Laryngeal Cancer: Causes, Symptoms and Treatment

What is Laryngeal Cancer?

Laryngeal cancer (medically known as laryngeal carcinoma) is a malignant tumor originating from the tissue of the larynx, commonly referred to as the voice box. The larynx plays a vital role in breathing, swallowing, and speech. The most common type is a squamous cell carcinoma, arising from the mucosal lining of the larynx. Laryngeal cancer is one of the more frequent cancers of the head and neck region and occurs significantly more often in men than in women.

Causes and Risk Factors

The development of laryngeal cancer is usually linked to a combination of risk factors:

• Smoking: Tobacco use is the single most important risk factor. Smokers face up to ten times the risk of non-smokers.
• Alcohol consumption: Heavy and regular alcohol use significantly increases the risk, especially when combined with smoking.
• HPV infection: Certain strains of Human Papillomavirus (HPV) have been linked to the development of laryngeal tumors.
• Occupational exposure: Long-term contact with asbestos, wood dust, chemical fumes, or other carcinogens raises the risk.
• Chronic irritation: Persistent irritation of the laryngeal mucosa, such as from acid reflux (gastroesophageal reflux disease), may increase risk.
• Age and sex: Risk increases after the age of 50 and is substantially higher in men.

Symptoms

Symptoms of laryngeal cancer depend on the exact location of the tumor within the larynx. Common signs include:

• Hoarseness: Persistent, unexplained hoarseness lasting more than three weeks is often the first and most common symptom, particularly for tumors affecting the vocal cords.
• Throat pain and difficulty swallowing: Pain when swallowing or a sensation of something being stuck in the throat.
• Cough: A persistent cough, sometimes with traces of blood.
• Shortness of breath: In advanced stages, the tumor may narrow the airway.
• Unexplained weight loss: Due to swallowing difficulties or as a general sign of cancer.
• Enlarged lymph nodes: Swellings in the neck caused by lymph node metastases.

Diagnosis

Several diagnostic procedures are used to confirm a diagnosis of laryngeal cancer:

• Laryngoscopy: Direct visualization of the larynx by an ear, nose, and throat (ENT) specialist using a flexible or rigid endoscope. This is the primary initial examination.
• Biopsy: A tissue sample is taken from the suspicious area and examined under a microscope (histology) to detect malignant cells.
• Imaging: Computed tomography (CT) or magnetic resonance imaging (MRI) of the neck and chest to assess the extent of the tumor and possible metastases.
• PET-CT scan: Used to detect distant metastases in advanced cases.
• Ultrasound: Sonographic examination of the cervical lymph nodes.

Staging of the tumor using the TNM classification system is essential for determining the appropriate treatment plan.

Treatment

Treatment depends on the stage and location of the tumor as well as the overall health of the patient. The main treatment options include:

Surgery

In early-stage disease, the tumor can often be removed minimally invasively through laser surgery (transoral laser microsurgery) without removing the entire larynx. In more advanced stages, a partial or total laryngectomy (surgical removal of the larynx) may be required. After a total laryngectomy, natural speech is no longer possible; however, patients can communicate using voice prostheses, esophageal speech, or electronic speaking aids.

Radiation Therapy

Radiation therapy is frequently used as the primary treatment in early-stage disease or as an adjunct after surgery. It can preserve the voice and is equally effective as surgery in certain tumor stages.

Chemotherapy and Combined Chemoradiation

For advanced laryngeal cancer, radiation therapy is often combined with chemotherapy (chemoradiation) to enhance effectiveness. The goal is to shrink the tumor and avoid surgery, thereby preserving laryngeal function where possible.

Immunotherapy and Targeted Therapies

In certain cases, particularly for recurrent or metastatic tumors, immune checkpoint inhibitors (e.g., pembrolizumab) or targeted agents (e.g., cetuximab) may be used as part of the treatment plan.

Prognosis and Follow-Up

The chances of recovery depend strongly on the stage of the disease at the time of diagnosis. In early stages (stage I and II), five-year survival rates exceed 80%. In advanced stages, the prognosis worsens significantly. After treatment, regular follow-up examinations with an ENT specialist or oncologist are essential for early detection of recurrence. Speech therapy and rehabilitation are often important components of post-treatment care.

Prevention

The risk of developing laryngeal cancer can be significantly reduced by:

• Complete cessation of tobacco use
• Reduction or elimination of alcohol consumption
• HPV vaccination
• Avoidance of occupational exposure to carcinogens
• Regular medical evaluation for persistent hoarseness

References

1. American Cancer Society (2023): Laryngeal and Hypopharyngeal Cancer. Available at: www.cancer.org
2. National Cancer Institute (2023): Laryngeal Cancer Treatment (PDQ) - Patient Version. Available at: www.cancer.gov
3. Steiner W., Ambrosch P. (2000): Endoscopic Laser Surgery of the Upper Aerodigestive Tract. Thieme, Stuttgart.