Laryngeal Cancer.Care & specialists in South Africa

The earliest and most common sign is persistent hoarseness or voice change lasting more than 3 weeks. Because the vocal cords are exquisitely sensitive to even small lesions, glottic tumours typically declare themselves while they are still curable. Any adult smoker or former smoker with hoarseness beyond 3 weeks should be referred for urgent ENT laryngoscopy rather than treated empirically for laryngitis.

Yes — laryngeal cancer is highly curable when caught early. Five-year relative survival is approximately 78% for localised disease and exceeds 90% for T1 glottic cancer treated with either transoral laser surgery or radiation. Survival falls to roughly 47% for regional disease and 34% for distant disease, which is why early symptoms must be investigated quickly.

SEER 2024 reports a 5-year relative survival of approximately 61% overall for laryngeal cancer: 78% for localised, 47% for regional, and 34% for distant disease. Glottic cancers do better stage-for-stage than supraglottic or subglottic primaries because they present earlier with hoarseness. Stage, subsite, smoking status during treatment, and access to multidisciplinary care drive the differences in outcome.

Cigarette smoking causes 70-80% of laryngeal cancers, and heavy alcohol use is a strong independent and synergistic risk factor; combined heavy smoking and drinking accounts for over 90% of cases in many series. Other contributors include occupational asbestos and chemical exposures, chronic laryngopharyngeal reflux, HPV in a small subset, and inherited DNA-repair disorders such as Fanconi anaemia.

Diagnosis starts with flexible laryngoscopy in the ENT clinic, followed by biopsy under general anaesthesia at panendoscopy to confirm tissue diagnosis and map the tumour. Contrast-enhanced CT or MRI of the neck and chest defines T-stage and nodal disease; PET/CT is used for stage III-IV disease. Every confirmed case is reviewed at a multidisciplinary head and neck oncology meeting before treatment is offered.

The larynx is divided into supraglottis (epiglottis, false cords, aryepiglottic folds), glottis (true vocal cords), and subglottis (below the cords). Glottic cancers account for ~60% of cases and present early with hoarseness. Supraglottic cancers account for ~30-35% and often present with neck lymph node metastasis. Subglottic cancers account for under 5% and tend to present late with airway obstruction.

Glottic cancer arises on the vocal cords, presents very early with hoarseness, has limited lymphatic drainage, and has the best stage-for-stage prognosis. Supraglottic cancer arises above the cords, presents later with sore throat, otalgia, or a neck lump, has rich bilateral lymphatic drainage, and produces nodal metastasis in 25-50% of patients at diagnosis. Treatment plans and elective neck dissection decisions differ accordingly.

Early laryngeal cancer (T1-T2 N0) is treated with single-modality therapy — transoral laser microsurgery, transoral robotic surgery, or definitive radiation therapy — with equivalent local control rates of 85-95%. The choice depends on tumour location, voice priorities, comorbidities, and centre expertise. Voice outcomes are generally similar between modalities; surgery preserves radiation as a salvage option, and vice versa.

Total laryngectomy is surgical removal of the entire larynx, creating a permanent breathing stoma in the neck. It is the standard for T4a tumours with cartilage destruction, dysfunctional larynx, or after failed larynx-preserving therapy. Voice rehabilitation with a tracheoesophageal voice prosthesis is achieved by 80-90% of motivated patients; electrolarynx and oesophageal speech are alternatives.

Yes — for many T3 cancers and selected T4 cancers, concurrent platinum-based chemoradiation preserves the larynx in 67% of patients at 10 years (RTOG 91-11). T4a tumours with bulky cartilage destruction or non-functional larynx have poor outcomes with non-surgical preservation and are typically offered upfront total laryngectomy with adjuvant therapy. The decision is made in a multidisciplinary tumour board with patient values weighted heavily.

RTOG 91-11 was a landmark randomised trial of 547 patients with locally advanced laryngeal cancer that compared induction chemotherapy plus radiation, concurrent cisplatin-radiation, and radiation alone. Concurrent chemoradiation produced superior larynx preservation (84% at 2 years, 67% at 10 years) and locoregional control. The trial established concurrent cisplatin-radiation as a standard of care for larynx preservation.

A standard course of definitive radiotherapy delivers 66-70 Gy in 30-35 daily fractions over 6-7 weeks (typically Monday to Friday). Each daily appointment lasts 15-30 minutes including set-up. Acute side effects (sore throat, mucositis, fatigue) peak in weeks 4-6 and settle over 8-12 weeks after the last fraction.

Yes — most patients achieve fluent intelligible speech after total laryngectomy. The gold standard is a tracheoesophageal voice prosthesis inserted during or shortly after surgery, which 80-90% of motivated patients use successfully. Alternatives are oesophageal speech (swallowing air and releasing it through the upper oesophagus) and an electrolarynx device held against the neck.

HPV is identified in only 5-15% of laryngeal cancers, far less than the >70% rate in oropharyngeal cancer. The prognostic benefit seen in HPV-driven oropharyngeal cancer does not consistently apply to the larynx. HPV-6 and HPV-11 cause recurrent respiratory papillomatosis, which has a small lifetime risk of malignant transformation. HPV vaccination is expected to reduce both oropharyngeal and recurrent respiratory papillomatosis-related cancers over the coming decades.

Yes — continued smoking during radiotherapy reduces response rates by 30-40%, doubles the risk of a second primary cancer, and roughly halves long-term survival (Browman NEJM 1993). Smoking cessation at diagnosis is the single most powerful patient-controlled intervention. Every head and neck oncology unit should offer formal cessation support, nicotine replacement, or varenicline at diagnosis.

Common side effects include mucositis, dysphagia, weight loss, fatigue, xerostomia, taste change, skin reaction, hoarseness, and tinnitus or hearing loss with cisplatin. Long-term effects include chronic xerostomia, dental decay, hypothyroidism (in up to 50% within 5 years of neck irradiation), lymphoedema, and risk of osteoradionecrosis. Total laryngectomy adds permanent stoma care and the need for voice rehabilitation.

Yes — local or regional recurrence occurs in 15-30% of patients within 5 years, most often within the first 2 years. Distant metastases (lung most common) develop in 15-25% of advanced cases. Surveillance with clinical exam, laryngoscopy, and cross-sectional imaging is intensive in years 1-2 and tapers thereafter. Salvage surgery offers a curative option for isolated local recurrence in many cases.

In the United States, total billed cost for stage III-IV laryngeal cancer commonly ranges from USD 80,000 to USD 250,000 across surgery, radiation, chemotherapy, and rehabilitation; insurance covers most costs for in-network multidisciplinary care. In India and other emerging markets, comprehensive treatment in a high-volume cancer centre typically ranges from INR 4 to 12 lakh (USD 5,000 to 15,000). Voice prosthesis maintenance is an ongoing yearly cost.

Most laryngeal cancer is sporadic and driven by tobacco and alcohol rather than inheritance. Rare inherited DNA-repair disorders, particularly Fanconi anaemia, increase head and neck SCC risk 500-700-fold and often present before age 40. Common genetic variants in alcohol and DNA-repair genes modify individual risk modestly. Family history of head and neck cancer doubles personal risk and warrants earlier symptom-led assessment.

Yes — women account for roughly 20-25% of US cases, and the gap is closing in countries where female smoking rose in recent decades. Female laryngeal cancer patients tend to be older at diagnosis, have a higher proportion of supraglottic disease, and historically have had inferior stage-adjusted survival linked to delayed referral. Persistent hoarseness should be investigated as urgently in women as in men.

Immune checkpoint inhibitors targeting PD-1 (pembrolizumab and nivolumab) are now standard for recurrent or metastatic head and neck SCC. Pembrolizumab — alone in PD-L1 CPS ≥1 disease or combined with platinum-fluorouracil regardless of CPS — is first-line based on KEYNOTE-048 (Burtness Lancet 2019). Nivolumab is approved for platinum-refractory disease. Trials are evaluating immunotherapy in the curative-intent setting alongside chemoradiation.

NCCN recommends review every 1-3 months in year 1, every 2-6 months in year 2, every 4-8 months in years 3-5, and annually thereafter. Each visit includes clinical exam, laryngoscopy, and a review of voice, swallowing, and pain. Chest imaging is performed at least annually given the elevated lung primary risk in smokers; PET/CT and MRI are used selectively. TSH is checked annually after neck irradiation.