Laryngeal cancer

For many patients, a logopedic and dental examination or nutrition advice is already useful before the treatment begins.

There are various treatment approaches for laryngeal tumors. The main goal of therapy is optimal treatment of the tumor, but also to preserve the function of the larynx to the greatest extent possible. The treatment depends on:

• the general state of health
• the spread of the tumor
• potential therapy consequences
• individual patient requirements

Treatment of a laryngeal tumor

In an early stage, tumors can be cured by either an operation or radiation therapy. Only when tumors are growing below the vocal folds do experts recommend removal of the larynx. While these tumors are very rare, they grow the most aggressively in most cases.

Even for advanced tumors, there are various therapeutic options that can be used for a curative purpose: 

• Tumor operation with partial removal or if necessary complete removal of the larynx followed by radiation therapy.  
• In the event of risk factors, the operation is followed by chemoradiotherapy. 
• If an operation is not possible or the patient refuses it, chemoradiotherapy or radiation therapy may be used in combination with an antibody therapy.  

Patients should discuss the advantages and disadvantages of every therapeutic option in detail with the doctors treating them. For example, it is important with surgery on a laryngeal tumor for the tumor to be fully removed. This can mean that the surgeon has to completely remove the larynx as well.  

Treatment of cervical lymph nodes 

In most cases, experts recommend removal of the cervical lymph nodes as a precaution or radiation treatment of these. That even applies when no suspicious cervical lymph nodes were detected during the examinations because quite often, there are already hidden lymph node metastases.  

Only if the tumor is growing on the vocal folds and is still in an early stage is the risk for hidden metastases low. In that case, such a treatment is not required.  

Have noticeable symptoms already been found during the examinations?

The surgeons then remove the cervical lymph nodes rather more extensively during the operation. If necessary, they also have to remove other tissue. If an operation is not possible, radiation therapy or chemoradiotherapy is used on the cervical lymph nodes. 

Treatment for incurable laryngeal cancer 

In this situation, the most important therapy goal is to repress the tumor and thus prolong the patient’s survival. At the same time, symptoms should be relieved to the best extent possible. An individual determination is made about what the therapy looks like. The following can be used: 

• chemotherapy
• targeted therapy
• immunotherapy
• radiation therapy 
• surgical measures

In each instance, an early supportive therapy like pain therapy, nutrition advice or monitoring by a psycho-oncologist is important. 

Would you like to know more about the treatment of laryngeal cancer? Which side effects are possible and how can debilitating symptoms be handled? Get free information about this from the Cancer Information Service of the German Cancer Research Center.
Particularly if you find speaking difficult, you can use the e-mail service. But you can also get tailored information on the phone. 

Malignant tumors that grow above, below or on the vocal folds are called laryngeal cancer. These cancers mostly originate from the mucosa that lines the larynx from within. Experts also refer to laryngeal cancer as laryngeal carcinoma.

The larynx is located about halfway up the anterior region of the neck, and forms the passageway from the pharynx to the trachea. On the one hand, it ensures that no food or drink gets into the windpipe – thus providing protection from choking. On the other, its vocal folds make it possible to produce sounds and thus to speak.  

Experts divide laryngeal tumors into three groups, depending on where they grow: 

• above the vocal folds
• below the vocal folds
• on the vocal folds 

Laryngeal cancer pertains to head and neck tumors, along with oral cancer and pharyngeal cancer. It is a rather rare tumor, with about 3,600 people in Germany developing it every year. Men are affected by laryngeal cancer far more frequently than women. 

The symptoms caused by laryngeal cancer depend on whereabouts in the larynx the cancer develops. If laryngeal tumors grow on the vocal folds, they usually cause hoarseness early on. If tumors grow above or below the vocal folds, symptoms often appear later. In particular, they include difficulty swallowing and breathing problems. 

The following warning signs may indicate a tumor in the larynx: 

• hoarseness in particular 
• a constant foreign body sensation, especially on one side 
• pain that spreads into the ear 
• difficulty swallowing 
• pain when swallowing 
• neck swelling 
• speaking difficulties 
• breathing difficulties 
• coughing up blood  
• mouth odor 

Do these symptoms last longer than four weeks? It is advisable to see a doctor no later than then. General Practitioners can already narrow down what is causing the symptoms and, if necessary, initiate further diagnostic steps with specialists. 

Like nearly every cancer, laryngeal cancer is based on genetic mutations. These cause normal body cells to change into malignant cancer cells and begin growing in an uncontrolled manner. Most of these genetic mutations develop by chance in the course of a lifetime. But there are risk factors that promote laryngeal cancer.   

Known risk factors include: 

• regular smoking 
• excessive alcohol consumption 
• asbestos dust exposure 
• exposure to harmful substances like ionizing radiation (e.g. uranium), aerosols containing sulfuric acid, polycyclic aromatic hydrocarbons, coal or tar products 
• in a smaller portion of patients, infections with human papillomaviruses (HPVs), especially with the high-risk HPV 16 type 
• certain whitish (leukoplakia or pachydermia) or reddish (erythroplakia) mutations of the laryngeal mucosa (cancer precursors) 

Tobacco and alcohol consumption are the major risk factors and collectively are especially harmful. When they are consumed together, the risk of developing cancer is about 30 times higher.  

There is moreover evidence that malnutrition or increased consumption of meat or fried food may raise the risk for laryngeal cancer.

Laryngeal cancer can develop from cancer precursors. These are tissue changes in which cells are altered compared to the original tissue. If these altered cells grow destructively deep into the tissue, then a malignant laryngeal tumor has developed that can spread to other organs (metastasize).  

Depending on the tumor’s point of origin, the further spread and progression of the laryngeal cancer are different:

• Laryngeal tumors that grow on the vocal folds only rarely develop lymph node metastases in the early stages of the disease. 
• On the other hand, laryngeal tumors that grow above or below the vocal folds often spread into the cervical lymph nodes early on.   

Laryngeal cancer spreads into the lungs in particular via the blood, while more rarely, metastases settle in bone and the liver. The main risk factors, tobacco and alcohol, may encourage a second cancer in the head and neck region, most commonly lung cancer, esophageal cancer, cancer of the oral cavity or pharynx. 

According to current knowledge, the most effective protection from laryngeal cancer is refraining from tobacco and alcohol. 

If laryngeal cancer is suspected, the doctor initially asks patients about their symptoms, possible existing risk factors and their general state of health. Clinical examinations follow after this medical history.  

Clinical examination and biopsy  

A detailed otolaryngological examination is performed. What if a malignant tumor of the larynx is suspected after this examination? In that case, the doctor takes tissue samples (biopsies) from suspected areas to make sure of the diagnosis. The patient usually receives a general anesthetic for that. Doctors moreover examine the upper respiratory and digestive tracts. This should rule out possible secondary tumors.  

The tissue samples taken are examined in a laboratory under a microscope and with microbiological tests to determine their histological properties. If this analysis reveals cancerous tissue, the diagnosis is confirmed.  

Imaging techniques 

Further examinations help doctors assess how far the tumor has spread. They can thus also find out whether the cancer has already formed metastases in the cervical lymph nodes or organs further away, or whether there are secondary tumors. Doctors can use the following imaging techniques for that:  

• magnetic resonance imaging (MRI)
• computed tomography (CT)
• positron emission tomography (PET/CT),
• an ultrasound of the neck and, if necessary, the abdomen.  

What if it is not definitely possible to assess the lymph nodes with imaging techniques?

Doctors can then carry out an additional fine needle biopsy (puncture). In this procedure, a thin cannula sucks in cells which can then be examined. 

Do you want to learn more about how a biopsy is taken and what happens to the cell and tissue samples afterwards? The website of the Cancer Information Service of the German Cancer Research Center has detailed information about a biopsy procedure and its risks (in German). 

Cancer treatment can be physically and mentally exhausting. Medical rehabilitation (rehab) after a cancer therapy should help patients to recuperate. It should also assist them in dealing with the consequences of the disease and the treatment in the best possible manner.  

A medical rehab program thus focuses on the personal medical history and existing limitations. Possible measures for those affected by laryngeal cancer are: 

• voice rehabilitation
• swallowing and speech therapy 
• nutritional therapy 
• psycho-oncological care 

Aftercare   

The aftercare for laryngeal cancer has various aims. Above all, it is used to recognize a relapse, possible secondary carcinomas and long-term consequences of the treatment early and introduce appropriate measures. Once treatment has been completed, patients are examined regularly, initially at short intervals, then at longer ones. However, if experiencing symptoms, patients can visit the doctor more frequently.  

An aftercare appointment always includes: 

• precise questioning about the general state of health, symptoms and results of therapy (medical history) 
• a thorough otolaryngological examination
• palpation and ultrasound of the neck

Depending on the individual tumor, the risk of relapse and the therapy, doctors can regularly arrange for computed tomography (CT) or magnetic resonance imaging (MRI). If necessary, a positron emission tomography (PET/CT) can also be added.

Is the cancer incurable? 

Follow-ups and regular care help with recognizing debilitating symptoms early and alleviating them. The aim is to maintain the patient’s quality of life for as long as possible. 

During or after laryngeal cancer, it is not always easy for patients to get back into everyday life. Cancer and its treatment can involve radical changes. What can help someone cope better with the disease and potential therapy outcomes depends on the individual situation.  

Depending on the therapy, the following problems are just some that can occur:  

• dysphonia or aphonia (loss of voice) 
• difficulty swallowing 
• loss of the normal sense of smell 
• dry mouth 
• changes to the teeth and jaws 
• chewing problems 
• lymphedemas 

For those whose larynx was surgically removed, new voice training techniques must be learned. They moreover have to learn to deal with an artificial connector to the trachea (tracheostoma).  

If you need support, talk with the doctors treating you about the options. Self-help groups and patient associations can also help. 

Doctors of various specialties work closely together in the treatment of laryngeal cancer. Hospitals that are particularly experienced in the treatment of patients with laryngeal cancer can also have this confirmed with certification. The German Cancer Society (DKG) regularly checks their compliance with certain professional requirements.

You can find the addresses of the certified centers on the OncoMAP website.   

Do you have further questions about dealing with the condition in everyday life and additional support options? You will find information about this at the website of the Cancer Information Service of the German Cancer Research Center (in German).

If you have any questions about laryngeal cancer, you can also make personal contact with the Cancer Information Service by dialing the freephone number (0800) 420 30 40 or writing an email to krebsinformationsdienst@dkfz.de.