Head and Neck Oncology
Laryngeal Cancer
Voice-preserving surgery in early stages; total laryngectomy and rehabilitation in advanced disease.
What are the symptoms of laryngeal cancer, and how serious is it?
Laryngeal cancer is the umbrella term for tumours arising from the mucosa within the larynx (voice box). The most common presenting complaint is hoarseness lasting more than 2 weeks; advanced disease adds dysphagia, referred ear pain, haemoptysis, and breathing difficulty. Risk factors are smoking and alcohol; HPV association is lower than for oropharyngeal cancer. Early diagnosis is critical: in T1–T2 tumours, transoral laser microsurgery or radiotherapy delivers 85–95% survival with near-normal voice. In T3–T4 advanced disease, chemoradiation or total laryngectomy is required; survival 50–70%.
Treatment options
Early stage (T1–T2): transoral laser microsurgery (TLM) or radiotherapy alone. TLM is curative in a single session; radiotherapy requires daily treatment over 6 weeks. Voice outcomes are excellent with both.
Advanced stage (T3–T4): organ-preserving chemoradiation (radiotherapy + cisplatin) may be the first choice; on failure, salvage surgery (salvage laryngectomy) is performed. Some cases proceed directly to total laryngectomy + neck dissection + post-operative radiotherapy. The decision is multidisciplinary via tumour board.
Post-laryngectomy rehabilitation: tracheoesophageal voice prosthesis (most common), electrolarynx, oesophageal voice. The speech therapist plays a critical role; most patients reach intelligible speech in 4–6 weeks.
Frequently Asked Questions
- Hoarseness exceeding 2 weeks (especially in smokers aged 50+) requires laryngeal examination. Endoscopic laryngeal evaluation + stroboscopy if needed is standard.
- Risk decreases but does not zero out — it approaches baseline after roughly the years equal to past use. Annual ENT check-up for 10 years post-cessation is advised.
- A tracheostomy is created in the neck. The patient breathes directly through the stoma — not through nose or mouth. A heat-and-moisture filter assists.
- Yes — both diminish because air no longer flows through the nose. Partial compensation via the "polite yawning" technique is possible.
- Laryngeal cancer is not generally familial. The primary risk factors are smoking and alcohol use. Even with family history, primary prevention targets these.
References
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