Laryngeal cancer is a malignant tumor that arises from the tissue of the larynx, the organ that houses the vocal cords at the entrance to the airway. Its most important early sign is persistent hoarseness, and when it is detected at an early stage, treatment options are generally broader; in many patients, voice-preserving methods can be used. This article explains its causes, symptoms, staging and current treatments in plain language.
What Is Laryngeal Cancer?
The larynx, or voice box, is a cartilage-framed organ below the base of the tongue and just above the windpipe. It produces sound through vocal cord vibration, lets air pass to the lungs and closes during swallowing to keep food out of the windpipe.
The larynx has three regions:
- Supraglottic region: The area above the vocal cords, where the epiglottis (the lid of the larynx) is found.
- Glottic region: The area containing the vocal cords. This is where laryngeal tumors most often occur.
- Subglottic region: The area below the vocal cords, where the larynx joins the windpipe. Tumors are rare here.
Most laryngeal tumors are squamous cell carcinomas, which develop from the cells lining the inner surface of the larynx. The disease is far more common in men than in women and usually appears in people over 50 who have smoked for many years. Where the tumor starts strongly influences when symptoms begin and how the disease behaves.
Causes of Laryngeal Cancer
The disease develops as genetic damage gradually builds up in laryngeal cells. Several risk factors play a clear role:
- Smoking and tobacco products: The most important risk factor. Most patients have a long history of smoking, and risk rises with the amount smoked and the number of years.
- Alcohol: Particularly linked to supraglottic tumors. Using tobacco and alcohol together raises the risk far more than either one alone.
- Occupational exposure: Long-term contact with asbestos, paint and varnish fumes, coal dust, certain chemicals and heavy metals.
- HPV infection: Some subtypes have been linked to laryngeal tumors, although this link is not as strong as it is for tumors of the tonsils and base of the tongue.
- Other factors: A diet low in fruits and vegetables, conditions that weaken the immune system, and older age.
Smoking is one of the most important risk factors that can be changed, and risk declines steadily after quitting. In patients undergoing treatment, continuing to smoke can worsen results and raise the chance of a new tumor.
Precancerous Changes
Some changes on the vocal cords, seen as white patches (leukoplakia) or red areas, may signal a precancerous condition of the cells called dysplasia. Not all of these changes turn into cancer, but they should be evaluated with a biopsy and followed regularly.
Symptoms of Laryngeal Cancer
Symptoms depend on where the tumor starts. Tumors on the vocal cords affect the voice very early and are usually noticed early, while those above or below the cords may remain silent for longer.
Main symptoms to watch for:
- Hoarseness lasting longer than 2-3 weeks, or a voice that becomes deeper or rough
- A constant feeling of something stuck in the throat
- Pain or difficulty when swallowing
- Pain radiating to the ear
- A persistent cough or blood in the phlegm
- A lump in the neck (which may indicate spread to a lymph node)
- In advanced cases, shortness of breath, noisy breathing (stridor) and weight loss
Hoarseness very often has benign causes, such as a cold, voice overuse or reflux. However, hoarseness lasting more than 2-3 weeks, especially in an adult who smokes, should always lead to an examination of the larynx by an ear, nose and throat (ENT) specialist.
Symptoms by Tumor Location
In glottic tumors, the first and often only symptom is hoarseness; this area has few lymph vessels, so early spread to the neck is uncommon. Supraglottic tumors may first cause a stuck feeling in the throat, a pricking sensation when swallowing or ear pain before any voice change. This region is rich in lymph vessels, so in some patients the first sign is a neck lump. Subglottic tumors more often cause shortness of breath and noisy breathing.
How Is Laryngeal Cancer Diagnosed?
Diagnosis begins with a detailed history and an ENT examination; because the larynx cannot be seen directly, special methods are used.
Patients traveling from abroad are encouraged to bring previous examination and biopsy reports, CT, MRI or PET scans (images as well as reports) and a list of their current medications.
Endoscopic Examination
A thin camera passed through the mouth or nose gives a detailed view of the larynx and vocal cords in a few minutes in the clinic. If needed, a method called stroboscopy shows the vibration of the vocal cords in slow motion, which gives an idea of how deep a superficial tumor goes.
Biopsy
A definitive diagnosis requires pathological examination of tissue from the suspicious area. The biopsy is usually taken under general anesthesia through the mouth with the help of a microscope, a procedure called direct laryngoscopy. The tumor’s extent is also mapped in detail.
Imaging and Staging
Computed tomography (CT) or magnetic resonance imaging (MRI) of the neck shows whether the tumor extends into cartilage and surrounding tissues and evaluates the neck lymph nodes. When advanced disease is suspected, PET-CT can be used to scan other parts of the body. Chest imaging is also part of the evaluation.
With this information, the disease is staged using the TNM system, which considers the size of the tumor and vocal cord movement (T), spread to the neck lymph nodes (N) and spread to distant organs (M). Stages I and II are considered early stage, and stages III and IV advanced. Treatment is largely planned on this basis.
Laryngeal Cancer Treatment
Treatment aims to control the disease while preserving speech, swallowing and natural breathing as much as possible. Decisions are made by a team of ENT, radiation oncology, medical oncology, radiology and pathology specialists, taking the patient’s overall health and preferences into account.
Early-Stage Treatment
Early-stage tumors can often be treated with a single method. Two main options stand out:
- Transoral laser surgery: The tumor is removed with a laser under a microscope through the mouth, without a neck incision. The hospital stay is short, and most patients return to daily life fairly soon.
- Radiation therapy: Delivered in daily sessions over several weeks, it is an effective alternative, especially for tumors limited to the vocal cords.
In early-stage disease, both achieve similar disease control; the choice depends on the tumor’s location, expectations for voice preservation and the patient’s circumstances.
Organ-Preserving Treatments
For some advanced tumors, approaches that aim to keep the larynx may be used. The main one is chemoradiotherapy, which combines radiation therapy and chemotherapy. In carefully selected patients, this method aims to control the disease while preserving laryngeal function. The response is closely monitored, and surgery is considered if tumor remains or returns.
Surgical Options
The extent of surgery depends on how widespread the tumor is:
- Partial laryngectomy: Operations that remove only the affected part of the larynx, aiming to preserve speech and natural breathing. Different techniques cover the upper part of the larynx or one side of the vocal cords.
- Total laryngectomy: Removal of the entire larynx, used for widespread tumors, cartilage involvement or disease that returns after other treatments. Afterward, the windpipe is brought to an opening at the front of the neck (a tracheostoma), through which the patient breathes.
- Neck dissection: If the tumor has spread to the neck lymph nodes or the risk is high, these nodes are removed in a planned way during the same operation.
Depending on its extent, the operation takes roughly 1 to 5 hours. The hospital stay is generally 2-3 days for limited procedures and may be longer after extensive surgery, depending on the individual. Based on the pathology result, additional radiation therapy or chemoradiotherapy may be needed after surgery.
Voice and Swallowing Rehabilitation
Speaking is still possible after a total laryngectomy, even without vocal cords. The most commonly used method today is a small voice prosthesis placed between the windpipe and the esophagus; when the patient covers the stoma, air is directed into the esophagus and sound is produced by vibration. Esophageal speech and electrolarynx devices, which create vibration when held against the neck, are other options. Speech and swallowing therapy makes adjusting to daily life considerably easier.
Daily Life After Total Laryngectomy
Because breathing takes place through the stoma rather than the nose, humidifying and filtering the air becomes important; special heat and moisture filters placed over the stoma serve this purpose. Shower covers keep water out of the stoma; swimming is generally not recommended. Patients and families learn stoma cleaning, prosthesis care and that, in emergencies, breathing support must be given through the neck. Over time, many patients return to work, social life and hobbies, and patient associations and support groups play a valuable role.
Notes for Patients Traveling from Abroad
How long to stay in Istanbul cannot be estimated in advance; it depends on the stage, the treatment chosen and the plan agreed by the multidisciplinary team. After limited laser surgery, a stay of about a week may be enough, while extensive surgery, rehabilitation or radiation therapy can require several weeks. Flying is generally postponed until wounds have healed and breathing and swallowing are stable; your surgeon will advise on timing. Long-term follow-up can be shared with a team at home.
Possible Risks and Important Considerations
Each treatment has its own side effects, discussed in detail beforehand. Radiation therapy can cause dry mouth, a burning throat, voice changes and skin redness. Surgery can cause swallowing difficulty, wound healing problems and changes in voice quality. After total laryngectomy, the sense of smell may decrease and getting used to stoma care takes time.
Regular check-ups after treatment are essential, especially in the first two years, because a recurrence caught early leaves more options for retreatment. During follow-up:
- Stop smoking and drinking alcohol completely
- Do not miss follow-up appointments
- Report any new voice change, neck lump, swallowing difficulty or shortness of breath promptly
- After radiation therapy, have thyroid function and dental health checked regularly
Laryngeal Cancer: Frequently Asked Questions
When should hoarseness raise concern about laryngeal cancer?
Hoarseness from a cold usually clears within a week or two. Hoarseness lasting more than 2-3 weeks, getting worse or appearing in a smoker should be examined; endoscopy takes only minutes and helps reach an early diagnosis.
Can laryngeal cancer be treated?
For tumors found at an early stage, treatment success is generally high and the voice can be preserved in most patients. In advanced stages treatment is more extensive, but with current methods disease control can be the goal for many patients. Outcomes vary from person to person depending on stage, tumor location and overall health.
Will I be able to speak after surgery for laryngeal cancer?
After laser surgery and partial laryngectomy, patients continue to speak with their own voice, although voice quality may change. After a total laryngectomy, speech can be regained with methods such as a voice prosthesis.
Is laryngeal cancer contagious?
No, laryngeal cancer does not pass from person to person. Some HPV types being a risk factor does not make the cancer itself contagious.
Does quitting smoking reduce the risk?
Yes. In people who quit, the risk declines markedly over the years. For patients who have been treated, quitting also matters for treatment effectiveness and for lowering the chance of a new tumor.
Conclusion
Op. Dr. Tayfun Demirel, an ENT specialist, evaluates patients with persistent hoarseness or suspected laryngeal cancer at the practice in Ataşehir, Istanbul, using endoscopic examination and any necessary tests. For patients who receive a diagnosis, treatment options are planned individually together with the relevant specialists, with care taken to preserve voice and swallowing function. Please contact the clinic to book an appointment or for more information. This article is for informational purposes only; an in-person examination is required for diagnosis and treatment.
