Laryngeal (Voice Box) Cancer: Early Signs, Staging and Treatment

Laryngeal cancer accounts for approximately 25% of all head and neck cancers and is 4–5 times more common in men than women. The most common age group is 50–70. Anatomically, the larynx is divided into three regions: glottic (vocal cords), supraglottic (epiglottis, aryepiglottic folds, false cords), and subglottic. 65% of tumours begin in the glottic region, 32% in the supraglottic. Glottic tumours present with early hoarseness and are therefore usually diagnosed early, resulting in dramatically better prognosis.

Hoarseness is the earliest and most valuable symptom of glottic laryngeal cancer. Because diagnosis is usually made early, 5-year survival reaches 90–95%. In supraglottic cancer, voice change occurs late; early symptoms are dysphagia, foreign body sensation, ear-referred pain (otalgia), and a neck mass. Warning signs to highlight: hoarseness lasting more than 3 weeks, especially in smokers; pain on swallowing; stridor; a palpable neck mass; unexplained weight loss.

Laryngoscopy is the primary diagnostic tool when laryngeal cancer is suspected. Flexible fiberoptic laryngoscopy in the clinic, and rigid laryngoscopy under general anaesthesia for biopsy and histological diagnosis. Videostroboscopy evaluates vocal cord vibration and shows tumour invasion of the cord. Neck-thorax CT investigates regional lymph node involvement and distant metastasis. PET-CT is used in advanced disease. The AJCC TNM staging system is determinative in treatment decisions.

For early-stage (T1–T2N0) glottic cancer, transoral CO₂ laser microsurgery (TLM) or radiotherapy provide equivalent local control. TLM shortens hospitalisation, offers fewer late side effects, and allows re-treatment. For advanced stage (T3–T4a) in eligible patients, concurrent chemoradiotherapy (CCRT) organ preservation strategy can be attempted, but the functional integrity of the larynx must be assessed. Total laryngectomy is performed when organ preservation is impossible, in salvage surgery, and in T4b cases. In selected cases, partial laryngeal surgery (supraglottic laryngectomy, supracricoid laryngectomy) may be applied.

Voice rehabilitation after total laryngectomy is central to quality of life. The tracheoesophageal voice prosthesis (TEP) consists of a small valve connecting the oesophagus to the trachea; it directs lung air to the oesophagus to produce sound. It is the most widely used method today. Oesophageal speech (belching speech) can be learned by naturally swallowing and releasing air. An electrolarynx produces sound through vibration when applied to the neck or mouth. Psychological support and multidisciplinary rehabilitation after laryngectomy are critical for long-term adjustment.