Laryngeal Cancer

Description

• A friable, granular squamous cell carcinoma of the larynx that leads to hoarseness, hemoptysis, and cough
• System(s) affected: pulmonary; ear, nose, throat (ENT)
• Synonym(s): cancer of the larynx; throat cancer; cancer of the voice box

Epidemiology

Incidence

• 150,000 new cases diagnosed per year worldwide (13,430 new cases per year in the United States, 2016) (1)
• Second most common cancer of the upper aerodigestive tract (2)
• 85–90% of laryngeal cancers are squamous cell (2).
• Laryngeal cancer represents 0.8% of all new cases of cancer in the United States (1).
• ~60% of the cases present in advanced stages (III, IV) (2)
• 5-year survival rate 63% (1,2)
• Predominant age
  • Median age at diagnosis is 65 years; most frequently diagnosed between 50 and 70 years of age (3)
  • <1% of laryngeal cancers arise in patients <30 years.
• Predominant sex: male > female (5:1); blacks > whites (1); blacks diagnosed younger and higher death rate (2)

Prevalence

• 3,620 people dying from laryngeal cancer in 2016 in United States (1)
• Second most common site for head and neck cancer
• 11th most common cancer in men (4)

Etiology and Pathophysiology

• Smoking tobacco (dose dependent) is the most significant risk factor (1) linear association:
  • 30 times greater risk for heavy smoker
• Heavy alcohol use, 8 or more drinks per day (1,3)
• Smoking plus moderate alcohol use—synergistic (1)
• Smoking cannabis (3)
• Possibly chronic gastroesophageal and laryngopharyngeal reflux (1,2)
• Occupational hazards (asbestos, pesticides, polycyclic aromatic hydrocarbons, textile dust, exposure to radiation) (1,2)
• Dietary—too much red meats have been suggested (1). Decrease risk with increase fruits and vegetables.
• Viruses, for example, HPV/p16, prevalence ranges from 20% to 30% in laryngeal cancer with prognostic value unknown (1)

Genetics
Unknown—possible genetic inheritance

Risk Factors

See “Etiology and Pathophysiology.”

General Prevention

• Avoid or cease smoking and/or alcohol abuse (85% attributed to smoking and alcohol abuse) (1).
• Wear proper respiratory masks/respirators if chronic exposure to certain chemicals, gases, and wood dust.
• Control chronic gastric/laryngopharyngeal reflux (2)[A].
• Indirect laryngoscopy for at-risk patients with persistent hoarseness lasting >2 to 3 weeks
• High intake of natural β-carotenoid equivalents may reduce risk of developing laryngeal cancer (3)[A].
• HPV vaccination: Cost-effectiveness specifically for laryngeal cancer is unclear.
• Prevention of second primary head and neck cancer with isotretinoin (3)[A]
• Diet high in fruits and vegetables (1)[A]

Commonly Associated Conditions

Up to 10% of patients may have a synchronous squamous cell carcinoma in the lower or upper aerodigestive tract, most notably in the esophagus or lungs.