The most common form of laryngeal cancer is squamous cell carcinoma (95%); rare forms include adenocarcinoma, sarcoma, and others. Such cancer may be intrinsic or extrinsic.
An intrinsic tumor is on the true vocal cord and tends not to spread because underlying connective tissues lack lymph nodes. An extrinsic tumor is on some other part of the larynx and tends to spread early.
Gender and Age
Laryngeal cancer is nine times more common in males than in females; most victims are between ages 50 and 65.
With laryngeal cancer, major predisposing factors include smoking and alcoholism; minor factors include chronic inhalation of noxious fumes and familial tendency.
Laryngeal cancer is classified according to its location:
supraglottis (false vocal cords)
glottis (true vocal cords)
subglottis (downward extension from the vocal cords [rare]).
Signs and symptoms
With intrinsic laryngeal cancer, the dominant and earliest indication is hoarseness that persists longer than 3 weeks; with extrinsic cancer, it’s a lump in the throat or pain or burning in the throat when drinking citrus juice or hot liquid. Later signs and symptoms of metastasis include dysphagia, dyspnea, cough, enlarged cervical lymph nodes, and pain radiating to the ear.
Any hoarseness that lasts longer than 2 weeks requires visualization of the larynx by laryngoscopy.
A firm diagnosis also requires xeroradiography, a biopsy, laryngeal tomography, computed tomography scan, or laryngography to define the borders of the lesion, and a chest X-ray to detect metastasis.
Early lesions are treated with surgery or radiation; advanced lesions, with surgery, radiation, and chemotherapy. Chemotherapeutic agents may include methotrexate, cisplatin, bleomycin, fluorouracil, and vincristine.
The treatment goal is to eliminate the cancer and preserve speech. If speech preservation is impossible, speech rehabilitation may include esophageal speech or prosthetic devices; surgical techniques to construct a new voice box are still experimental. Surgical procedures vary with tumor size and can include cordectomy, partial or total laryngectomy, supraglottic laryngectomy, or total laryngectomy with laryngoplasty.