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- 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
- 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)
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)
Unknown—possible genetic inheritance
See “Etiology and Pathophysiology.”
- 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.