Laryngeal cancer
Squamous cell carcinoma of the larynx is the tobacco- and alcohol-driven, usually HPV-negative head and neck cancer that presents with progressive hoarseness (glottic disease) or a painless neck mass (supraglottic/nodal disease). Diagnosis requires laryngoscopy and biopsy before staging imaging, and management is sequenced by resectability, from larynx-sparing surgery or radiation for small tumors to chemoradiation or total laryngectomy for advanced disease.
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What this article covers
- Overview
Squamous cell carcinoma of the laryngeal mucosa: accounts for more than 95% of laryngeal cancers and is one of the sites of head and neck squamous cell carcinoma (HNSCC), alongside the oral cavity…
- Epidemiology
Male predominance: 3- to 6-fold higher prevalence than females.
- Risk factors
Tobacco use: the most important risk factor, including smoking, chewing tobacco, and secondhand smoke.
- Pathophysiology
Direct mucosal carcinogenesis from tobacco and alcohol drives malignant transformation of laryngeal epithelium, the HPV-negative HNSCC pathway.
- Clinical features
Progressive hoarseness (dysphonia) persisting beyond 4 weeks: the cardinal, earliest symptom of glottic disease; a hoarse voice lasting more than 4 weeks should be examined endoscopically with flexible laryngoscopy.
- Differential diagnosis
Non-Hodgkin lymphoma of Waldeyer's ring (tonsils, nasopharynx, base of tongue): dysphagia, dysphonia, weight loss, and painless enlarged cervical nodes; distinguished from squamous cell carcinoma only by biopsy.
- Diagnosis
The diagnosis is confirmed by biopsy: tissue from the laryngoscopically visualized lesion, or fine-needle aspiration (FNA) of a suspicious neck mass, showing squamous cell carcinoma; proceed to excisional biopsy if FNA is nondiagnostic.
- Management
First, triage at tumor board by resectability: small/localized, locally advanced but resectable, unresectable/extensively nodal, or distantly metastatic disease are managed differently.
- Complications
Airway obstruction: bulky or advanced tumor can progress to stridor and airway compromise requiring urgent airway control.
- Prognosis
Stage is the most important determinant of prognosis: early-stage head and neck cancers have 70% to 90% long-term survival.
- Prevention
Smoking cessation and reduced alcohol use: tobacco is the primary risk factor and alcohol acts synergistically with it, making cessation of both the single most impactful preventive measure.
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