Laryngeal Cancer

The most common form (>95%) of laryngeal cancer is squamous cell carcinoma. It occurs mostly in men aged >50 years who are heavy smokers. It is sometimes preceded by leukoplakia (epithelial dysplasia) or pachydermia (thickening of the epithelium).

Risk factors include smoking and drinking alcohol.

Sign and symptoms: Chronic hoarseness, sore throat radiating to the ear when swallowing, dysphagia, sometimes cough, shortness of breath, and a palpable lump in the neck.

Diagnosis: Laryngeal cancer is frequently detected by palpation of the neck (palpable lymph nodes and decreased laryngeal mobility). If suspected, refer the patient urgently to an ear, nose, and throat (ENT) specialist. Laryngoscopy may reveal a tumor, infiltration, and immobilization of one or both vocal folds. A definitive diagnosis is based on histologic examination. The disease extent is assessed based on computed tomography (CT), ultrasonography with assessment of cervical lymph nodes (possibly with a biopsy) and the pre-epiglottic space, chest radiography in 2 projections, as well as chest CT, magnetic resonance imaging (MRI) of the neck, and/or positron emission tomography (PET), depending on the indications.

Treatment: Irradiation or larynx-sparing methods, including microsurgical endoscopic techniques with a laser (early in the disease), or partial or total laryngeal resection, most often combined with cervical lymphadenectomy and radiotherapy or chemotherapy, molecularly targeted treatment (cetuximab), and immunotherapy (PD-L1 inhibitors) in advanced disease. Treatment decisions are usually made in the setting of a multidisciplinary team.