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Laryngeal cancer, or larynx cancer, occurs when cancerous cells form in the larynx. The larynx, also known as the voice box, is the part of the throat that controls your vocal cords. Cancer can develop in any of the three major parts of the larynx:

• Glottis:?the middle portion that contains the vocal cords
• Supraglottis: the?area above the vocal cords
• Subglottis: the?area below the vocal cords and above the trachea (windpipe)

We spoke with head and neck surgeon , to learn more about laryngeal cancer.

How common is laryngeal cancer?

It¡¯s much less common than it used to be because fewer Americans are smoking, which is a risk factor for this type of cancer. That said, laryngeal cancers represent about one-fifth of head and neck cancers.

The most common type of laryngeal cancer is squamous cell carcinoma. Other less common types include:

• verrucous cancer
• adenocarcinoma
• undifferentiated carcinoma of the lymph nodes

What are the symptoms of laryngeal cancer?

Hoarseness is the most common symptom of laryngeal cancer. Other symptoms include:

• trouble swallowing
• shortness of breath
• blood-tinged mucus

¡°It¡¯s very common to get hoarse when you have a cold or an allergy attack,¡± says Diaz. ¡°You don¡¯t need to run to the doctor every time that happens. However, your symptoms should improve after about a week.¡±

If you¡¯ve got hoarseness and/or persistent voice changes for more than a week, or you have hoarseness associated with other symptoms, you should see an ear, nose and throat (ENT) specialist.

How is laryngeal cancer typically diagnosed?

When you visit an ENT, they¡¯ll do a complete head and neck exam.

Your doctor may also perform a fiberoptic laryngoscopy, in which a small scope is placed through the back of your nose so the doctor can get a clear view of your voice box.

¡°This painless procedure is done in the clinic and gives us an excellent view of your voice box and vocal cords,¡± says Diaz. ¡°In some cases, we can even perform biopsies in the clinic using one of these scopes.¡±

If you have a biopsy, a pathologist will examine your cell tissue and then determine if you have cancer.

¡°In some cases, if we suspect cancer has spread to a lymph node in the neck, we can perform a fine-needle aspiration of the lymph node to confirm our suspicions,¡± says Diaz.

What are the risk factors for laryngeal cancer?

The biggest risk factor for developing laryngeal cancer is smoking and tobacco use.

Some less common risk factors associated with laryngeal cancer include:

• silent reflux, or heartburn
• drinking alcohol
• the human papillomavirus (HPV)

¡°Silent reflux is when stomach acid flows up the esophagus and spills over onto your voice box,¡± explains Diaz. ¡°The acid is an irritant that washes away mucus, a protectant. For example, if you smoke, the mucus protects the carcinogens from reaching the mucosa, but if the reflux washes that away, it increases your chance of developing cancer.¡±

Alcohol is a solvent that also washes away mucus.

¡°We¡¯re seeing a lot of tumors in the larynx that look like they¡¯re associated with HPV, so it¡¯s important to get vaccinated for HPV if you¡¯re eligible,¡± says Diaz.

The HPV vaccine prevents six types of cancer, including throat cancers like laryngeal cancer. Everyone ages 9-26 is encouraged to get the vaccine, and it is most effective when given between ages 11 and 12. Adults ages 27-45 should talk to their doctor about the benefits of getting vaccinated.

How is laryngeal cancer typically treated?

Laryngeal cancer is typically treated with radiation therapy and/or surgery. For lesions that are caught very early, surgery is the best option.

¡°Once the biopsy confirms it¡¯s cancer, we can use a laser to burn off the cancer,¡± says Diaz. ¡°This is a very effective option with a high cure rate.¡±

Radiation therapy is preferred for intermediate-stage cancers.???

¡°It¡¯s excellent for treating laryngeal cancer, but we don¡¯t use it for all stages because radiation therapy is something you can only use once,¡± says Diaz. ¡°We don¡¯t want to use it for a small tumor and then have the patient get another type of cancer in the future, and we can¡¯t use radiation because they¡¯ve already used it.¡±

Most late-stage laryngeal cancers, T3s and some T4s, will be treated with chemotherapy and radiation. The advanced stage T4s are typically treated with surgery first. In T3 laryngeal cancer, the tumor is limited to the larynx while T4 laryngeal cancer means the tumor has spread beyond the larynx.

¡°For patients with pretty advanced cancer of the larynx, killing the cancer is wonderful, but it doesn¡¯t go back to being a normal larynx because the tissue around the larynx is affected as well,¡± explains Diaz. ¡°So, if a patient has a really large tumor and their voice box isn¡¯t working well, radiation therapy may not do the patient much good in terms of function. So, we¡¯ll typically go with surgery first, then radiation.¡±

What lifestyle changes can laryngeal cancer patients expect?????

At MD Anderson, we focus on preserving function when treating laryngeal cancer.

¡°How do we, one, cure the cancer, and two, preserve function so patients can have a good voice, tolerate a regular diet and avoid having a permanent stoma, or hole in their neck?¡± says Diaz.

Some patients are not excited by the idea of a total laryngectomy, a procedure to remove the entire voice box through your neck, but Diaz says that this is a great curative option for some extensive cases.

¡°A total laryngectomy does leave you with a permanent hole in your neck to breathe through, but we¡¯re able to rehabilitate patients, so they can talk hands-free and communicate openly in public,¡± says Diaz. ¡°We try to introduce them to other laryngeal cancer patients who communicate well and have wonderful lives.¡±

Diaz recognizes that total laryngectomies can be concerning for some patients, so he does his best to avoid those types of surgeries when possible.

¡°That¡¯s why we try to diagnose laryngeal cancer early and do simple surgeries,¡± he says. ¡°Sometimes we can use treatments that don¡¯t involve surgery, like radiation therapy and chemotherapy combined.¡±

Diaz also performs conservation laryngeal surgery, which often requires only a laser to remove the cancer while preserving enough of the voice box¡¯s functionality, so the patient can still talk and swallow without having a permanent stoma.

What are the latest advances in laryngeal cancer treatment?

We just presented research at the American Society of Clinical Oncology Annual Meeting showing success in treating some patients with only immunochemotherapy.

¡°We found that we could control the disease with just immunotherapy and chemotherapy in a good portion of patients,¡± says Diaz. ¡°They never receive radiation therapy or surgery. We¡¯re trying to expand this study nationally to make it available to more patients.¡±

or by calling 1-877-632-6789.

For high school football coach Mark Teague, the only symptom of throat cancer he noticed was a small lump beneath his jaw.?

¡°I¡¯d been aware of it for a while,¡± says Teague, who was diagnosed with HPV-related throat cancer at age 49. ¡°But I¡¯d had sinus problems all my life, so I didn¡¯t think anything of it. I just assumed it was another swollen lymph node.¡±

George Brownfield had a similar experience.

¡°I found a little lump on my neck one day while shaving,¡± says the senior systems analyst, who was diagnosed with the same disease at age 48. ¡°I remember thinking, ¡®Hey, why does that side of my neck look so puffy?¡¯ and going to my general practitioner. He told me it was probably an infection and prescribed some antibiotics.¡±

The most common throat cancer symptoms: painless neck lumps and swollen lymph nodes

Mark and George¡¯s experiences are not unusual. Most people with throat cancer don¡¯t have any symptoms. But when they do, a swollen lymph node or a painless lump in the neck are among the most common.

Why?

¡°Lymph nodes are essentially tiny little sieves that capture dangerous particles circulating around our bodies,¡± explains head and neck cancer surgeon ¡°Sometimes, cancer cells get caught in there and start growing in place. Eventually, they form tumors that can get big enough to grow out of the lymph nodes.¡±

Other throat cancer symptoms, including (rarely) pain

Other MD Anderson patients have reported different throat cancer symptoms, such as news photographer Damion Smith, who lost his voice, and senior civil engineering inspector Scott Courville, who developed pain in his jaw, felt lumps in his throat and saw little white spots on his tonsils.

¡°Laryngitis, visible abnormalities and pain are far less common symptoms of throat cancer,¡± notes Lango. ¡°Though we do occasionally see patients who report ear pain, a type of ¡®referred¡¯ pain from the tongue or throat. And, sometimes, people say it feels like something is kind of caught back there.¡±

Pain as a symptom of throat cancer is almost always only on one side, though. ¡°It¡¯s usually not in the middle,¡± Lango says. ¡°And it tends to be both dull and persistent. Once it¡¯s there, it¡¯s always there. It never goes away. That¡¯s a sign that it should get checked out.¡±

When to see a doctor for throat cancer symptoms

As a general rule, you should see a doctor about any worrisome symptoms that don¡¯t resolve on their own within two or three weeks. But see a doctor much sooner if you experience any of the following throat cancer symptoms:

• swallowing difficulties
• involuntary weight loss
• breathing problems
• a change in your voice or ability to speak clearly
• bleeding in the throat (which may be coughed or spit up)

¡°All of these symptoms should be considered more urgent,¡± explains Lango. ¡°They might not warrant an immediate emergency room visit, but they do need to be looked into pretty quickly.¡±

Having one or more of these symptoms doesn¡¯t necessarily mean you have throat cancer. But it¡¯s important to be evaluated because throat cancer is easiest to treat when it¡¯s caught in its earliest stages.

¡°You¡¯re much more likely to need a combination of treatments ¡ª such as surgery plus radiation rather than surgery alone ¡ª if you¡¯re diagnosed in the latter stages of throat cancer,¡± notes Lango. ¡°And that can mean both a longer course of treatment and more side effects. So, early diagnosis can make a huge difference.¡±

See a complete list of throat cancer symptoms.?

or by calling 1-877-632-6789.

By the time I was diagnosed with HPV-related throat cancer in the summer of 2014, I¡¯d been working as a senior systems analyst at MD Anderson for more than 20 years. I¡¯d seen some of the incredible things our doctors were doing for people and was very aware of our reputation. So, there was never any doubt about where I¡¯d be going for throat cancer treatment.?

Once I was cancer-free, I realized I wanted to pay it forward. That¡¯s why I started volunteering through myCancerConnection, MD Anderson¡¯s one-on-one cancer support community for patients and caregivers. I also became a vocal advocate for vaccinating kids against HPV.?

My throat cancer diagnosis

The ear, nose and throat specialist who initially diagnosed me was very timid about telling me why my lymph nodes were swollen. The only thing he ever really stated plainly was that I needed to get to MD Anderson.??

As a result, I wasn¡¯t even sure I had throat cancer until I met with surgical oncologist . She was clear and precise about my diagnosis, but also very comforting. She told me that the cancer was stage I, and she knew exactly how to treat it. I was going to be fine. I felt such a sense of relief.?

The cancer was mainly in my left aryepiglottic fold and piriform sinus. That's the first part of the swallowing tube, which acts sort of like a funnel in directing food to the esophagus. Dr. Hessel told me that because of the cancer¡¯s location, she wouldn¡¯t be able to remove it surgically. If she did, I wouldn¡¯t be able to eat or drink normally.?

Instead, I had six rounds of chemotherapy under medical oncologist Dr. Merrill Kies (now retired), followed by 33 rounds of radiation therapy under radiation oncologist . I rang the bell to mark the end of my treatments on Feb. 25, 2015.?

My throat cancer treatment side effects

I lost 20 pounds during radiation, because I couldn¡¯t taste anything for about three months. I also had to take a day off work each week due to fatigue during chemotherapy.??

But the most severe side effect I had during treatment was dry mouth, because my salivary glands weren¡¯t working as well as they normally did. I still have some dry mouth today, though it¡¯s much less severe and not that big of a deal anymore. I just have to drink plenty of water. I figure if that¡¯s the worst thing I have to complain about, I¡¯m doing pretty well.?

Why I¡¯m an HPV vaccine advocate

When you blow out a tire, figuring out what popped it is not nearly as interesting as getting to the side of the road safely. So, I was far more concerned with survival after my throat cancer diagnosis than I was with the fact that it had been caused by HPV.??

Now, I¡¯m a pretty vocal advocate for the HPV vaccine. The vaccine wasn¡¯t around when I was a kid, but I wish it had been. Because my cancer treatment wasn¡¯t as difficult as a lot of other people¡¯s, but it wasn¡¯t a cakewalk either. So, I tell everyone I meet who has adolescents and teenagers to get their children vaccinated. I made sure my own kids got vaccinated, too.?

Why I joined myCancerConnection

My job at MD Anderson involves fixing servers and maintaining the many computer applications that help support our mission. I¡¯m a small cog in very big machine, so I know I¡¯m not going to directly save anyone¡¯s life.?

But I feel like if you¡¯re not actively trying to do some good in this world, you¡¯re missing an opportunity. That¡¯s why I joined myCancerConnection almost immediately after finishing treatment. I wanted to share what I¡¯d learned with other cancer patients. So far, I¡¯ve talked to about six people.?

I never really felt that same sense of dread that some cancer patients experience. But I know that many other people do. So, if I can give them hope or help to lessen their anxiety even a little, I want to do it.??

or by calling 1-877-632-6789.

Most people who are diagnosed with throat cancer won¡¯t see anything unusual if they look in the mirror, open their mouths and say, ¡°Ahhhh.¡±

¡°That¡¯s because there¡¯s usually not much to see,¡± says head and neck surgeon ¡°These tumors are often buried deep in the throat, or hidden under the surface of the tissue. Throat cancers are usually quite small, too, and they can be very difficult to see, even by trained experts. So, only about 20% to 30% of patients will notice something visible.¡±

Symptoms of throat cancer

When a throat cancer is visible to the naked eye, here are some of the features it could have:

• Asymmetry: when one side looks odd or just noticeably different from the other
• Lesions: might appear as red or white patches
• Swelling: may or may not involve lesions

Throat cancers are usually found in the oropharynx, which includes the tonsils, the uvula (the small structure dangling in the middle), the soft palate, and the hind-most portion of the tongue, which is not visible without a scope. But they can also develop in the larynx (voice box) and the nasopharynx (the area behind the nose).

The most common symptom of throat cancer is actually a painless mass on the side of the neck.

¡°Normally, it doesn¡¯t hurt,¡± notes Lango. ¡°But it¡¯s there for longer than it should be, it¡¯s only on one side, and it¡¯s too large to be a swollen lymph node.¡±

Rarely, patients may report pain in the back of the throat or difficulty swallowing. But most have no symptoms at all, and are very surprised to hear that they have throat cancer.????????

Throat cancer and HPV: the viral connection

Almost all throat cancers that doctors see at MD Anderson are squamous cell carcinomas. Roughly 80% of them are caused by the human papillomavirus, or HPV, though this figure may be lower at other hospitals.

¡°I can¡¯t even remember the last time I saw a throat cancer that wasn¡¯t HPV-positive,¡± says Lango. ¡°Before the year 2000, we hardly saw any at all. Now, we¡¯re seeing a ton. It really is an epidemic.¡±

That¡¯s why Lango encourages everyone ages 9-26 to get vaccinated against HPV. The HPV vaccine is most effective when given at ages 11-12. But unvaccinated men and women ages 27-45 should talk to their doctors about the benefits of receiving the vaccine.

¡°The amount of throat cancer caused by tobacco has dropped exponentially in the last 20 years,¡± Lango notes. ¡°That¡¯s partially because people aren¡¯t smoking as much as they used to. But if we could get more young people vaccinated against HPV now, that would really go a long way toward reducing future cases of throat cancer.¡±

Know your throat cancer treatment options

Whether a throat cancer is related to HPV or not, it¡¯s important to seek treatment for it at a comprehensive cancer center like MD Anderson.

¡°A lot of people just go with the first thing they¡¯re offered, not realizing there are other options,¡± says Lango. ¡°That¡¯s why it¡¯s critical to get a second opinion, at the very least.¡±

One reason is that many patients will survive for years after a throat cancer diagnosis. That means they may have to live for decades with the side effects of their treatments, such as dry mouth or difficulty swallowing.

¡°Both of these issues can affect your quality of life and your ability to enjoy food,¡± Lango says. ¡°So, it¡¯s very worthwhile to make sure you¡¯re getting the right treatment.¡±

Throat cancer treatment

With early stage throat cancers, surgery alone might be all that¡¯s needed. With more advanced cases, patients will likely be offered some combination of chemotherapy, surgery and/or radiation therapy.

¡°In the old days, everybody got chemotherapy and radiation,¡± notes Lango. ¡°But trans-oral robotic surgery (TORS) has become a very effective tool to treat some patients. The survival rate is just phenomenal.¡±

Options to reduce the intensity of treatments ¡ª and potentially decrease long-term side effects by participating in ¡°de-escalation¡± clinical trials ¡ª may also be available. Studies may incorporate immunotherapy or highly targeted proton therapy.

¡°Some treatments are conducted through clinical trials because they¡¯re promising, but not yet the standard of care,¡± says Lango. ¡°But some of our patients¡¯ responses were very good. So, the way we treat patients now may not be the same way we treat patients in a couple of years. And classical chemo has been such a mainstay of throat cancer treatment for so long, that not needing to have it is kind of a big deal.¡±

or by calling 1-877-632-6789.