[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Head and neck](https://durgical.com/en/general-pathology/areas/head-neck/) › Laryngeal carcinoma

# Laryngeal carcinoma

- Lesion

Laryngeal cancer is a squamous carcinoma of smokers and drinkers. On the vocal cord it causes hoarseness early and spreads late.

Updated Nov 12, 2026

## Key points

- Risk: tobacco (dose-related), alcohol (synergistic), asbestos, irradiation, high-risk HPV in a minority.
- Glottic (true cords): the most common site; early hoarseness; few lymphatics, so nodal spread is late; good prognosis when early.
- Supraglottic: rich lymphatics, early neck node metastases; often presents late with dysphagia or a neck mass.
- Subglottic: least common, often silent until advanced.
- Dysplasia grade predicts risk: mild dysplasia rarely progresses, severe dysplasia much more often.
- Epithelial changes may regress after quitting smoking.

## 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](https://durgical.com/en/conditions/laryngeal-cancer/) | 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.

## Memory aid

Glottic: good voice warning, good prognosis. Supraglottic: silent, spreads to the neck.

## 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.

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## Connections

## Related 6

- [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/)
- [Metaplasia](https://durgical.com/en/general-pathology/metaplasia/)
- [Benign lesions of the larynx](https://durgical.com/en/general-pathology/benign-lesions-of-the-larynx/)
- [Head and neck squamous cell carcinoma](https://durgical.com/en/general-pathology/head-and-neck-squamous-cell-carcinoma/)
- [Leukoplakia and erythroplakia](https://durgical.com/en/general-pathology/leukoplakia-and-erythroplakia/)

## Related conditions 2

- [Laryngeal cancer](https://durgical.com/en/conditions/laryngeal-cancer/)
- [Head and neck squamous cell carcinoma (oral cavity and oropharynx, HPV)](https://durgical.com/en/conditions/head-and-neck-squamous-cell-carcinoma/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

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](https://www.ncbi.nlm.nih.gov/books/NBK526076/) (StatPearls (NCBI Bookshelf), 2025); [Throat Cancer](https://medlineplus.gov/throatcancer.html) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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