What Is Laryngeal Cancer? Treatment Of Laryngeal Cancer?

Laryngeal cancer is a malignancy of the voice box (larynx) that can affect breathing and voice production. It arises when cells in the larynx grow abnormally and may invade nearby tissues or spread to lymph nodes in the neck if not treated. This article explains the common symptoms, main causes and risk factors, how the condition is staged and diagnosed, and the principal treatment and therapy options — including surgery, radiation and systemic treatments — so you know when to see a doctor and what to expect.

Key facts: Persistent hoarseness is the commonest early symptom; smoking and alcohol are the main preventable risks; treatments range from organ-preserving radiotherapy and minimally invasive surgery to more extensive operations and systemic therapy for advanced disease.

If you have red-flag symptoms — such as hoarseness lasting more than three weeks, difficulty breathing, persistent difficulty swallowing, or a new neck lump — contact your GP or an ENT specialist promptly for assessment.

What is Laryngeal Cancer?

Laryngeal cancer is a malignancy that develops when cells in the larynx (voice box) grow uncontrollably. The larynx sits between the throat and the trachea and is divided into three anatomical subsites: the supraglottis (above the vocal cords), the glottis (which contains the vocal cords) and the subglottis (below the vocal cords). The subsite matters because it influences symptoms, prognosis and treatment — for example, glottic tumours commonly present early with hoarseness, while supraglottic tumours more often cause swallowing problems or a neck lump.

Tumours of the larynx may invade nearby structures as they grow. Local spread can involve the trachea (windpipe), the oesophagus, regional lymph nodes in the neck and, less commonly, adjacent blood vessels or deeper soft tissues. Distant spread (metastasis) is possible in advanced disease. Treatment and therapy — ranging from radiation therapy and conservative surgery to combined-modality treatment with chemotherapy — are chosen according to the tumour site, stage and the patient’s overall health.

Clinical example: a patient with a small glottic cancer may notice persistent hoarseness but have no neck nodes, allowing curative radiotherapy or limited surgery that preserves voice; conversely, a supraglottic cancer may present later with a palpable neck node requiring combined treatment. If you are concerned about persistent voice changes or a neck lump, see your doctor or ENT specialist promptly for assessment and staging.

What Are the Symptoms of Laryngeal Cancer?

Symptoms of laryngeal cancer depend on the tumour’s location in the larynx and on the stage of disease. Early cancers — especially those affecting the vocal cords — often cause voice change alone, while more advanced disease can cause breathing and swallowing problems or spread to lymph nodes in the neck. Some people have no obvious symptoms in the first stages, which is why awareness of red-flag signs is important.

Red-flag symptoms — see a doctor urgently

Persistent hoarseness or change in the voice lasting more than three weeks (common with glottic/vocal cords disease).
A new, unexplained lump in the neck (possible spread to lymph nodes).
Difficulty swallowing (dysphagia) or sensation of food sticking.
Breathing difficulty, noisy breathing or stridor (possible airway obstruction).
Unexplained weight loss, persistent ear pain (referred otalgia) or blood-stained sputum — particularly if these are new and unexplained.

Other common and supportive symptoms

Hoarseness and voice change: The single most common early sign when the vocal cords are involved. Even subtle voice changes warrant assessment if persistent.
Throat discomfort or chronic throat pain: Deep or persistent throat pain that does not settle with usual measures.
Bad breath (halitosis): May occur in later disease due to local tissue breakdown or infection.
Fatigue and constitutional symptoms: General tiredness, loss of appetite and weight loss can accompany more advanced cancers.
Palpable neck nodes: Enlarged lymph nodes in the neck may indicate regional spread — these should be examined by a doctor.

Clinical notes on symptoms

Site matters: glottic (vocal cords) cancers commonly present earlier with hoarseness; supraglottic cancers may present with swallowing problems or neck lumps.
Referred ear pain is explained by shared nerve supply and is a recognised symptom in head and neck cancers.
Blood-stained sputum (haemoptysis) can occur but is more commonly associated with lower respiratory tract disease; nevertheless, any fresh blood should prompt urgent review.

When to expect diagnosis and treatment

If you present with red-flag symptoms, your GP will usually arrange an urgent ENT review. Diagnosis commonly involves clinical examination, flexible nasendoscopy, imaging (CT or MRI) and biopsy. Early detection improves options for organ-preserving treatment such as radiotherapy or limited surgery; more advanced disease may require combined therapy including surgery, chemotherapy and other systemic treatments. If you notice persistent voice change, a neck lump or any of the red flags above, see your doctor without delay.

What Causes Laryngeal Cancer?

Laryngeal cancer develops when cells in the larynx (voice box) acquire genetic changes that allow uncontrolled growth. Several risk factors influence this process; some you cannot change (non‑modifiable) and others you can (modifiable). Understanding these helps with prevention, earlier detection and treatment planning.

Major modifiable risk factors

Tobacco smoking: The single biggest risk factor. Smoking damages laryngeal tissue and dramatically increases the chance of cancer; risk falls after quitting.
Alcohol: Heavy alcohol consumption independently raises risk and acts synergistically with smoking to further increase the likelihood of cancer.
Occupational exposures: Long‑term exposure to substances such as wood dust, nickel compounds, formaldehyde and some industrial fumes is associated with higher risk; use of appropriate personal protective equipment and workplace controls reduces exposure.
Dietary factors: Low intake of fruit and vegetables may modestly increase risk; a balanced diet is protective for many head and neck cancers.

Other contributory and non‑modifiable factors

Human papillomavirus (HPV): High‑risk HPV strains are a recognised cause of some head and neck cancers; HPV has a stronger established role in oropharyngeal disease than in laryngeal cancer, though it may contribute in a subset of cases.
Age and sex: Laryngeal cancer is more common in older adults and historically has been more frequent in men, reflecting past smoking and alcohol patterns.
Chronic reflux (laryngopharyngeal reflux): Repeated exposure of the laryngeal mucosa to stomach acid may cause irritation and has been proposed as a risk factor; evidence suggests an association rather than definitive causation.
Genetic and medical factors: A family history of head and neck cancers, prior radiation to the head and neck, and certain medical conditions can alter risk.

How risk leads to cancer — carcinogens in tobacco, alcohol and workplace substances damage DNA in laryngeal cells, allowing abnormal cell division and the formation of a tumour. Over time a tumour can invade nearby tissue (for example the trachea or oesophagus) or spread to regional lymph nodes in the neck and, rarely, to distant sites.

Prevention and practical advice: the most effective steps are smoking cessation and reducing excess alcohol intake. If you work with hazardous substances, follow occupational health guidance and use protective equipment. Discuss reflux management, dietary changes and vaccination (for HPV where indicated) with your doctor.

When to see a doctor: if you have persistent hoarseness, a new neck lump, difficulty swallowing or other concerning symptoms, consult your GP or ENT specialist — early detection broadens treatment options and improves outcomes.

Stages of Laryngeal Cancer

Staging describes how far laryngeal cancer has spread and helps guide treatment. Modern staging uses the TNM system (Tumour, Nodes, Metastasis) and classifies disease from Stage 0 (carcinoma in situ) through Stage IV (with subdivisions IVA, IVB, IVC). Staging depends on the size and extent of the primary tumour, involvement of regional lymph nodes in the neck, and whether the cancer has spread to distant sites.

Quick TNM overview (simple)

T (tumour): T1–T4 describes increasing size and/or local invasion (for example, T1 glottic tumours are small and limited to the vocal cords; T4 tumours invade nearby structures such as cartilage, trachea or oesophagus).
N (nodes): N0 means no regional lymph node involvement; N1–N3 indicate increasing size/number of affected lymph nodes in the neck.
M (metastasis): M0 = no distant spread; M1 = distant metastasis (rare at presentation but important for prognosis and systemic treatment).

What the stages mean in practice

Stage 0 (carcinoma in situ): Abnormal cells are limited to the surface lining. Treatment is usually curative with local excision or radiation therapy.
Stage I–II (early stage): Small, localised tumours (for example many glottic cancers) with no or minimal nodal disease. Curative options frequently include radiotherapy or conservative surgery that aim to preserve voice and airway function.
Stage III: Larger primary tumours or single ipsilateral lymph node involvement. Treatment often requires combined approaches such as surgery plus radiotherapy, or chemoradiation for organ preservation.
Stage IV (advanced): Tumours invading adjacent structures, multiple or large lymph nodes, or distant metastases. Management may involve extensive surgery (including partial or total laryngectomy), neck dissection, chemotherapy, radiation therapy and palliative measures depending on the individual case.

Clinical implications: Early-stage glottic cancers often present with voice changes and have excellent cure rates with organ-preserving treatment. More advanced tumours are more likely to need multimodality treatment, which can include surgery (sometimes total laryngectomy) with significant effects on voice and breathing; rehabilitation (speech and swallow therapy) is important after such treatments.

Staging and treatment planning are best performed by a multidisciplinary team (MDT) including head and neck surgeons, radiation oncologists, medical oncologists and speech therapists. For up-to-date stage definitions and prognosis data, refer to national guidelines such as those from NICE or Cancer Research UK and discuss individual staging with your treating doctor.

How is Laryngeal Cancer Diagnosed?

Early diagnosis of laryngeal cancer improves treatment options and outcomes. Diagnosis is led by an ear, nose and throat (ENT) specialist and typically follows a stepwise pathway: clinical assessment, direct visualisation of the larynx, imaging to assess extent and staging, and histological confirmation with a biopsy.

Clinical assessment

Your doctor will take a history focusing on symptoms (persistent hoarseness, swallowing or breathing problems, neck lumps, weight loss) and risk factors (smoking, alcohol, occupational exposures). A physical neck examination looks for enlarged lymph nodes in the neck that may indicate regional spread.

Direct visualisation — laryngoscopy

Flexible nasendoscopy (a thin scope via the nose) is usually performed in clinic to inspect the larynx and vocal cords. If a suspicious lesion is seen, a diagnostic microlaryngoscopy under general anaesthetic allows a detailed view and enables tissue sampling (biopsy). Flexible nasendoscopy is quick and well tolerated; microlaryngoscopy is required when a biopsy is needed or when clearer assessment is essential.

Imaging tests

CT scan of the neck (and usually chest) is commonly used to define tumour size, cartilage invasion and to look for spread to lymph nodes or lungs.
MRI provides superior soft-tissue detail and is helpful when assessing invasion into laryngeal cartilage or adjacent soft tissues.
PET–CT is used selectively to detect distant metastases or to clarify ambiguous findings on CT/MRI, particularly in advanced disease or when planning salvage treatment.

Biopsy and pathology

A tissue biopsy provides a definitive diagnosis and is examined by a histopathologist to determine the type of cancer (most commonly squamous cell carcinoma) and features that influence treatment. Biopsy is usually taken during microlaryngoscopy; occasionally fine-needle aspiration of a neck node is used to confirm spread to lymph nodes.

Blood tests and pre-treatment assessment

Routine blood tests (full blood count, renal and liver function) do not diagnose cancer but are important to assess general fitness and to plan systemic treatments such as chemotherapy. Other tests (cardiac assessment, dental review, nutrition and swallowing evaluations) may be necessary before treatment starts.

Practical considerations and safety netting

If you are taking anticoagulant medications, inform your team before biopsy — management may need temporary adjustment.
Ask your clinician about likely effects of biopsy or treatment on voice and swallowing; early referral to speech and language therapy can assist rehabilitation.
Staging (TNM) is completed after imaging and pathology so the multidisciplinary team can recommend the most appropriate cancer treatment and therapy plan.

If you have persistent red-flag symptoms (for example hoarseness >3 weeks, a new neck lump, swallowing or breathing problems), contact your GP for urgent ENT referral. Accurate diagnosis and staging are essential to select the best treatment — whether organ-preserving radiotherapy, conservative surgery, combined chemoradiation or more extensive surgery such as laryngectomy in advanced cases.

How is Laryngeal Cancer Treated?

Treatment for laryngeal cancer is personalised according to the tumour’s stage, its location in the larynx (supraglottic, glottic or subglottic), and the patient’s overall health and preferences. The main aims are cure when possible, preservation of breathing and voice function where feasible, symptom control and quality of life. Below are the principal treatment approaches, typical indications and what patients can expect.

Curative-intent, early-stage treatments (organ preservation)

Radiation therapy is a common curative option for many early-stage glottic and selected supraglottic tumours. It uses high-energy rays to kill cancer cells while aiming to preserve the larynx and voice. Typical side-effects for head and neck radiotherapy include mucositis, sore throat, difficulty swallowing, dry mouth (xerostomia), skin redness and fatigue; nausea or vomiting are uncommon unless given with systemic chemotherapy. Radiation therapy schedules vary but are usually delivered daily over several weeks.

Conservative surgery includes endoscopic excision or transoral laser microsurgery for small tumours of the vocal cords or supraglottis. These procedures can offer excellent local control with shorter recovery and often preserve voice better than more extensive surgery.

Combined-modality treatment for more advanced local disease

Chemoradiotherapy (concurrent chemotherapy with radiation therapy) is frequently used to attempt organ preservation in larger tumours or where nodal disease is present. Chemotherapy agents increase the effectiveness of radiation but add systemic side-effects such as nausea, fatigue, hair thinning and lowered blood counts. Treatment is planned by a multidisciplinary team and includes supportive measures to manage side-effects.

Neoadjuvant (induction) chemotherapy may be used in selected cases to shrink bulky tumours prior to definitive local therapy.

Surgery — from partial to total laryngectomy

Partial laryngectomy removes only the affected part of the larynx and may preserve some voice and swallowing function. It is suitable for selected tumours.

Total laryngectomy removes the entire larynx and is sometimes required for very advanced tumours or when organ preservation has failed. After a total laryngectomy the airway is diverted through a permanent opening (stoma) in the neck; patients lose natural voice but speech can often be restored using voice prostheses, electrolarynx devices and speech therapy. Neck dissection (removal of lymph nodes in the neck) is performed when there is nodal involvement.

Targeted therapies and immunotherapy

Some systemic treatments target specific molecular pathways in cancer cells (targeted therapy) or enhance the immune response (immunotherapy). These options are generally employed in recurrent or metastatic disease or within clinical trials. Availability and indications vary — your oncologist can advise whether these are appropriate based on tumour biology and prior treatments.

Palliative care and symptom control

When cure is not possible, treatment focuses on maintaining airway patency, relieving pain, improving swallowing and maximising quality of life. Options include radiotherapy for local control, systemic therapy to slow cancer spread, surgical procedures to secure the airway or feeding access, and multidisciplinary palliative support.

Rehabilitation, follow-up and survivorship

Rehabilitation is an essential part of care. Speech and language therapists help patients regain or adapt communication and swallowing after surgery, radiation or chemoradiation. Regular follow-up in a multidisciplinary clinic monitors for recurrence, manages late effects and offers support for nutrition, dental care and psychosocial needs.

Side-effects and practical patient information

Radiation therapy — mucositis, dysphagia, xerostomia, skin changes, altered voice; manage with mouth care, dietary advice and speech therapy.
Chemotherapy — systemic effects such as nausea, fatigue, infection risk and blood count changes; supportive medications and monitoring reduce risks.
Surgery — risks depend on extent; total laryngectomy has major functional consequences but can be life-saving; rehabilitation services are available.

Decisions about laryngeal cancer treatment are complex and best made by a multidisciplinary team (MDT) that includes head and neck surgeons, radiation oncologists, medical oncologists and speech therapists. If you or someone you care for has symptoms or a diagnosis of laryngeal cancer, discuss organ-preservation versus radical surgery, likely side-effects and rehabilitation options with your MDT and treating doctor.

Quick FAQs

Will I lose my voice? It depends on treatment — many early tumours are treated with voice-preserving techniques; total laryngectomy results in loss of natural voice but alternatives exist. How long is radiotherapy? Typically several weeks of daily treatment. What is recovery like after laryngectomy? Hospital stay and rehabilitation vary; speech therapy and stoma care training are essential.

If you have persistent symptoms — such as hoarseness for more than three weeks, difficulty swallowing, a new neck lump or breathing problems — contact your GP or ENT specialist promptly. Early assessment increases options for curative, organ-preserving treatment and improves outcomes.