Laryngeal Cancer

[en Español]

What is laryngeal cancer?

Laryngeal cancer occurs when cancerous (malignant) cells form on the tissues of the larynx, or voice box. The larynx contains the vocal folds. The vocal folds vibrate. This makes sound when air is directed against them. A person's voice is heard when this sound echoes through the throat, mouth, and nose.

What are some signs or symptoms of laryngeal cancer?

A person with laryngeal cancer may notice:

  • hoarseness or change in his or her voice
  • difficulty swallowing
  • a lump in the throat
  • bad cough or chest infection
  • shortness of breath
  • bad breath (halitosis)
  • weight loss
  • prolonged earache

How is laryngeal cancer diagnosed?

You should visit a doctor if you have any of the above-mentioned symptoms. A doctor will feel your throat for lumps. He or she will also look down your throat with an endoscope, a tube with a special light, to see your larynx. This procedure is called a laryngoscopy. The doctor may need to cut out a small piece of tissue, if the larynx has tissue that does not look normal. The doctor will look at the tissue under a microscope to see if it contains any cancer cells. This procedure is called a biopsy, and it is the only way to diagnose cancer.

What treatments are available for individuals with laryngeal cancer?

One or more of the following approaches may be used depending on the size, location, and time of cancer detection:

  • radiation therapy
  • chemotherapy
  • partial removal of the larynx (laryngectomy)
  • total laryngectomy

In these cases, the person may still be able to produce voice. However, the person's voice may not be the same because of removing parts of the larynx, changes to laryngeal tissue from radiation or chemotherapy, or removal of nearby neck muscles (to prevent or stop the spread of the cancer).

In extreme cases, total laryngectomy, with or without radiation therapy or chemotherapy, may be the only life-saving solution.

Patients who have undergone radiation treatment may have:

  • dry and/or red skin at the site of the treatment
  • sore throat
  • dry mouth (xerostomia)
  • sensitive mouth
  • mouth sores
  • difficulty swallowing
  • decreased taste
  • fatigue
  • breathing difficulties from swelling

Patients who have received chemotherapy, often for the treatment of metastasized cancer (i.e., cancer that has spread), may have:

  • nausea or vomiting
  • increased chance of infection
  • bleeding or bruising
  • fatigue
  • shortness of breath

These side effects often stop after the chemotherapy is discontinued.

Speech-language pathologists (SLPs) play an important role both before and after surgery.

What is a laryngectomy?

A laryngectomy is the removal of the voice box (larynx) from the neck, usually because of cancer. During this operation, a new route for breathing is surgically created. The end of the windpipe (trachea) is connected to a hole (stoma) made in the neck. Rather than using the mouth and the nose, the person will breathe through this hole.

Because the patient with the laryngectomy breathes through a stoma, the air inhaled into the lungs is no longer warmed or moisturized by structures of the nose and mouth. As a result, the breathing tubes can become irritated and create a thick mucus. This mucus may also crust on the stoma and require routine removal. The patient may benefit from humidifiers and a cover to protect the stoma.

What other organizations have information on laryngeal cancer?

This list is not exhaustive and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA.

What causes laryngeal cancer?

The following may increase your risk of laryngeal cancer:

  • heavy smoking and drinking
  • poor eating habits-not enough vitamins from fruits and vegetables
  • weakened immune system
  • exposure to chemicals and certain substances (e.g., wood dust, paint fumes, soot)
  • acid reflux 

How common is laryngeal cancer?

Cancers of the larynx make up about 2%-5% of diagnosed cancers. More than twice as many men as women are diagnosed. Most cases occur between the ages of 50 and 70. 

What does a speech-language pathologist (SLP) do when working with individuals with laryngeal cancer?

The SLP will meet with the person and family before surgery. The SLP will evaluate factors like vocal quality, pitch range, and presence or absence of accent or regional speech variations. This evaluation allows the SLP to understand the person's speech and voice abilities. This understanding helps the SLP plan treatment after surgery.

The SLP will also explain the anatomy and physiology of the larynx, describe how surgery will change this, and provide information on what will happen in the intensive care unit immediately following the surgery.

The person will not have a voice after the larynx is removed. The SLP will provide a pad of paper and a pen or another writing device for expressing basic needs to nurses, doctors, family, and friends immediately after surgery.

After surgery, the SLP's primary goal is to provide the person with a new sound source for speech. There are three primary options:

Esophageal Speech: A person takes air in through the mouth, traps it in the throat, and then releases it. As the air is released, it makes the upper parts of the throat/esophagus vibrate and produces sound that is shaped into words in the same way it was before surgery: with the lips, tongue, teeth, and other mouth parts. This type of alaryngeal speech is difficult to learn and use effectively, especially in rushed or stressful communication situations.

Artificial Larynx: The person uses an electronic or mechanical instrument that provides the sound source for speech. Some of these devices are held against the neck, and others have a tube that the patient puts in his mouth. Many people use an artificial larynx as their first means of alaryngeal speech. Effective use still requires training and practice, and some disadvantages exist. The artificial larynx has a mechanical voice quality, requires the use of one hand, and draws attention to the speaker.

Tracheoesophageal Puncture (TEP): This surgical procedure is one of the more popular methods of alaryngeal speech production. It can be performed at the time of the laryngectomy surgery or afterwards. The surgeon creates a connection between the trachea and the esophagus with a small hole. A small, one-way shunt valve is then inserted into this hole. To speak, the person inhales air through the stoma and into the lungs. Then, he or she covers the stoma with a finger. Air from the lungs is then directed from the trachea, through the shunt valve, and into the esophagus. The esophagus vibrates, creating a sound source for speech. This sound is then shaped into speech sounds in the mouth in the same way it was done before laryngectomy. The SLP will assist the individual in selecting and fitting the prosthesis and can teach proper prosthesis care and use.