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[Conditions](https://durgical.com/en/conditions/) · [Head and neck](https://durgical.com/en/anatomy/region/head-and-neck/)

# Laryngeal cancer

Laryngeal cancer is a malignant tumour of the voice box; when it starts on the vocal cords it causes early, lasting hoarseness.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Vocal folds](https://durgical.com/en/anatomy/vocal-fold/)
- [Thyroid cartilage](https://durgical.com/en/anatomy/thyroid-cartilage/)
- [Epiglottis](https://durgical.com/en/anatomy/epiglottis/)
- [Cricoid cartilage](https://durgical.com/en/anatomy/cricoid-cartilage/)
- [Arytenoid cartilages](https://durgical.com/en/anatomy/arytenoid-cartilage/)
- [Neck lymph nodes](https://durgical.com/en/anatomy/lymph-nodes-of-neck/)
- [Recurrent laryngeal nerves](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/)
- [Trachea](https://durgical.com/en/anatomy/trachea/)

## Microorganisms that cause it

- [Human papillomavirus](https://durgical.com/en/microbiology/human-papillomavirus/)

## In histology

- [The airway: from nose to bronchioles](https://durgical.com/en/histology/the-airway-from-nose-to-bronchioles/)

## Why it happens

- [Dysplasia and carcinoma in situ](https://durgical.com/en/general-pathology/dysplasia-and-carcinoma-in-situ/)
- [Tobacco: how smoking injures tissue](https://durgical.com/en/general-pathology/tobacco-how-smoking-injures-tissue/)
- [Chemical carcinogens: initiation, promotion and the table to know](https://durgical.com/en/general-pathology/chemical-carcinogens-initiation-promotion-and-the-table-to-know/)

## What it is

Malignant tumour of the larynx, almost always squamous cell carcinoma. It can arise above, at or below the vocal folds; glottic tumours cause early hoarseness and are often found at an early stage.

## Who gets it

Mostly affects men over 50 with a history of smoking and alcohol use; rates in women have risen with smoking. One of the most common [head and neck](https://durgical.com/en/anatomy/region/head-and-neck/) cancers.

## Causes

- Squamous cell carcinoma (most cases)
- Tobacco smoking (main cause)
- Alcohol (synergistic with tobacco)
- Human papillomavirus (a minor role compared with the oropharynx)
- Occupational exposures (asbestos and others)

## Risk factors

- Smoking
- Heavy alcohol use
- Male sex and older age
- Laryngopharyngeal reflux (association proposed)
- Leukoplakia or dysplasia of the vocal folds
- Occupational exposure to carcinogens

## Pathophysiology

Carcinogens cause dysplasia of the laryngeal epithelium, progressing to carcinoma in situ and invasive cancer. The glottis has few lymphatics, so glottic tumours spread late to lymph nodes; supraglottic tumours have rich lymphatic drainage and often present with neck nodes. Growth can fix the vocal fold and invade cartilage.

## Classification

- By site: supraglottic, glottic (most common), subglottic
- TNM staging (fixation of the vocal fold, cartilage invasion, neck nodes, distant spread)

## Symptoms and signs

- Persistent hoarseness (early sign of glottic cancer)
- Sore throat or pain on swallowing
- Ear pain referred from the larynx
- Lump in the neck (lymph node)
- Difficulty swallowing
- Stridor and breathing difficulty in advanced disease
- Weight loss, coughing up blood

## Red flags

- Hoarseness lasting more than about 3 weeks in a smoker or older adult needs laryngoscopy
- Stridor or breathing difficulty
- Neck mass in an adult
- Haemoptysis

## Diagnosis

**Clinical**
Laryngoscopy (flexible nasal endoscopy) shows the lesion and [vocal fold](https://durgical.com/en/anatomy/vocal-fold/) movement. Examination of the neck looks for nodes.

**Tests**
Biopsy under direct laryngoscopy (microlaryngoscopy) confirms the diagnosis and maps the tumour; fine-needle aspiration of neck nodes.

**Imaging**
Contrast CT and/or MRI of the neck to stage the tumour, cartilage invasion and nodes; [chest](https://durgical.com/en/anatomy/region/chest/) CT or PET-CT for distant spread and a second primary tumour.

## Differential diagnosis

- Vocal fold nodules or polyps
- Chronic laryngitis and reflux laryngitis
- Leukoplakia without invasive cancer
- Laryngeal papillomatosis
- Vocal fold paralysis (from a lesion along the [recurrent laryngeal nerve](https://durgical.com/en/anatomy/recurrent-laryngeal-nerve/))

## Goal of treatment

Cure the cancer while preserving the voice, swallowing and airway whenever possible; in advanced disease, control symptoms and quality of life.

## Treatment

**Procedure**
Radiotherapy, organ-preserving, for early (stage I–II) disease, particularly glottic cancer.

**Surgical**
Transoral laser microsurgery or open partial laryngectomy for selected early tumours.

**Surgical**
Total laryngectomy with neck dissection for advanced disease with cartilage destruction, or for recurrence after radiotherapy; the patient breathes through a permanent tracheostoma.

**Medical**
Concurrent chemoradiotherapy (platinum-based) for larynx preservation in selected advanced cases; immunotherapy or other systemic therapy for recurrent or metastatic disease.

**Rehabilitation**
Voice rehabilitation after laryngectomy (tracheoesophageal prosthesis, electrolarynx, oesophageal speech) and swallowing therapy.

**Lifestyle**
Stopping smoking and alcohol, which improves treatment results and lowers the risk of a second cancer.

## Complications

- Airway obstruction
- Loss of the natural voice after laryngectomy
- Swallowing problems and aspiration
- Treatment effects: dry mouth, fibrosis, hypothyroidism after neck radiation
- Second primary cancers (lung, head and neck)

## Prognosis

Early glottic cancer has high cure rates. Prognosis worsens with nodal spread, supraglottic or subglottic site and advanced stage.

## Prevention

- Not smoking and limiting alcohol
- Early laryngoscopy for persistent hoarseness

## Test yourself

Think of the answer, then tap the question to see it.

## What is the most common histological type of laryngeal cancer?

Squamous cell carcinoma.

## Why do glottic cancers rarely spread to lymph nodes early?

The vocal folds have very sparse lymphatic drainage.

## Which symptom lasting more than about 3 weeks in a smoker requires laryngoscopy?

Persistent hoarseness.

## Which laryngeal cancers more often present with neck node metastases, supraglottic or glottic?

Supraglottic tumours, because the supraglottis has rich lymphatic drainage.

## How does a patient breathe after total laryngectomy?

Through a permanent tracheostoma in the neck; the airway is separated from the mouth and nose.

[Add to my cards (5)](https://durgical.app/estudiar/?add=/en/conditions/laryngeal-cancer/)

## Related conditions

- [Lung cancer](https://durgical.com/en/conditions/lung-cancer/)
- [Gastro-oesophageal reflux disease (GERD)](https://durgical.com/en/conditions/gastro-oesophageal-reflux-disease/)
- [Cervical lymphadenopathy](https://durgical.com/en/conditions/cervical-lymphadenopathy/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Laryngeal Cancer](https://www.ncbi.nlm.nih.gov/books/NBK526076/) (StatPearls (NCBI Bookshelf), 2024).

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Source: https://durgical.com/en/conditions/laryngeal-cancer/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/laryngeal-cancer/