Laryngeal cancer: symptoms, tests, treatment and survival

The larynx, or voice box, sits at the entrance to the windpipe and contains the vocal cords. The NHS describes laryngeal cancer as a type of throat cancer that affects the voice box, and notes that there are other throat cancers, including nasopharyngeal, oropharyngeal and hypopharyngeal cancer. Cancer Research UK explains that it is a type of head and neck cancer.

The NHS says how serious laryngeal cancer is depends on where it is in the larynx, how big it is, whether it has spread and your general health.

The NHS says symptoms vary depending on where in the voice box the cancer is. Many of these symptoms are very common and can be caused by other conditions, so having them does not definitely mean you have laryngeal cancer, but it is important to get checked.

• A hoarse voice or change in your voice that does not go away.

• A lump or swelling in your neck or throat.

• Pain when swallowing, or difficulty swallowing.

• Shortness of breath or difficulty breathing.

• Less commonly, an earache that does not go away, bad breath and unexplained weight loss.

Most hoarse voices are not cancer. Cancer Research UK lists laryngitis (inflammation of the larynx, often from a cold, chest infection or overusing the voice), smoking, acid reflux, post-nasal drip, allergies, thyroid problems and injury as other causes.

The point at which hoarseness needs checking is persistence. Cancer Research UK says to see a doctor if you have had a hoarse voice for more than 3 weeks, and the NHS says to see a GP if a hoarse voice or voice change does not go away.

The NHS says to see a GP if you have a hoarse voice or change in your voice that does not go away, a lump or swelling in your throat, including a lump that has been checked before but is getting bigger, or pain or difficulty swallowing. It says to contact NHS 111 if you have difficulty breathing or are more short of breath than usual, and to call 999 or go to A&E immediately if you have severe difficulty breathing, gasping, choking or are not able to get words out, and not to drive yourself.

The GP may look inside your mouth, feel your neck, listen to your chest and may arrange a blood test or chest X-ray. The NHS says the GP may refer you straight to the ear, nose and throat (ENT) department, which may be an urgent referral that does not definitely mean you have cancer.

The NHS says it is not always clear what causes laryngeal cancer and anyone can get it. You might be more at risk if you are over 40, are a man, especially if you are Black, have a close relative who has had laryngeal cancer, have conditions such as acid reflux (gastro-oesophageal reflux disease) or have had radiotherapy to the neck. Cancer Research UK lists smoking tobacco and drinking alcohol as factors that increase the risk.

The NHS says you cannot always prevent it, but cutting down alcohol, avoiding more than 14 units a week, and trying to quit smoking can lower your chances.

The NHS says that if the GP or specialist thinks you might have laryngeal cancer, you will be referred for tests to look inside your throat: using a thin tube with a camera to look inside the nose, throat and mouth, using a thin tube with a camera to look at the voice box, which may include a biopsy, and checking any neck lumps with a needle and syringe to take a sample. It can take several weeks to get results.

If cancer is found, the NHS says you will usually need more tests such as CT, MRI, ultrasound and PET scans, a vocal cord check using a small video camera, and a test to look at your nose, throat and upper food pipe under local anaesthetic. These help find the size of the cancer and how far it has spread (the stage). Your team includes a clinical nurse specialist who is your main point of contact.

The NHS says laryngeal cancer is often treatable. Treatment depends on the size and type of laryngeal cancer, where it is, whether it has spread and your general health, and may include surgery, chemotherapy, radiotherapy, or targeted medicines and immunotherapy.

Cancer Research UK stresses that survival depends on many factors including the stage and grade of the cancer, and that statistics cannot tell you what will happen in your own case. Because this cancer is less common, some statistics are based on small numbers.

For people diagnosed in England between 2014 and 2016, Cancer Research UK gives five-year net survival by stage, shown below. For men generally in the UK it gives around 85% surviving at least 1 year, more than 60% at least 5 years and around 45% at least 10 years.

The NHS says if you have part or all of your larynx removed, recovery can take a long time, and your team will help you manage side effects, including changes to your diet, and support you to speak or communicate after surgery. You will have regular check-ups during and after treatment, and you do not need to wait for the next one if you have symptoms or side effects you are worried about.

If the cancer cannot be cured, the NHS says the aim of treatment is to slow its growth and spread, help with symptoms and help you live longer, with a palliative care or symptom control team helping you stay comfortable. Support is available from Macmillan Cancer Support, whose helpline the NHS says is open every day from 8am to 8pm, and from the Throat Cancer Foundation.

On the NHS the route is GP to an urgent ENT referral, with endoscopic examination and biopsy, then a multidisciplinary head and neck team. Private ENT consultation can give a faster first appointment or a second opinion, and laryngoscopy is available privately, but treatment decisions are made by a specialist cancer team in either sector. Ask who will be your main contact and which team will manage surgery, radiotherapy and speech and swallowing rehabilitation.