What Are the Early Signs of Larynx Cancer?

Hoarseness, voice changes and a persistent sore throat are all early signs of laryngeal cancer. A doctor must diagnose larynx cancer, however.

Laryngeal cancer (larynx cancer) occurs when cells in the larynx (voice box) grow out of control. 

What Are Symptoms of Laryngeal Cancer?

Early signs and symptoms of laryngeal cancer include: 

• Hoarseness 
• Voice changes 

Other symptoms of laryngeal cancer include: 

• Persistent sore throat 
• Constant coughing
• Pain when swallowing
• Difficulty swallowing
• Ear pain/earache
• Unexplained weight loss
• Bad breath
• Wheezing
• Fatigue
• Breathing difficulty, in severe cases
• A lump or mass in the neck (if cancer spreads to nearby lymph nodes)

The cause of laryngeal cancer is unknown. 

Risk factors for developing laryngeal cancer include: 

• Smoking tobacco
• Moderate to heavy alcohol use
• A family history of head and neck cancer
• An unhealthy diet high in red meat, processed foods, and fried foods
• Human papilloma virus (HPV) infection
• Exposure to certain chemicals and substances, such as 
  • Asbestos 
  • Coal or wood dust 
  • Paint or diesel fumes
  • Nickel
  • Sulphuric acid fumes
  • Formaldehyde  
  • Isopropyl alcohol 
• Certain genetic syndromes
  • Fanconi anemia
  • Dyskeratosis congenita
• Gender
  • four times more common in men than women
• Age
  • Over half of patients are 65 or older 
• Race
  • More common among African Americans and whites than among Asians and Latinos
• Gastroesophageal reflux disease (GERD)

Laryngeal cancer is diagnosed with a patient history and a physical examination, including:

• Laryngoscopy
• Pan-endoscopy (combines laryngoscopy, esophagoscopy, and sometimes bronchoscopy)
• Biopsy
  • Endoscopic biopsy
  • Fine needle aspiration (FNA) biopsy
• Imaging tests
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Barium swallow
  • Positron emission tomography (PET) scan
  • Chest X-ray (to see if the cancer has spread to the lungs)
• Blood tests 
  • Liver function 
  • Kidney function
• Electrocardiogram (EKG) to check the heart if surgery is planned
• Pulmonary function tests (PFTs) if surgery is planned

Treatment for laryngeal cancer may include one or more of the following: 

• Surgery
  • Endoscopic resection to remove the tumor
    • Used in early-stage laryngeal cancer
  • Partial laryngectomy
    • Surgical removal of the affected part of the larynx
    • Some of vocal cords will be left in place, so patients can still talk but the voice may be hoarse or weak
    • A temporary hole in the neck (tracheostomy) may be created to help patients breathe
  • Total laryngectomy
    • Removal of the entire larynx
    • Used to treat advanced laryngeal cancer
    • A permanent hole in the neck (stoma) may be created to help patients breathe
• Radiation therapy
  • External beam radiation therapy
  • Internal radiation therapy (brachytherapy)
• Chemotherapy
  • Cisplatin
  • Carboplatin
  • 5-fluorouracil (5-FU)
  • Docetaxel (Taxotere)
  • Paclitaxel (Taxol)
  • Epirubicin
• Targeted therapy
  • Cetuximab (Erbitux) 
• Immunotherapy
  • Immune checkpoint inhibitors: pembrolizumab (Keytruda) and nivolumab (Opdivo)

Life expectancy for laryngeal cancer is often expressed in 5-year survival rates, that is, how many people will be alive 5 years after diagnosis. 

Supraglottis (part of the larynx above the vocal cords) 5-year survival rates:

• Localized (no sign the cancer has spread outside the larynx): 61% 
• Regional (cancer has spread outside the larynx to nearby structures or lymph nodes): 47% 
• Distant (cancer has spread to distant parts of the body such as the lungs): 30%

Glottis (part of the larynx including the vocal cords) 5-year survival rates:

• Localized (no sign the cancer has spread outside the larynx): 83% 
• Regional (cancer has spread outside the larynx to nearby structures or lymph nodes): 48% 
• Distant (cancer has spread to distant parts of the body such as the lungs): 42%

Subglottis (part of the larynx below the vocal cords) 5-year survival rates:

• Localized (no sign the cancer has spread outside the larynx): 60% 
• Regional (cancer has spread outside the larynx to nearby structures or lymph nodes): 33%* 
• Distant (cancer has spread to distant parts of the body such as the lungs): 45%*

*The 5-year survival for these tumors at the distant stage is better than for the regional stage but the reason for this is not clear.