carcinoma (larynx)

Last reviewed 01/2018

Laryngeal carcinoma is one of the most common head and neck tumours with an annual incidence of approximately 1 per 100,000. It should be suspected in any patient with hoarseness of the voice for three weeks or longer until proven otherwise.

Men are affected more often than women but during the last decade, the number of cases in women has increased such that they now account for about 20% of cases. Most patients are elderly and almost always, are smokers.

Other features of laryngeal cancer include:

• sixty percent of tumours occur in the glottis and present early with dysphonia
  • glottic cancer has the most favourable prognosis of all forms of laryngeal cancer, as people tend to seek medical advice for chronic hoarseness, which is the most common early symptom
• other symptoms of laryngeal cancer may include pain or problems with swallowing (dysphagia). There can also be a lump in the neck, sore throat, earache, or a persistent cough.
• virtually all cancer of the larynx is squamous cell carcinoma.
• if detected early, the prognosis is excellent with a 90% 5 year cure rate
• overall survival rates are better than for oral or pharyngeal cancer, with nearly two-thirds of patients surviving for five years

Treatment of early stage disease (3)

Squamous cell carcinoma of the larynx

• offer transoral laser microsurgery to people with newly-diagnosed T1a squamous cell carcinoma of the glottic larynx
• offer a choice of transoral laser microsurgery or radiotherapy to people with newly-diagnosed T1b-T2 squamous cell carcinoma of the glottic larynx
• offer a choice of transoral surgery or radiotherapy to people with newly-diagnosed T1-T2 squamous cell carcinoma of the supraglottic larynx

Treatment of advanced disease (3)

Squamous cell carcinoma of the larynx

• offer people with T3 squamous cell carcinoma of the larynx a choice of:
  • radiotherapy with concomitant chemotherapy, or
  • surgery with adjuvant radiotherapy, with or without concomitant chemotherapy
• for people with T4a squamous cell carcinoma of the larynx consider surgery with adjuvant radiotherapy, with or without concomitant chemotherapy

Reference:

1. Referral Guidelines for Suspected Cancer (April 2000). NHS Executive.
2. NICE (2004). Improving the outcomes in head and neck cancers - the manual
3. NICE (February 2016).Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over