Laryngeal cancer - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Laryngeal cancer is frequently associated with smoking and alcohol consumption.
Hoarseness, dysphonia, sore throat, difficulty swallowing, referred otalgia, vocal cord lesions on indirect laryngoscopy, and neck mass/adenopathy that persists for >3 weeks are sentinel signs that should be evaluated by an otolaryngologist.
Treatment is dictated by TNM stage.
Modalities include surgical resection, radiation therapy, chemotherapy, or any combination of these.
Goals of therapy are eradication of cancer with organ preservation.

Irregular mass of left arytenoid and aryepiglottic folds, and the right arytenoid mucosa

From the collection of Dr Amy Chen, Emory University; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Small whitish mass along anterior third of left true vocal fold
Irregular mass of left arytenoid and aryepiglottic folds, and the right arytenoid mucosa
CT scan showing bulky tumor invading ala of thyroid cartilage
Large, bulky transglottic mass and increased uptake on PET (bright yellow/orange)

Citations

Key Articles

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: head and neck cancers [internet publication].[Full Text]
Pelucchi C, Gallus S, Garavello W, et al. Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol Res Health. 2006;29(3):193-8.[Abstract]
Forastiere AA, Ismaila N, Lewin JS, et al. Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2018 Apr 10;36(11):1143-69.[Abstract][Full Text]
Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013 Mar 1;31(7):845-52.[Abstract][Full Text]
American College of Radiology. ACR Appropriateness Criteria: retreatment of recurrent head and neck cancer after prior definitive radiation. 2014 [internet publication].[Full Text]

Other Online Resources

Patient selection for hypoxia modifying treatments in larynx carcinomas
ACS: laryngeal and hypopharyngeal cancer

Referenced Articles

1. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: head and neck cancers [internet publication].[Full Text]
2. Pan Y, Hong Y, Liang Z, et al. Survival analysis of distant metastasis of laryngeal carcinoma: analysis based on SEER database. Eur Arch Otorhinolaryngol. 2019 Jan;276(1):193-201.[Abstract]
3. American Cancer Society. Cancer facts and figures 2024. 2024 [internet publication].[Full Text]
4. National Cancer Institute. Cancer stat facts: laryngeal cancer. 2023 [internet publication].[Full Text]
5. Zhang QW, Wang JY, Qiao XF, et al. Variations in disease burden of laryngeal cancer attributable to alcohol use and smoking in 204 countries or territories, 1990-2019. BMC Cancer. 2021 Oct 7;21(1):1082.[Abstract][Full Text]
6. World Health Organization. Data visualization tools for exploring the global cancer burden in 2022. 2022 [internet publication].[Full Text]
7. Nocini R, Molteni G, Mattiuzzi C, et al. Updates on larynx cancer epidemiology. Chin J Cancer Res. 2020 Feb;32(1):18-25.[Abstract][Full Text]
8. Zuo JJ, Tao ZZ, Chen C, et al. Characteristics of cigarette smoking without alcohol consumption and laryngeal cancer: overall and time-risk relation. A meta-analysis of observational studies. Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1617-31.[Abstract]
9. Pelucchi C, Gallus S, Garavello W, et al. Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol Res Health. 2006;29(3):193-8.[Abstract]
10. Bagnardi V, Blangiardo M, La Vecchia C, et al. A meta-analysis of alcohol drinking and cancer risk. Br J Cancer. 2001 Nov 30;85(11):1700-5.[Abstract][Full Text]
11. Altieri A, Garavello W, Bosetti C, et al. Alcohol consumption and risk of laryngeal cancer. Oral Oncol. 2005 Nov;41(10):956-65.[Abstract]
12. Eells AC, Mackintosh C, Marks L, et al. Gastroesophageal reflux disease and head and neck cancers: a systematic review and meta-analysis. Am J Otolaryngol. 2020 Nov-Dec;41(6):102653.[Abstract]
13. Parsel SM, Wu EL, Riley CA, et al. Gastroesophageal and laryngopharyngeal reflux associated with laryngeal malignancy: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2019 Jun;17(7):1253-64.e5.[Abstract][Full Text]
14. Galli J, Cammarota G, Calo L, et al. The role of acid and alkaline reflux in laryngeal squamous cell carcinoma. Laryngoscope. 2002 Oct;112(10):1861-5.[Abstract]
15. van der Laan BF, Baris G, Gregor RT, et al. Radiation-induced tumours of the head and neck. J Laryngol Otol. 1995 Apr;109(4):346-9.[Abstract]
16. Karatayli-Ozgursoy S, Pacheco-Lopez P, Hillel AT, et al. Laryngeal dysplasia, demographics, and treatment: a single-institution, 20-year review. JAMA Otolaryngol Head Neck Surg. 2015 Apr;141(4):313-8.[Abstract][Full Text]
17. Kostev K, Jacob LEC, Kalder M, et al. Association of laryngeal cancer with vocal cord leukoplakia and associated risk factors in 1,184 patients diagnosed in otorhinolaryngology practices in Germany. Mol Clin Oncol. 2018 May;8(5):689-93.[Abstract][Full Text]
18. Theodosiou MG, Yiotakis J, Dikoglou C, et al. Laryngeal dysplasia: a long-term follow-up study. J BUON. 2013 Jul-Sep;18(3):683-8.[Abstract][Full Text]
19. Garavello W, Foschi R, Talamini R, et al. Family history and the risk of oral and pharyngeal cancer. Int J Cancer. 2008 Apr 15;122(8):1827-31.[Abstract][Full Text]
20. Egeli U, Ozkan L, Tunca B, et al. The relationship between genetic susceptibility to head and neck cancer with the expression of common fragile sites. Head Neck. 2000 Sep;22(6):591-8.[Abstract]
21. Yu KK, Zanation AM, Moss JR, et al. Familial head and neck cancer: molecular analysis of a new clinical entity. Laryngoscope. 2002 Sep;112(9):1587-93.[Abstract]
22. Johnson DE, Burtness B, Leemans CR, et al. Head and neck squamous cell carcinoma. Nat Rev Dis Primers. 2020 Nov 26;6(1):92.[Abstract][Full Text]
23. Renan MJ. How many mutations are required for tumorigenesis? Implications from human cancer data. Mol Carcinog. 1993;7:139-46.
24. Li X, Gao L, Li H, et al. Human papillomavirus infection and laryngeal cancer risk: a systematic review and meta-analysis. J Infect Dis. 2013 Feb 1;207(3):479-88.[Abstract][Full Text]
25. National Cancer Institute. Laryngeal cancer treatment (PDQ®)-health professional version. 2024 [internet publication].[Full Text]
26. Lindeberg H, Elbrond O. Malignant tumours in patients with a history of multiple laryngeal papillomas: the significance of irradiation. Clin Otolaryngol Allied Sci. 1991 Apr;16(2):149-51.[Abstract]
27. Frumkin H. Agent Orange and cancer: an overview for clinicians. CA Cancer J Clin. 2003 Jul-Aug;53(4):245-55.[Full Text]
28. Seoane JT. Impact of delay in diagnosis on survival to head and neck carcinomas: a systematic review with meta-analysis. Clin Otolaryngol. 2012 Apr;37(2):99-106.[Abstract]
29. Shephard EA, Parkinson MA, Hamilton WT. Recognising laryngeal cancer in primary care: a large case-control study using electronic records. Br J Gen Pract. 2019 Feb;69(679):e127-33.[Abstract][Full Text]
30. American College of Radiology. ACR Appropriateness Criteria: staging and post-therapy assessment of head and neck cancer. 2023 [internet publication].[Full Text]
31. Kraft M, Betz CS, Leunig A, et al. Value of fluorescence endoscopy for the early diagnosis of laryngeal cancer and its precursor lesions. Head & Neck. 2011 Jul;33(7):941-8.[Abstract]
32. Agarwal V, Branstetter BF 4th, Johnson JT. Indications for PET/CT in the head and neck. Otolaryngol Clin North Am. 2008 Feb;41(1):23-49.[Abstract]
33. Yilmaz E, Ismaila N, Bauman JE, et al. Immunotherapy and biomarker testing in recurrent and metastatic head and neck cancers: ASCO guideline. J Clin Oncol. 2023 Feb 10;41(5):1132-46.[Abstract][Full Text]
34. Tesic-Vidovic L. Laryngeal tuberculosis: a report of three cases. Internet J Otorhinolaryngol. 2006;4.
35. Dipika A, Balakrishnan C, Nene A, et al. Upper airways involvement in Wegener's granulomatosis: a case report and review. J Indian Rheumatol Assoc. 2004;12:127-9.[Full Text]
36. Amin MB, Edge S, Green F, et al. AJCC cancer staging manual. 8th ed. (2017). Cham, Switzerland: Springer International; 2017.
37. Kuhn MA, Gillespie MB, Ishman SL, et al. Expert consensus statement: management of dysphagia in head and neck cancer patients. Otolaryngol Head Neck Surg. 2023 Apr;168(4):571-92.[Abstract][Full Text]
38. Boyle K, Jones S. Functional outcomes of early laryngeal cancer - endoscopic laser surgery versus external beam radiotherapy: a systematic review. J Laryngol Otol. 2022 Oct;136(10):898-908.[Abstract]
39. Agrawal N, Ha PK. Management of early-stage laryngeal cancer. Otolaryngol Clin North Am. 2008 Aug;41(4):757-69.[Abstract]
40. Thomas L, Drinnan M, Natesh B, et al. Open conservation partial laryngectomy for laryngeal cancer: a systematic review of English language literature. Cancer Treat Rev. 2012 May;38(3):203-11.[Abstract]
41. Feng YW. Comparison of preoperative radiation and surgery with surgery alone for laryngeal carcinoma. Cancer Treat Rev. 2010;17:1949-52.
42. Forastiere AA, Ismaila N, Lewin JS, et al. Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2018 Apr 10;36(11):1143-69.[Abstract][Full Text]
43. Higgins KM, Shah MD, Ogaick MJ, et al. Treatment of early-stage glottic cancer: meta-analysis comparison of laser excision versus radiotherapy. J Otolaryngol Head Neck Surg. 2009 Dec;38(6):603-12.[Abstract]
44. Warner L, Chudasama J, Kelly CG, et al. Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. Cochrane Database Syst Rev. 2014 Dec 12;(12):CD002027.[Abstract][Full Text]
45. Spielmann PM, Majumdar S, Morton RP, et al. Quality of life and functional outcomes in the management of early glottic carcinoma: a systematic review of studies comparing radiotherapy and transoral laser microsurgery. Clin Otolaryngol. 2010 Oct;35(5):373-82.[Abstract]
46. Lefebvre JL, Ang KK; Larynx Preservation Consensus Panel. Larynx preservation clinical trial design: key issues and recommendations: a consensus panel summary. Head Neck. 2009 Apr;31(4):429-41.[Abstract]
47. Tandon S, Munir N, Roland NJ, et al. A systematic review and number needed to treat analysis to guide the management of the neck in patients with squamous cell carcinoma of the head and neck. Auris Nasus Larynx. 2011 Dec;38(6):702-9.[Abstract]
48. Chen AY, Halpern M. Factors predictive of survival in advanced laryngeal cancer. Arch Otolaryngol Head Neck Surg. 2007 Dec;133(12):1270-6.[Abstract][Full Text]
49. Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991 Jun 13;324(24):1685-90.[Abstract]
50. Ghadjar PS, Zimmermann FB. Concomitant cisplatin and hyperfractionated radiotherapy in locally advanced head and neck cancer: 10-year follow-up of a randomized phase III trial (SAKK 10/94). Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):524-31.[Abstract]
51. Bourhis JS, Martin LA, ly-Schveitzer NS, et al. Concomitant chemoradiotherapy versus acceleration of radiotherapy with or without concomitant chemotherapy in locally advanced head and neck carcinoma (GORTEC 99-02): an open-label phase 3 randomised trial. Lancet Oncology. 2012 Feb;13(2):145-53.[Abstract]
52. Ang KK, Zhang Q, Rosenthal DI, et al. Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. J Clin Oncol. 2014 Sep 20;32(27):2940-50.[Abstract][Full Text]
53. Nguyen-Tan PF, Zhang Q, Ang KK, et al. Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 trial: long-term report of efficacy and toxicity. J Clin Oncol. 2014 Dec 1;32(34):3858-66.[Abstract][Full Text]
54. Kiyota N, Tahara M, Mizusawa J, et al. Weekly cisplatin plus radiation for postoperative head and neck cancer (JCOG1008): a multicenter, noninferiority, phase II/III randomized controlled trial. J Clin Oncol. 2022 Jun 20;40(18):1980-90.[Abstract][Full Text]
55. Wee JT, Anderson BO, Corry J, et al. Management of the neck after chemoradiotherapy for head and neck cancers in Asia: consensus statement from the Asian Oncology Summit 2009. Lancet Oncol. 2009 Nov;10(11):1086-92.[Abstract]
56. Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013 Mar 1;31(7):845-52.[Abstract][Full Text]
57. Hristov B, Bajaj GK. Radiotherapeutic management of laryngeal carcinoma. Otolaryngol Clin North Am. 2008 Aug;41(4):715-40.[Abstract]
58. Paleri V, Thomas L, Basavaiah N, et al. Oncologic outcomes of open conservation laryngectomy for radiorecurrent laryngeal carcinoma: a systematic review and meta-analysis of English-language literature. Cancer. 2011 Jun 15;117(12):2668-76.[Abstract]
59. Caudell JJ, Sawrie SM, Spencer SA, et al. Locoregionally advanced head and neck cancer treated with primary radiotherapy: a comparison of the addition of cetuximab or chemotherapy and the impact of protocol treatment. Int J Radiat Oncol Biol Phys. 2008 Jul 1;71(3):676-81.[Abstract]
60. Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006 Feb 9;354(6):567-78.[Abstract][Full Text]
61. National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: palliative care [internet publication].[Full Text]
62. Brouwer J, Hooft L, Hoekstra OS, et al. Systematic review: accuracy of imaging tests in the diagnosis of recurrent laryngeal carcinoma after radiotherapy. Head Neck. 2008 Jul;30(7):889-97.[Abstract]
63. American College of Radiology. ACR Appropriateness Criteria: retreatment of recurrent head and neck cancer after prior definitive radiation. 2014 [internet publication].[Full Text]
64. Bradley PJ, Mackenzie K, Wight R, et al. Consensus statement on management in the UK: transoral laser assisted microsurgical resection of early glottic cancer. Clin Otolaryngol. 2009 Aug;34(4):367-73.[Abstract]
65. ClinicalTrials.gov. Chemotherapy with or without bevacizumab in treating patients with recurrent or metastatic head and neck cancer. Jan 2016 [internet publication].[Full Text]
66. Argiris A, Li S, Savvides P, et al. Phase III randomized trial of chemotherapy with or without bevacizumab in patients with recurrent or metastatic head and neck cancer. J Clin Oncol. 2019 Dec 1;37(34):3266-74.[Abstract][Full Text]
67. Janssens GO, van Bockel LW, Doornaert PA, et al. Computed tomography-based tumour volume as a predictor of outcome in laryngeal cancer: results of the phase 3 ARCON trial. Eur J Cancer. 2014 Apr;50(6):1112-9.[Abstract]
68. Biel MA. Photodynamic therapy and the treatment of neoplastic diseases of the larynx. Laryngoscope. 1994 Apr;104(4):399-403.[Abstract]
69. Biel MA. Photodynamic therapy treatment of early oral and laryngeal cancers. Photochem Photobiol. 2007 Sep-Oct;83(5):1063-8.[Abstract]
70. Cohen EE, LaMonte SJ, Erb NL, et al. American Cancer Society head and neck cancer survivorship care guideline. CA Cancer J Clin. 2016 May;66(3):203-39.[Abstract][Full Text]
71. National Institute for Health and Care Excellence. Cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck. Jun 2017 [internet publication].[Full Text]
72. Cancer Research UK. Laryngeal cancer: survival. Jan 2022 [internet publication].[Full Text]
73. van Imhoff LC, Kranenburg GG, Macco S, et al. Prognostic value of continued smoking on survival and recurrence rates in patients with head and neck cancer: a systematic review. Head Neck. 2016 Apr;38 Suppl 1:E2214-20.[Abstract]
74. Brandstorp-Boesen J, Sørum Falk R, Folkvard Evensen J, et al. Risk of recurrence in laryngeal cancer. PLoS One. 2016 Oct 7;11(10):e0164068.[Abstract][Full Text]
75. Rudolph E, Dyckhoff G, Becher H, et al. Effects of tumour stage, comorbidity and therapy on survival of laryngeal cancer patients: a systematic review and a meta-analysis. Eur Arch Otorhinolaryngol. 2011 Feb;268(2):165-79.[Abstract]
76. Meyer FF. Predictors of severe acute and late toxicities in patients with localized head-and-neck cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):1454-62.[Abstract]
77. Jacobi I, van der Molen L, Huiskens H, et al. Voice and speech outcomes of chemoradiation for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol. 2010 Oct;267(10):1495-505.[Abstract][Full Text]
78. Anderson CM, Lee CM, Saunders DP, et al. Phase IIb, randomized, double-blind trial of GC4419 versus placebo to reduce severe oral mucositis due to concurrent radiotherapy and cisplatin for head and neck cancer. J Clin Oncol. 2019 Dec 1;37(34):3256-65.[Abstract][Full Text]
79. Marron M, Boffetta P, Zhang ZF, et al. Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk. Int J Epidemiol. 2010 Feb;39(1):182-96.[Abstract][Full Text]