Laryngeal Cancer

Overview

Laryngeal cancer is cancer that starts in the larynx — your voice box. The larynx is the small tube in the front of your neck that holds your vocal cords. It does three important jobs: it lets you make sound and speak, it keeps your airway open so you can breathe, and it closes off when you swallow so food and drink go down the right way. When cells in this area grow out of control, it is called laryngeal cancer. Most cases start in the vocal cords themselves, which is actually helpful — changes in your voice often show up early.

It is not common. Laryngeal cancer is an uncommon cancer compared with things like breast, lung or bowel cancer. Because it is uncommon, doctors take voice changes seriously and check them carefully rather than assuming the worst.

It mostly affects people over the age of 60, and it is more common in men than in women. It is rare in people under 40. It is strongly linked to smoking and to heavy alcohol use. It can happen to anyone, including people who have never smoked, so having it does not mean you did something wrong.

Symptoms

Common symptoms

• A hoarse, rough or croaky voice that lasts more than three weeks
• A voice that sounds different from your normal voice, or that tires quickly
• A lump or swelling in the neck
• A sore throat or pain when swallowing that does not go away
• Pain that spreads to one ear (this can happen with throat problems)
• A long-lasting cough, or coughing up mucus
• Noisy breathing or a feeling of a blockage when breathing
• Bad breath or a bad taste in the mouth that does not settle
• Losing weight without trying, or finding eating and drinking harder than before

Symptoms in children

• Laryngeal cancer is extremely rare in children. Voice changes, coughs and noisy breathing in children almost always have other causes, such as infections, reflux, vocal strain from shouting, or harmless lumps on the vocal cords.
• Still, if a child has a hoarse voice or noisy breathing that lasts more than a few weeks, or any trouble breathing, they should be checked by a doctor.

Symptoms in older adults

• Older adults are the group most likely to develop laryngeal cancer, so a voice change lasting more than three weeks deserves a check rather than being put down to age or 'just a cold'.
• Symptoms can be easy to miss or blame on other things, such as a long-standing smoker's cough, dentures, dry mouth, or a chest problem.
• Weight loss, tiredness and swallowing difficulties can be more serious in older adults, so mention them to your doctor early.

Causes

Main causes

• The main cause is damage to the cells of the voice box over many years. Tobacco smoke and alcohol are the two biggest culprits, and they damage cells directly.
• Some cases are linked to long-term infection with certain types of the human papillomavirus (HPV), a very common virus passed on through skin-to-skin and sexual contact. This link is stronger for other head and neck cancers than for laryngeal cancer.
• In many people no single clear cause is found, and the cancer may come from a mix of factors, including age and genetics.

Risk factors

• Smoking or using other tobacco products — this is the biggest risk factor
• Drinking a lot of alcohol regularly, especially alongside smoking
• Being male and being over 60
• Long-term contact at work with certain dusts, fumes or chemicals, such as asbestos or some industrial substances
• Long-term acid reflux (stomach acid coming up into the throat), which can irritate the voice box
• A weakened immune system
• Previous radiotherapy to the neck
• A family history of head and neck cancer

When to see a doctor

See a doctor urgently if:

• You are coughing up blood
• You have a lump in your neck that is new or getting bigger
• You are finding it hard to swallow liquids, or swallowing is very painful
• Your breathing is becoming noisy or difficult — if it is severe, call your local emergency number straight away
• A hoarse voice is getting worse quickly over days rather than weeks

Book a routine appointment if:

• Your voice has been hoarse or changed for more than three weeks
• You have a sore throat or earache that keeps coming back without a clear cause
• You have a cough or throat clearing that has lasted more than a few weeks
• You have lost weight without trying, or your appetite has changed
• You have a feeling of a lump in your throat or that food sticks on the way down

Diagnosis

Your doctor will start by asking about your symptoms, how long you have had them, and whether you smoke or drink. They will look in your mouth and feel your neck for lumps. If your voice has been hoarse for more than about three weeks, or there is a neck lump, they will usually refer you to a specialist ear, nose and throat (ENT) team. The specialist examines your voice box with a small flexible camera passed through the nose, or a rigid camera via the mouth. If something looks abnormal, they take a small sample of tissue (a biopsy) to check it under a microscope. Only a biopsy can confirm whether a growth is cancer.

Tests that may be done

• A careful examination of your mouth, throat and neck, including feeling for lumps
• Nasendoscopy — a thin flexible camera passed gently through the nose to look at the voice box; it is quick and usually only mildly uncomfortable
• Biopsy — a small tissue sample taken under local or general anaesthetic and checked in a laboratory
• CT or MRI scans of the neck to see the size of the cancer and whether it has spread to nearby lymph nodes
• A chest X-ray or CT scan of the chest, and sometimes a PET scan, to check the rest of the body
• Blood tests to check your general health and to help plan treatment

What to expect at your appointment

Being referred for tests can be an anxious time, and waiting for results is often the hardest part. The tests themselves are usually quick. The camera examination may make your eyes water or feel strange for a minute or two, and your throat may be a little numb afterwards if a spray anaesthetic is used. A biopsy may cause a sore throat or a small amount of blood-tinged spit for a day or so. Ask the team any questions you have, and take someone with you if that helps. You are entitled to clear explanations, and it is fine to ask for them to be repeated or written down.

Treatment

Treatment depends on the size and position of the cancer, whether it has spread, and your general health and wishes. The main treatments are surgery, radiotherapy (high-energy X-rays that destroy cancer cells) and chemotherapy (medicines that attack cancer cells). These are often combined. A team of specialists — surgeons, cancer doctors, radiologists, speech and language therapists, dietitians and specialist nurses — will discuss your case together and agree a plan with you. The two big goals are curing the cancer and keeping you breathing, swallowing and speaking as well as possible.

Self-care at home

• Stop smoking if you smoke — this helps treatment work better and lowers the chance of the cancer coming back. Ask for help; it is much easier with support than alone.
• Cut down or stop alcohol, especially during treatment, as it can make side effects worse
• Keep your mouth clean and moist — sip water often, and ask your team about mouth care and saliva products
• Use a humidifier or steam in the room if the air is dry, and avoid smoky or dusty places
• Keep eating and drinking as well as you can, and ask to see a dietitian early if swallowing is hard
• Rest your voice when it feels tired, and use other ways to get attention instead of shouting
• Write down your questions and bring someone to appointments — it is hard to remember everything alone

Medical treatments

Radiotherapy uses carefully aimed high-energy rays to kill cancer cells while sparing as much healthy tissue as possible. It is usually given in short daily sessions over several weeks. Chemotherapy uses cancer-fighting medicines, usually given into a vein, and is often used alongside radiotherapy to make it work better. Some people are offered targeted treatments, which are medicines that focus on specific features of cancer cells, or immunotherapy, which helps the immune system attack the cancer. Your specialist team will explain which options suit your situation, along with the likely benefits and side effects. Side effects can include a sore mouth and throat, dry mouth, tiredness, voice changes, taste changes and skin reactions in the treated area, and the team has ways to help manage each of these. Always ask your own care team before taking any new medicine, including over-the-counter ones and herbal products.

When is surgery considered?

Surgery is often used for laryngeal cancer, especially when the cancer is small and can be removed while keeping the voice. Some small cancers can be removed through the mouth using a laser or fine instruments, with a short recovery. Larger cancers may need an operation through the neck to remove part or all of the voice box. If the whole voice box is removed (laryngectomy), the breathing tube is brought out through a small opening in the front of the neck called a stoma. This sounds frightening, but people live full lives after it, and speech can be restored in several ways with the help of speech and language therapists. Your surgeon will explain exactly what is planned, what your voice is likely to be like afterwards, and what rehabilitation and support are available.

Living with this condition

Life after treatment settles into a new routine. Many people notice their voice is different — perhaps weaker, breathier or lower — and it may tire more easily. Speech and language therapists can teach you ways to protect your voice, and if part or all of your voice box was removed, they will help you learn to speak again using methods such as a small valve, an external device, or oesophageal speech. Eating and swallowing may take time to adjust, and a dietitian can help with textures and nutrition. Follow-up appointments are usually every few months at first, then less often, and are a chance to raise anything that worries you.

Lifestyle tips

• Stay smoke-free — this is the single most helpful thing you can do for your recovery and to reduce the risk of the cancer returning
• Limit alcohol, and ask for support if cutting down is difficult
• Keep up gentle daily movement — walking, stretching, or whatever your team says is safe
• Cover your stoma with a scarf or bib in cold, dusty or windy weather, and keep the area clean and dry
• Keep up with dental check-ups; radiotherapy can affect teeth and gums
• Protect your skin in the treated area from strong sun
• Pace yourself — tiredness after treatment is common and usually improves over weeks to months

Diet and exercise

Good food and gentle activity help you recover and cope with treatment. Aim for regular meals and snacks rather than one big meal, and choose soft, moist, higher-protein foods if swallowing is sore — things like soup, scrambled eggs, yoghurt, soft fish, mashed vegetables and smoothies. A dietitian can suggest texture changes and supplements if you are losing weight. Keep alcohol low and drink water little and often. For exercise, start gently and build up — short walks, light housework, and simple strength exercises with your doctor's or physiotherapist's agreement. If breathing feels harder than usual during activity, stop and rest, and tell your team.

Mental health and emotional wellbeing

A cancer diagnosis is a big deal emotionally, and it is completely normal to feel shocked, frightened, angry or low. Changes to your voice can affect how you feel about yourself and how easily you join in with conversations, which can feel isolating. Many people find anxiety peaks around tests and follow-up scans. Talking helps — with a friend, a specialist nurse, a counsellor or a support group. If low mood, worry or poor sleep lasts more than a couple of weeks, or if you have thoughts of harming yourself, please reach out for help straight away: contact your GP or care team, or call your local emergency number if you feel unsafe. You do not have to cope alone, and support is a sign of strength, not weakness.

Prevention

Many cases could be prevented, because the biggest risk factors are things you can change. Not smoking — or stopping now, at any age — is the most powerful step. Keeping alcohol within low-risk levels also helps a lot, and the benefit is greatest if you do both. Avoiding long-term contact with harmful workplace dusts and fumes (and using proper protective equipment) matters too. If you have persistent acid reflux, treating it is sensible for your throat in general.

Vaccines

There is no vaccine against laryngeal cancer itself. The HPV vaccine protects against the types of human papillomavirus that cause several head and neck cancers as well as cervical cancer, and it is offered routinely to young people in many countries. It does not treat an existing cancer. Ask your doctor or school health service whether it is available to you or your family.

Screening programmes

There is no national screening programme for laryngeal cancer. The best 'screening' is paying attention to your own voice: if hoarseness or a voice change lasts more than about three weeks, get it checked. People who smoke or drink heavily, or who have had head and neck cancer before, may be seen more regularly by specialist teams.

Complications

If left untreated

• The cancer can grow and spread to nearby lymph nodes in the neck
• It can block the airway, causing serious breathing difficulty
• It can make swallowing very difficult, leading to weight loss and poor nutrition
• It can spread to other parts of the body, such as the lungs
• It can cause pain, bleeding, or a hoarse voice that becomes very weak

Long-term outlook

The outlook for laryngeal cancer is best when it is found early, and many people are successfully treated and return to a good quality of life. Treatment has improved a lot, and specialists now work hard to preserve breathing, swallowing and speech wherever possible. Some people need ongoing help with voice or swallowing afterwards, and follow-up care is there to catch any problems early. If you are worried about your future, it can help to talk it through honestly with your specialist team — they can explain what is known about your situation, what support is available, and what the plan is. Thinking about the future with hope, while taking things one step at a time, is a reasonable way through.

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