Laryngeal Cancer is a topic covered in the 5-Minute Clinical Consult.

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Basics

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, e.g., 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.

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Laryngeal Cancer ID - 116338 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116338/all/Laryngeal_Cancer PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -