Laryngeal Cancer: Symptoms, Types, Causes and Treatment

Laryngeal cancer, a malignancy arising in the tissues of the larynx (voice box), not only threatens essential functions like breathing, speaking, and swallowing, but also deeply affects quality of life. Each year, thousands of individuals worldwide are diagnosed with this challenging disease, often after experiencing subtle symptoms that may be overlooked. In this comprehensive guide, we explore the key symptoms, distinct types, underlying causes, and modern treatment strategies for laryngeal cancer—empowering patients, caregivers, and the curious reader alike with evidence-based insights.

Symptoms of Laryngeal Cancer

Recognizing the symptoms of laryngeal cancer early is crucial for prompt diagnosis and effective treatment. While some symptoms are classic and well-known, others are subtle and often mistaken for benign conditions, delaying intervention.

Symptom	Description	Frequency/Significance	Sources
Hoarseness	Persistent change in voice quality	Most common, early sign	1 2 5
Sore Throat	Lasting throat pain, especially if persistent	Overlooked, higher risk if chronic	1 4
Dysphagia	Difficulty swallowing	Associated with advanced disease	1 2 5
Cough	Persistent, may be dry or productive	Sometimes early, variable	2 5
Otalgia	Ear pain without ear disease	Can indicate tumor spread	1
Dyspnoea	Shortness of breath	More common in late stages	1 2 5
Neck Lump	Swelling or mass in neck	Suggests lymph node involvement	5

Table 1: Key Symptoms

Understanding Laryngeal Cancer Symptoms

Hoarseness: The Classic Red Flag

Persistent hoarseness is the hallmark early symptom, often prompting medical attention. This occurs as the tumor affects the vocal cords, disrupting their normal vibration and sound production. If hoarseness lasts more than three weeks, it warrants evaluation, especially in individuals over 40 or with risk factors 1 2 5.

Sore Throat and Recurrent Throat Pain

A sore throat that does not resolve, particularly when combined with other symptoms like difficulty swallowing or ear pain, is a significant warning sign. Recent studies emphasize that persistent sore throat, even in the absence of hoarseness, should not be dismissed—especially if accompanied by dysphagia or neck lumps 1 4.

Difficulty Swallowing (Dysphagia)

Dysphagia often signals more advanced disease, when the tumor starts to obstruct the laryngeal or pharyngeal passage. Patients may report pain or a sensation of food sticking in the throat 1 5.

Other Notable Symptoms

• Cough: A persistent cough, sometimes dry, may be an early manifestation.
• Ear Pain (Otalgia): This can occur when cancer irritates nerves that refer pain to the ear, even without ear disease 1.
• Shortness of Breath (Dyspnoea): In late-stage cases, airway obstruction leads to breathing difficulties.
• Neck Lump: Swelling in the neck, due to lymph node involvement, is often a sign of metastasis 5.

Less Common Presentations

Symptoms like mouth discomfort, insomnia, or recurrent chest infections can occasionally herald laryngeal cancer, particularly when persistent and unexplained 1.

Types of Laryngeal Cancer

Laryngeal cancer is not a single entity—it encompasses several histological types and can arise in different anatomical regions of the larynx, each with unique implications for prognosis and treatment.

Type/Subsite	Description	Prevalence/Features	Sources
Squamous Cell Carcinoma	Arises from epithelial lining; most common	~95% of cases	5 7 9
Glottic	Originates in true vocal cords	Most frequent subsite	5 7
Supraglottic	Above the vocal cords	Second most common	5 7
Subglottic	Below the vocal cords	Rarest	5 7
Rare Histologies	Includes sarcomas, melanomas, etc.	Very rare, distinct behavior	7
Molecular Subtypes	Based on gene mutations (e.g., NSD1/2)	May influence prognosis	6 8

Table 2: Laryngeal Cancer Types and Subsites

Anatomy and Histology

Squamous Cell Carcinoma: The Dominant Type

The overwhelming majority of laryngeal cancers (>90%) are squamous cell carcinomas (SCC), developing from the epithelial lining due to carcinogenic exposures 5 7 9. Other histologies, such as adenocarcinoma, sarcoma, or melanoma, are exceedingly rare and often require different management 7.

Anatomic Subsites

• Glottic Cancer: Arises from the true vocal cords; presents early due to voice changes, usually has a favorable prognosis 5 7.
• Supraglottic Cancer: Develops above the vocal cords (e.g., epiglottis); tends to present later, often with swallowing difficulties or neck lumps 5 7.
• Subglottic Cancer: Originates below the vocal cords; rarest, often diagnosed at a more advanced stage 5 7.

Histological Variants

Besides conventional SCC, rare variants include:

• Verrucous carcinoma
• Basaloid SCC
• Sarcomas (e.g., leiomyosarcoma, chondrosarcoma)
• Papillary carcinoma
• Malignant melanoma
  These types exhibit different growth patterns and responses to treatment 7.

Molecular and Genetic Subtypes

Recent research has identified molecular subtypes of laryngeal cancer, such as those with NSD1 and NSD2 gene mutations, which may correlate with better prognosis. Other genetic changes (e.g., NOTCH1 mutations) are linked to more aggressive disease 6 8. Molecular profiling is an emerging tool in tailoring prognosis and therapy.

Causes of Laryngeal Cancer

Laryngeal cancer is a multifactorial disease. While certain behaviors and exposures dramatically increase risk, genetic and molecular factors also play a crucial role in its development.

Cause/Risk Factor	Description	Relative Risk/Strength	Sources
Tobacco Smoking	Cigarettes, cigars, pipes (all types)	Main cause, ~35x vs non-smokers	5 9 11 14
Alcohol Use	Especially heavy use, synergistic with smoking	Markedly increases risk	5 9 11 12 14
Occupational Exposures	Dust, asbestos, nickel, cement, port work	Elevated, especially with duration	10 12 13
Viral Infections	HPV, EBV	HPV present in ~27% of cases	5 9
Diet	Low fruit/vegetable intake, spicy food	Increased risk	11 14
Indoor Air Pollution	Biomass fuel, poor ventilation	Notable in developing countries	14
Other Factors	Mate tea, previous surgery, tonsillectomy	Emerging or minor risk	11 12

Table 3: Major Causes and Risk Factors

Decoding the Causes

Tobacco and Alcohol: The Potent Duo

Tobacco use is the single most significant risk factor for laryngeal cancer. All forms—including dark and flue-cured tobaccos—dramatically increase risk, with heavy smokers facing up to 35 times the risk of non-smokers 5 9 11 14. Alcohol use, especially heavy or chronic consumption, acts synergistically with tobacco, resulting in an exponential increase in risk—over 100 times greater when both habits are present 11 12.

Occupational and Environmental Exposures

• Asbestos: Epidemiological evidence confirms asbestos as a probable cause, with risk rising with exposure intensity and duration 13.
• Nickel, Dust, and Other Industrial Agents: Workers exposed to nickel, dust, cement, or who work outdoors (e.g., drivers, port workers) are at higher risk 10 12.
• Indoor Air Pollution: In regions with poor ventilation and high use of biomass fuels, risk is notably elevated 14.

Viral and Biological Factors

• HPV (Human Papillomavirus): Present in about 27% of laryngeal cancers, though its prognostic value remains unclear 5 9.
• EBV (Epstein–Barr Virus): Less clearly linked but under investigation 9.

Diet and Lifestyle

• Low Intake of Fruits and Vegetables: Diets lacking in fresh produce are associated with nearly threefold higher risk 11 14.
• Spicy Food, Nonvegetarian Diet: These have been implicated in some populations 14.
• Mate Tea: Habitual consumption linked to increased risk in South American studies 11.

Other Factors

• Previous Tonsillectomy, Laryngeal Surgery: Some studies suggest increased risk, though evidence is less consistent 12.
• Genetic and Epigenetic Changes: Changes in tumor suppressor genes, proto-oncogenes, and epigenetic modifications (such as those influenced by miRNAs) also contribute to carcinogenesis 9 8.

Treatment of Laryngeal Cancer

Treatment strategies for laryngeal cancer are highly individualized, aiming to cure while preserving vital laryngeal functions whenever possible. Advances in surgery, radiotherapy, and chemotherapy have transformed outcomes, but treatment must be tailored to the cancer's stage, location, and the patient's needs.

Stage/Scenario	Main Treatment Options	Key Considerations	Sources
Early Stage (T1/T2)	Radiation, Transoral Laser Surgery	Equal cure rates, voice preservation	16 17 18 19
Locally Advanced	Chemoradiation, Partial/Total Laryngectomy	Organ preservation vs. survival	15 16 17 19
Extensive/Metastatic	Total Laryngectomy, Adjuvant Chemoradiation, Palliative Care	Quality of life, communication	5 16 17 19
Salvage Treatment	Surgery after failed chemoradiation	Higher morbidity, careful selection	16 17 19

Table 4: Treatment Strategies by Stage

Modern Approaches to Treatment

Early-Stage Disease: Cure with Function Preservation

• Radiation Therapy: A mainstay for T1 and T2 tumors, offering excellent local control and voice preservation 18.
• Transoral Laser Microsurgery: Minimally invasive, with outcomes equivalent to radiation in early glottic cancers 17 18.
• Single Modality Preferred: To minimize toxicity, either surgery or radiation alone is recommended in early stages 18.

Locally Advanced Disease: Combining Modalities

• Chemoradiation: Concurrent chemotherapy and radiation is the standard for many advanced but resectable tumors, aiming for organ preservation 15 16 17.
• Partial or Total Laryngectomy: Surgical removal of part or all of the larynx is reserved for extensive or poorly functioning tumors, or when organ-preserving approaches are inappropriate 17.
• Adjuvant Therapy: Postoperative radiation or chemoradiation may be needed for high-risk features 16 17.

Salvage and Palliative Treatment

• Salvage Surgery: For recurrent or residual disease after chemoradiation, surgery (often total laryngectomy) may be required 16 17.
• Palliative Care: For metastatic or unresectable cancers, the focus shifts to symptom control and quality of life 5.

Technological and Multidisciplinary Advances

• Voice Rehabilitation: Voice prostheses and speech therapy are vital for patients who lose natural voice function 5.
• Multidisciplinary Teams: Optimal outcomes depend on coordinated care involving surgeons, oncologists, speech therapists, and nutritionists 19.
• Patient-Centered Decision Making: With multiple valid treatment options for many cases, shared decision-making is crucial for aligning care with patient preferences and priorities 17 18.

Conclusion

Laryngeal cancer is a complex disease with diverse presentations, underlying causes, and treatment approaches. Early recognition and tailored management are key to improving survival and preserving quality of life.

Key Points:

• Persistent hoarseness, sore throat, and difficulty swallowing are the most telling symptoms—seek evaluation if these last more than a few weeks.
• Most laryngeal cancers are squamous cell carcinomas, with the glottis (vocal cords) being the most common site.
• Tobacco and alcohol use are the dominant causes, but occupational exposures, HPV, diet, and environmental pollution also play important roles.
• Treatment is highly stage-dependent, with early cancers often cured by single-modality therapy (radiation or surgery), while advanced cases may require combined chemoradiation or surgery.
• Patient-centered, multidisciplinary care is essential, ensuring that treatment balances cure with the best possible functional outcomes.

Empowering individuals with knowledge about symptoms, causes, and modern treatment options is crucial for early intervention and optimal care in laryngeal cancer.