Laryngeal carcinoma
- Lesion
Laryngeal cancer is a squamous carcinoma of smokers and drinkers. On the vocal cord it causes hoarseness early and spreads late.
What it is
About 95% of laryngeal cancers are squamous cell carcinomas, strongly tied to tobacco, with alcohol multiplying the risk. They develop through a sequence of epithelial hyperplasia, dysplasia and carcinoma in situ, and the risk of transformation rises with the grade of dysplasia. Site determines presentation and spread: glottic tumours hoarsen the voice early and rarely reach nodes, supraglottic tumours spread to nodes early.
Structure
- Gross: early lesions are smooth, white or red thickenings or keratotic plaques; later pearly grey wrinkled plaques and then ulcerated, fungating masses.
- Microscopy: keratinising squamous carcinoma of varying differentiation invading the stroma; dysplasia and carcinoma in situ in neighbouring mucosa.
- Verrucous carcinoma: a well-differentiated, warty variant that pushes rather than infiltrates and rarely metastasises.
Step by step
- Smoke and alcohol bathe the laryngeal mucosa in carcinogens.
- Epithelium responds with hyperplasia and keratosis (white patches).
- Mutations accumulate (TP53, CDKN2A) and dysplasia appears, graded mild to severe.
- Full-thickness atypia (carcinoma in situ) breaks through the basement membrane: invasive carcinoma.
- The tumour spreads along the mucosa, into cartilage and, depending on lymphatic richness of the site, to neck nodes.
Laryngeal cancer by site
| Site | Frequency | First symptom | Nodal spread |
|---|---|---|---|
| Glottic | Most common | Early hoarseness | Late (few lymphatics) |
| Supraglottic | Common | Dysphagia, sore throat, neck mass | Early |
| Subglottic | Uncommon | Stridor, late | Intermediate |
Clinical notes
- Persistent hoarseness in a smoker over 50 needs laryngoscopy.
- Other symptoms: dysphagia, odynophagia, referred ear pain, cough, hemoptysis, stridor.
- Early disease is treated with organ-preserving surgery or radiotherapy; advanced disease with chemoradiation or laryngectomy.
Test yourself
Think of the answer, then tap the question to see it.
Why do glottic carcinomas have a better prognosis than supraglottic ones?
They cause hoarseness early and the true cords have few lymphatics, so nodal spread is late.
What are the two main risk factors for laryngeal carcinoma?
Tobacco smoking and alcohol, which act synergistically.
What determines the risk that laryngeal dysplasia will progress to cancer?
The grade of dysplasia: the more severe, the higher the risk.
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Laryngeal Cancer (StatPearls (NCBI Bookshelf), 2025); Throat Cancer (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.