Laryngeal cancer

Published by Bupa's Health Information Team, July 2010.

This factsheet is for people who have laryngeal (larynx) cancer, or who would like information about it.

Laryngeal cancer is cancer of the larynx. The larynx is a 5cm long tube that separates the oesophagus (the pipe that goes from the mouth to the stomach) from the windpipe (trachea). Laryngeal cancer is much more common in men - for every women diagnosed, four men are diagnosed.

About laryngeal cancer

Your larynx is found in the front of your neck at the level of the 'Adam's apple', which is often much easier to notice in men than it is in women. It is an air passage that extends from your tongue to your trachea and produces the sounds you make when you speak. It also stops food entering your trachea and allows you to breathe.

Laryngeal tumours develop when cells in your larynx grow in an abnormal and uncontrolled way. Malignant (cancerous) tumours can grow in your larynx and spread (metastasise) to other organs through your bloodstream or lymphatic system (part of your immune system). Benign (non-cancerous) tumours don't spread to other parts of your body.

About 1,800 men and 400 women develop laryngeal cancer in the UK every year. Older people (over 50) are more likely to develop laryngeal cancer than younger people.

Types of laryngeal cancer

There are several different types of laryngeal cancer. Squamous cell cancer, which starts in the cells lining your larynx, is the most common and causes more than 9 out of 10 laryngeal cancers. Another less common type is adenocarcinoma, which starts in your gland cells. These cells, also known as adenomatous cells, are scattered around the surface of your larynx and produce mucus. Sarcomas are a much rarer type of malignant tumour. They start in connective tissues such as cartilage, muscle and nerves.

Symptoms of laryngeal cancer

One of the most common symptoms of laryngeal cancer is a hoarse voice, or change in voice pitch. Hoarseness is a common symptom of conditions other than cancer, such as viral laryngitis (sore throat), or an allergy. However, if you have a hoarse voice for longer than four weeks, see your doctor. Other symptoms of laryngeal cancer include:

• pain or discomfort when you swallow - this can vary from feeling like there is a crumb stuck in your throat to being completely unable to swallow
• a lump in your neck or throat
• unexplained coughing
• restrictive and noisy breathing
• unexplained weight loss
• earache that doesn't go away

All of these symptoms can also be caused by conditions other than laryngeal cancer. If you have any of these symptoms, see your doctor to confirm a diagnosis.

Causes of laryngeal cancer

There is no single cause of laryngeal cancer, but there are certain factors that may increase your risk of developing it, as follows:

• Smoking tobacco. If you smoke regularly, you are at a higher than average risk because you inhale chemicals that cause cancer.
• Drinking alcohol excessively. If you drink heavily - particularly spirits - you are three times more likely to develop laryngeal cancer than non-drinkers.
• Having the human papilloma virus (HPV). If you develop papilloma growths on your larynx you may have an increased risk of developing laryngeal cancer later in life.
• Poor diet. If your diet lacks essential vitamins and minerals, this may increase your risk. A diet high in fresh fruit and vegetables and low in fat may help reduce your risk.
• Environmental factors, including exposure to chemicals such as asbestos, formaldehyde, nickel and sulphuric acid. Being regularly exposed to lots of wood dust, paint fumes and soot or coal dust for a long time may increase your risk.

Diagnosis of laryngeal cancer

Your doctor will examine your throat and ask about your symptoms. You may be referred to a doctor who specialises in ENT (ear, nose and throat) conditions. He or she may ask you to have the following tests to confirm a diagnosis:

• An indirect laryngoscopy. This involves putting a small mirror - like the one your dentist uses when checking your teeth - into your mouth to look at the back of your throat and your larynx.
• A nasoendoscopy. Your doctor will pass a narrow, flexible, tube-like telescopic camera, known as an endoscope, into your nose and down the back of your throat to see your larynx. The procedure may feel a bit uncomfortable, so your doctor may use a local anaesthetic spray.
• A biopsy. This is when a small sample of tissue is removed. Biopsies of the larynx are usually carried out under general anaesthesia, so you may need to stay in hospital overnight. Your tissue sample will be sent to a laboratory for testing and will usually come back within a week.

If your specialist has confirmed a diagnosis of laryngeal cancer, you may need further tests to find out the extent of your primary tumour and check whether the cancer has spread to other parts of your body. These tests may include a combination of CT (computerised tomography) and MRI (magnetic resonance imaging) scans, which use X-rays or radiowaves to produce two- and three-dimensional pictures of the inside of your body. You may also have blood tests and an X-ray of your chest.

Treatment or laryngeal cancer

Your treatment will depend on the type, stage and grade of your laryngeal cancer. It will also depend on your age and general health.

Radiotherapy

Radiotherapy is the most common treatment for people who have small laryngeal tumours that haven't spread. The aim of the treatment is to destroy the cancer cells in your larynx and surrounding lymph nodes.

If you have a large laryngeal tumour, you may need to have radiotherapy as well as surgery. Radiotherapy may be used either to shrink your tumour (to make it easier to remove), or to kill any cancerous cells that might not have been removed during surgery.

Chemotherapy

If you have a large laryngeal tumour, you may be given chemotherapy before, or at the same time as, radiotherapy treatment. You may be injected with a chemotherapy medicine, via a drip in your arm.

Surgery

If you have a very small or early stage laryngeal tumour, you may be able to have laser surgery to remove it. Your surgeon will use a narrow, intense beam of light to cut out the abnormal cancer cells - sparing as much of your larynx as possible.

If you have a large or advanced stage laryngeal tumour, you may need open surgery to remove part (partial laryngectomy) or all (total laryngectomy) of your larynx. Your surgeon may also need to remove some of your lymph nodes nearby. In a total laryngectomy, your surgeon separates your windpipe from your larynx, and joins it to an opening (stoma) in your neck.

After a partial laryngectomy your voice will be weaker, or more hoarse than it was before. You may need to have a tube called a tracheostomy inserted through the front of your neck to help you breathe. This is usually only temporary, until your larynx has healed.

If you have a total laryngectomy, it will affect the way you breathe, speak and swallow. You will breathe through your stoma and won't be able to speak like you used to. You may be able to have a voice prosthesis fitted, or use a battery-operated machine called an electropharynx. Alternatively, you may be able to learn to produce a voice by using your oesophagus. Your doctor or nurse will be able to advise you, or may refer you to a speech and language therapist for further advice.

Biological therapy

If you have squamous cell laryngeal cancer and your tumour hasn't spread, your surgeon may treat you with a biological therapy, in combination with radiotherapy. Biological therapies, including monoclonal antibody treatments like cetuximab, use substances which are naturally produced in your body to destroy cancer cells.

Help and support

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There may also be support groups so you can meet people who've have similar experiences to you. Ask your doctor for advice.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.