapy (chemoradiotherapy) to make the radiation more effective. Targeted therapies are newer medicines that block specific signals that help cancer cells grow. You may also receive supportive care to help manage side effects like sore mouth, tiredness, and swallowing problems.

When is surgery considered?

Surgery may be recommended if the cancer is small and limited, or as part of treatment for more advanced cancer. Some operations remove only the part of the larynx containing the tumor (partial laryngectomy), which helps preserve the voice. For more extensive cancers, the whole larynx may need to be removed (total laryngectomy). After a total laryngectomy, you will breathe through an opening in your neck (stoma) and learn new ways to speak, often with the help of a speech therapist.

Living with this condition

After treatment, your daily life may change depending on how much of the larynx was affected. You might need time to adapt to a hoarse voice or to a stoma. It is important to protect your throat and stoma from irritants like smoke and pollutants, and to keep the stoma clean as instructed. You will have regular check-ups to monitor your recovery.

Lifestyle tips

• Stop smoking and avoid secondhand smoke completely.
• Limit or avoid alcohol, especially during and right after treatment.
• Stay physically active at a level that feels comfortable for you.
• Maintain a healthy weight to reduce the risk of recurrence.
• Protect your voice by staying hydrated and avoiding shouting or long conversations when your voice is tired.

Diet and exercise

Eating can be difficult after laryngeal cancer treatment, especially if you have a sore throat or difficulty swallowing. Soft, moist foods, soups, and smoothies can be easier to manage. Your doctor or dietitian may recommend high-protein, high-calorie drinks to help you keep your strength up. Gentle exercise such as walking can help reduce tiredness and improve mood, but you should listen to your body and rest when needed.

Mental health and emotional wellbeing

A cancer diagnosis and treatment can bring up difficult emotions, including anxiety, sadness, and worry about the future. Changes to your voice and appearance can affect your self-esteem and identity. It is completely normal to need support. Talking to a counsellor, psychologist, or spiritual care provider can help. Many people find comfort in connecting with others who have been through the same experience.

Prevention

You cannot always prevent laryngeal cancer, but you can lower your risk by not smoking, avoiding chewing tobacco, limiting alcohol, eating a balanced diet with plenty of fruits and vegetables, and protecting yourself from HPV infection. If you have long-term reflux, managing it with your doctor may also reduce the risk.

Vaccines

There is no vaccine specifically for laryngeal cancer, but an HPV vaccination is available that protects against the high-risk HPV types linked to head and neck cancers, including some laryngeal cancers. Ask your doctor if you are eligible for HPV vaccination.

Screening programmes

There is no national screening programme for laryngeal cancer. If you are at high risk, your doctor may recommend regular check-ups with an ENT specialist. The best 'screening' is to be alert to persistent voice changes and see a doctor early.

Complications

If left untreated

• The tumor can grow and block the airway, making it hard to breathe.
• Cancer may spread to nearby lymph nodes in the neck.
• It can spread to other parts of the body, such as the lungs, liver, or bones.
• Swallowing may become very painful and lead to weight loss and malnutrition.
• Untreated cancer can cause significant bleeding or difficulty speaking.

Long-term outlook

The outlook for laryngeal cancer is good when it is found early. Many early-stage laryngeal cancers are cured, and modern treatments are designed to preserve the voice and quality of life as much as possible. Even for more advanced cancers, treatments can control the disease and help you live well. The outcome varies from person to person, so your medical team will give you more specific information based on your situation. There is always hope and support.

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