Laryngeal cancer is cancer that develops in the larynx, the structure in your throat that holds your vocal cords and helps you breathe, swallow, and speak. The vast majority of laryngeal cancers are squamous cell carcinomas, meaning they start in the thin, flat cells lining the inside of the larynx. Where exactly in the larynx the cancer grows has a major impact on how early it’s caught, how it spreads, and what treatment looks like.
The Three Regions of the Larynx
The larynx is divided into three sections, and cancer behaves differently depending on which one it starts in.
The glottis is the middle section, home to the true vocal cords. This is the most common site for laryngeal cancer, and also the most favorable. Because even a small growth on the vocal cords changes how they vibrate, glottic cancers tend to cause hoarseness early. That early warning sign means they’re often caught before they spread. The glottis also has very little lymphatic drainage, so these tumors rarely reach the lymph nodes.
The supraglottis sits above the vocal cords and includes structures like the epiglottis (the flap that covers your airway when you swallow) and the false vocal cords. Cancers here don’t cause hoarseness until they’ve grown large enough to reach the true cords or surrounding cartilage. Instead, early symptoms tend to be difficulty swallowing and ear pain. Because of this, supraglottic cancers are often discovered at a later stage, sometimes only when a lump appears in the neck from cancer that has already spread to a lymph node.
The subglottis is the area below the vocal cords, extending down to the cricoid cartilage (the ring-shaped cartilage at the base of the larynx). Isolated subglottic cancer is uncommon. Most subglottic tumors are actually extensions of glottic cancers growing downward. They carry a worse prognosis because they tend to invade surrounding structures early and are typically diagnosed late.
Risk Factors
Tobacco and alcohol are by far the two biggest risk factors, and they don’t just add together. A meta-analysis found that heavy smoking combined with heavy drinking increases the risk of laryngeal cancer roughly 35 to 39 times compared to someone who neither smokes nor drinks heavily. That synergy makes the combination far more dangerous than either habit alone.
Smoking on its own is the single strongest risk factor. The longer and more heavily you smoke, the greater the risk. Alcohol independently raises risk as well, likely because it damages the cells lining the throat and makes them more vulnerable to the carcinogens in tobacco.
Symptoms to Watch For
The most recognizable symptom is a hoarse voice or a noticeable change in how your voice sounds that simply doesn’t go away. For glottic cancers, this is often the first and only early sign. Other symptoms depend on where the tumor is growing and may include:
- Difficulty or pain when swallowing
- A persistent sore throat or feeling that something is stuck in your throat
- Ear pain (especially with supraglottic tumors)
- A lump in the neck
- Difficulty breathing or noisy breathing in more advanced cases
Many of these symptoms overlap with far more common conditions like acid reflux or a lingering cold. The key distinction is persistence. A hoarse voice that lasts more than a few weeks, with no obvious explanation like an upper respiratory infection, is worth getting checked by a doctor.
How Laryngeal Cancer Is Diagnosed
The first step is usually a physical exam of your throat. Your doctor will look inside using a thin, flexible tube with a camera on the end, passed through your nose and down into your throat. This gives a direct view of the larynx and vocal cords. If anything looks abnormal, the next step is a biopsy, where a small tissue sample is taken from the suspicious area and examined under a microscope.
If the biopsy confirms cancer, you’ll need imaging to determine how far it has spread. This typically involves some combination of CT scans, MRI scans, and PET scans. Your doctors may also check how your vocal cords move when you speak, since restricted movement can indicate that a tumor is affecting the muscles or nerves. Together, these tests determine the cancer’s stage, which is the most important factor in planning treatment.
There is no routine screening test for laryngeal cancer. The American Cancer Society does not recommend screening even for high-risk populations, because the cancer is relatively uncommon and the diagnostic tools require a specialist.
Staging and Survival Rates
Laryngeal cancer is staged using the TNM system, which evaluates three things: the size and extent of the primary tumor (T), whether cancer has reached nearby lymph nodes (N), and whether it has spread to distant parts of the body (M). Increasing tumor size and lymph node involvement are the two most important factors predicting outcome.
Five-year relative survival rates from the National Cancer Institute’s SEER database paint a clear picture of why early detection matters:
- Localized (cancer confined to the larynx): 79.8% five-year survival
- Regional (spread to nearby lymph nodes): 49.4%
- Distant (cancer has metastasized to other parts of the body): 36.0%
These numbers reflect all laryngeal cancers diagnosed between 2016 and 2022. Individual outcomes vary based on the specific location within the larynx, overall health, and how well the cancer responds to treatment.
Treatment Options
Treatment depends on the cancer’s stage, its exact location, and how much it affects your ability to speak and swallow. For early-stage glottic cancer, treatment often involves radiation therapy alone or a minimally invasive surgical procedure performed through the mouth (transoral surgery), sometimes using a laser. Both approaches aim to eliminate the cancer while preserving the larynx and, with it, your natural voice.
For more advanced cancers, treatment typically combines approaches. Radiation paired with chemotherapy is a common strategy when the goal is to avoid removing the larynx entirely. This is sometimes called an organ preservation approach.
When cancer is very advanced, has destroyed cartilage, or has not responded to other treatments, a total laryngectomy may be necessary. This surgery removes the entire larynx. After the procedure, you breathe through a permanent opening in the front of your neck called a stoma, rather than through your nose and mouth. Losing the larynx also means losing your natural voice, which requires significant adaptation.
Speaking After a Laryngectomy
If you do need a total laryngectomy, there are several ways to communicate afterward. The most common method is a voice prosthesis, placed through a small surgically created opening between the windpipe and the food pipe. This tiny one-way valve lets you push air from your lungs up through the valve and into your mouth to produce sound. You cover the stoma with your fingers to direct the air through the valve rather than out of the opening. Surgeons can place this valve during the laryngectomy itself or in a separate procedure later.
Other options include esophageal speech, which involves learning to swallow air and release it in a controlled way to vibrate the tissue at the top of the food pipe, and an electrolarynx, a handheld device you press against your neck or cheek that produces vibrations your mouth shapes into words. Each method takes practice. A speech and language therapist works with you after surgery to find the approach that suits you best.