Laryngeal cancer is a disease in which malignant (cancer) cells
form in the tissues of the larynx.
Use of tobacco products and drinking too much alcohol can affect the risk
of laryngeal cancer.
Signs and symptoms of laryngeal cancer include a sore throat and
ear pain.
Tests that examine the throat and neck are used to help diagnose and stage laryngeal cancer.
Certain factors affect prognosis (chance
of recovery) and treatment options.
Laryngeal cancer is a disease in which malignant (cancer) cells
form in the tissues of the larynx.
The larynx is a part of the throat, between the base of the tongue and the trachea. The larynx contains the vocal
cords, which vibrate and make sound when air is directed against
them. The sound echoes through the pharynx, mouth, and nose to make a person's
voice.
There are three main parts of the larynx:
Supraglottis: The
upper part of the larynx above the vocal cords, including the
epiglottis.
Glottis: The
middle part of the larynx where the vocal cords are located.
Subglottis: The
lower part of the larynx between the vocal cords and the trachea (windpipe).
EnlargeLaryngeal cancer forms in the tissues of the larynx (area of the throat that contains the vocal cords). The larynx includes the supraglottis, glottis (vocal cords), and subglottis. The cancer may spread to nearby tissues or to the thyroid, trachea, or esophagus. It may also spread to the lymph nodes in the neck, the carotid artery, the upper part of the spinal column, the chest, and to other parts of the body (not shown).
Use of tobacco products and drinking too much alcohol can affect the risk
of laryngeal cancer.
Anything that increases a person's chance of getting a disease is called
a risk factor. Not every person with one or more of these risk factors will develop laryngeal cancer, and it will develop in people who don't have any known risk factors. Talk with your doctor if you think you may be at risk.
Signs and symptoms of laryngeal cancer include a sore throat and
ear pain.
These and other signs and symptoms may be caused by laryngeal cancer or by
other conditions. Check with your doctor if you have any of the following:
A sore throat or cough that does not go away.
Trouble or pain when swallowing.
Ear pain.
A lump in the neck or throat.
A change or hoarseness in the voice.
Tests that examine the throat and neck are used to help diagnose and stage laryngeal cancer.
In addition to asking about your personal and family health history, your doctor may perform the following tests and procedures:
Physical exam of the throat and neck: An exam to check the throat and neck for abnormal areas. The doctor will feel the inside of the mouth with a gloved finger and examine the mouth and throat with a small
long-handled mirror and light. This will include checking the insides of the cheeks and lips; the gums; the back, roof, and floor of the mouth; the top, bottom, and sides of the tongue; and the throat. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical treatments will also be taken.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The sample of tissue may be removed during one of the following procedures:
Laryngoscopy: A procedure in which the doctor checks the larynx (voice box) with a mirror or a laryngoscope to check for abnormal areas.
A laryngoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the throat and voice box. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
Endoscopy: A
procedure to look at organs and tissues inside the body, such as the throat, esophagus, and trachea to check for abnormal areas. An endoscope (a thin, lighted tube with a light and a lens for viewing) is inserted through an opening in the body, such as the mouth. A special tool on the endoscope may be used to remove samples of tissue.
CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.EnlargeComputed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
PET scan (positron emission tomography scan): A procedure to find malignanttumor cells in the body. A small amount of radioactiveglucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
PET-CT scan: A procedure that combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time with the same machine. The combined scans give more detailed pictures of areas inside the body than either scan gives by itself. A PET-CT scan may be used to help diagnose disease, such as cancer, plan treatment, or find out how well treatment is working.
Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metalliccompound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.
Certain factors affect prognosis (chance
of recovery) and treatment options.
Smoking tobacco and drinking alcohol decrease the effectiveness of
treatment for laryngeal cancer. Patients with laryngeal cancer who continue to smoke and drink are less likely to be cured and more likely to develop a second tumor. After treatment for laryngeal cancer,
frequent and careful follow-up is important.
Stages of Laryngeal Cancer
Key Points
After laryngeal cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the larynx or to other parts of the
body.
There are three ways that cancer spreads in the body.
Cancer may spread from where it began to other parts of the body.
The following stages are used for laryngeal cancer:
Stage 0 (Carcinoma in Situ)
Stage I
Stage II
Stage III
Stage IV
After surgery, the stage of the cancer may change and more treatment may be needed.
Laryngeal cancer can recur (come back) after it has been treated.
After laryngeal cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the larynx or to other parts of the
body.
The process used to find out if cancer has spread within the
larynx or to other parts of the body
is called staging. The information
gathered from the staging process determines the stage of the disease. It is important to know the
stage of the disease in order to plan treatment. The results of some of the tests used to diagnoselaryngeal cancer are often also used to stage the disease.
There are three ways that cancer spreads in the body.
Tissue. The cancer spreads from where it began by growing into nearby areas.
Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
Cancer may spread from where it began to other parts of the body.
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.
Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if laryngeal cancer spreads to the lung, the cancer cells in the lung are actually laryngeal cancer cells. The disease is metastatic laryngeal cancer, not lung cancer.
Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.
The following stages are used for laryngeal cancer:
Supraglottis: Cancer is in more than one area of the supraglottis or has spread to the area at the base of the tongue or to tissues near the vocal cords. The vocal cords work normally.
Glottis: Cancer has spread to the supraglottis, subglottis, or both, and/or the vocal cords do not work normally.
Subglottis: Cancer has spread to one or both vocal cords and the vocal cords may not work normally.
EnlargeTumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).
In stage III cancer of the supraglottis:
cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroidcartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
cancer is in one area of the supraglottis and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
cancer is in more than one area of the supraglottis or has spread to the area at the base of the tongue or to tissues near the vocal cords. The vocal cords work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.
In stage III cancer of the glottis:
cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
cancer is in one or both vocal cords and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
cancer has spread to the supraglottis, subglottis, or both, and/or the vocal cords do not work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.
In stage III cancer of the subglottis:
cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
cancer is in the subglottis only. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
cancer has spread to one or both vocal cords and the vocal cords may not work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.
Cancer may have spread from the supraglottis, glottis, or subglottis to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. The vocal cords may not work normally. Cancer has spread:
to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller. Cancer has spread through the outside covering of the lymph node; or
to one lymph node on the same side of the neck as the primary tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters. Cancer has not spread through the outside covering of the lymph node; or
to more than one lymph node on the same side of the neck as the primary tumor and the lymph nodes are not larger than 6 centimeters. Cancer has not spread through the outside covering of the lymph nodes; or
to lymph nodes on both sides of the neck or on the side of the neck opposite the primary tumor and the lymph nodes are not larger than 6 centimeters. Cancer has not spread through the outside covering of the lymph nodes.
In stage IVB:
Cancer may have spread from the supraglottis, glottis, or subglottis to the space in front of the spine, the area around the carotid artery, or the area between the lungs. The vocal cords may not work normally. Cancer has spread:
to one lymph node that is larger than 6 centimeters. Cancer has not spread through the outside covering of the lymph node; or
to one lymph node on the same side of the neck as the primary tumor and the lymph node is larger than 3 centimeters. Cancer has spread through the outside covering of the lymph node; or
to more than one lymph node anywhere in the neck. Cancer has spread through the outside covering of the lymph nodes; or
to one lymph node of any size on the side of the neck opposite the primary tumor. Cancer has spread through the outside covering of the lymph node;
or
Cancer has spread from the supraglottis, glottis, or subglottis to the space in front of the spine, the area around the carotid artery, or the area between the lungs. Cancer may have also spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size.
In stage IVC, cancer has spread to other parts of the body, such as the lungs, liver, or bone.
After surgery, the stage of the cancer may change and more treatment may be needed.
If the cancer is removed by surgery, a pathologist will examine a sample of the cancer tissue under a microscope. Sometimes, the pathologist’s review will result in a change to the stage of the cancer and more treatment after surgery.
Laryngeal cancer can recur (come back) after it has been treated.
The cancer may come back in the
larynx or in other parts of the
body, such as lungs, liver, or bone. It is most likely to come back in the first 2 to 3 years.
Treatment Option Overview
Key Points
There are different types of treatment for patients with
laryngeal cancer.
The following types of treatment are used:
Radiation therapy
Surgery
Chemotherapy
Immunotherapy
New types of treatment are being tested in clinical
trials.
Targeted therapy
Radiosensitizers
Treatment for laryngeal cancer may cause side effects.
Patients may want to think about taking part in a clinical trial.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Follow-up tests may be needed.
There are different types of treatment for patients with
laryngeal cancer.
Different types of treatment are available for patients with
laryngeal cancer. Some treatments are standard (the currently
used treatment), and some are being tested in clinical trials. A treatment
clinical trial is a research study meant to help improve current treatments or
obtain information on new treatments for patients with cancer. When clinical
trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
The following types of treatment are used:
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.
EnlargeExternal-beam radiation therapy of the head and neck. A machine is used to aim high-energy radiation at the cancer. The machine can rotate around the patient, delivering radiation from many different angles to provide highly conformal treatment. A mesh mask helps keep the patient’s head and neck from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment.
Radiation therapy may work better in patients who have
stopped smoking before beginning treatment. External radiation therapy to the
thyroid or the
pituitary gland may change the way
the thyroid gland works. A blood test to check the thyroid hormone level in the body may be done before
and after therapy to make sure the thyroid gland is working properly.
Hyperfractionated radiation therapy may be used to treat laryngeal cancer. Hyperfractionated radiation therapy is radiation treatment in which a smaller than usual total daily dose of radiation is divided into two doses and the treatments are given twice a day.
Hyperfractionated radiation therapy is given over the same period of time (days or weeks) as standard radiation therapy. New types of radiation therapy are being studied in the treatment of laryngeal cancer.
Surgery
Surgery (removing the cancer in an operation) is a common
treatment for all stages of
laryngeal cancer. The following surgical procedures may be used:
Hemilaryngectomy: Surgery to remove half of the
larynx (voice box). A
hemilaryngectomy saves the voice.
Partial laryngectomy: Surgery to remove part of the
larynx (voice box). A
partial laryngectomy helps keep the patient's ability to talk.
Total laryngectomy: Surgery to remove the whole larynx.
During this operation, a hole is made in the front of the neck to allow the
patient to breathe. This is called a tracheostomy.
Thyroidectomy: The removal of all or part of the thyroid
gland.
Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor in the larynx.
After the doctor removes all the cancer that can be seen at the
time of the surgery, some patients may be given chemotherapy or radiation
therapy after surgery to kill any cancer cells that are left. Treatment given
after the surgery, to lower the risk that the cancer will come back, is called
adjuvant therapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy.
PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Nivolumab and pembrolizumab are types of PD-1 inhibitors used to treat metastatic or recurrent laryngeal cancer.
EnlargeImmune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).
Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.
New types of treatment are being tested in clinical
trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.
Monoclonal antibodies: Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Cetuximab is being studied in the treatment of laryngeal cancer.
How do monoclonal antibodies work to treat cancer? This video shows how monoclonal antibodies, such as trastuzumab, pembrolizumab, and rituximab, block molecules cancer cells need to grow, flag cancer cells for destruction by the body’s immune system, or deliver harmful substances to cancer cells.
Radiosensitizers
Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
Treatment for laryngeal cancer may cause side effects.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back).
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Radiation therapy followed by surgery if cancer comes back in the same area.
Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
Chemotherapy followed by chemotherapy and radiation
therapy given together. Laryngectomy may be done if cancer remains.
A clinical trial of radiation therapy alone compared with radiation and targeted therapy (cetuximab).
A clinical trial of immunotherapy, chemotherapy, radiosensitizers, or radiation therapy.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Chemotherapy followed by chemotherapy and radiation
therapy given together. Laryngectomy may be done if cancer remains.
Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
Surgery followed by radiation therapy. Chemotherapy may be given with the radiation therapy.
A clinical trial of radiation therapy alone compared with radiation and targeted therapy (cetuximab).
A clinical trial of immunotherapy, chemotherapy, radiosensitizers, or radiation
therapy.
If cancer is in the subglottis, treatment may include the
following:
Laryngectomy plus total thyroidectomy and removal of lymph
nodes in the throat, usually followed by radiation therapy with or without chemotherapy.
Chemotherapy and radiation therapy given together.
A clinical trial of radiation therapy alone compared with radiation and targeted therapy (cetuximab).
A clinical trial of immunotherapy, chemotherapy, radiosensitizers, or radiation
therapy.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Treatment of Metastatic and Recurrent Laryngeal Cancer
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
Purpose of This Summary
This PDQ cancer information summary has current information about the treatment of adult laryngeal cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.
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Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).
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