Laryngeal (larynx) cancer

Doctors don't know the exact cause of laryngeal cancer, but certain risk factors can raise your chance of getting it.

Having one or more risk factors doesn't mean you'll definitely get laryngeal cancer. Some people with risk factors never get it. Others can develop cancer of the larynx without any known risk factors, though this isn't common.

This type of cancer is rare in people under 40. It's more common in people over 60, and 4 times more common in men than women.

The main risk factors are smoking tobacco and drinking alcohol.

Smoking

The risk of developing cancer of the larynx increases the longer and the more you smoke.

Get advice about stopping smoking.

Alcohol

Drinking lots of alcohol, especially spirits, over a long time increases your risk of developing cancer of the larynx. The risk is higher for people who smoke and also drink lots of alcohol.

Get advice and support with alcohol.

As with other cancers, laryngeal cancer is not infectious, so you can't pass it on to other people.

If you have symptoms of laryngeal cancer, you'll usually see your GP first. They'll examine you and may arrange some tests, and might refer you to an ear, nose and throat (ENT) doctor or a specialist clinic.

The specialist will ask about your symptoms, check your general health, ask whether you take any medicines, and feel your neck for lumps. These lumps may be caused by swollen lymph nodes, though other conditions, such as a swollen salivary gland, can cause them too.

After examining you carefully, the specialist will explain what tests you need. These may include the following.

Nasendoscopy

A nasendoscopy is used to look at the back of your mouth and throat.

Laryngoscopy and biopsy

A laryngoscopy is used to look closely at the larynx. During this test, the doctor takes a small tissue sample, called a biopsy, if any area looks abnormal.

Fine needle aspiration (FNA)

An FNA is a simple test used to check lumps in the neck.

Further tests for laryngeal cancer

If cancer cells are found in your larynx, your doctor will ask you to have some more tests. These help you and your doctor decide on the right treatment.

Blood tests

You may have blood tests to check your general health and see what treatments might suit you.

CT scan

A CT scan builds a detailed picture of the inside of the body using a series of X-rays.

MRI scan

An MRI scan uses magnetism, rather than X-rays, to build a detailed picture of areas inside your body.

PET or PET-CT scan

A PET scan uses a low dose of radiation to check how active the cells are in different parts of the body. It can give more detailed information about the cancer or about unusual areas seen on X-rays, CT scans or MRI scans. Sometimes a PET scan and a CT scan are done together, known as a PET-CT scan.

Waiting for test results can be a difficult time. Talking to your doctor or a support organisation can help while you wait.

Staging and grading of laryngeal cancer

Your test results help doctors understand the size and position of the cancer, and whether it has spread. This is known as staging.

Doctors also grade the cancer by looking at how the cells appear under a microscope. This gives an idea of how quickly the cancer might grow or spread.

Knowing the stage and grade of laryngeal cancer helps your doctors plan the treatment that is best suited to you.

Treatment for laryngeal cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).Your cancer doctor or specialist nurse will explain the different treatments and their side effects. It can help to write down any questions before you see them. They’ll also talk to you about the things you should consider when making treatment decisions.Treatment for laryngeal cancer depends on:

• where the cancer is in the larynx
• the size of the cancer and whether it has spread (its stage)
• how fast-growing the cancer is (its grade)
• your general health

Macmillan Cancer Support have more information about laryngeal cancer treatment.The main treatments for early stage laryngeal cancer are radiotherapy and surgery. Other treatments may be used for locally advanced and advanced laryngeal cancer.

Radiotherapy

Radiotherapy uses high-energy rays to destroy the cancer cells. It can be given on its own, with chemotherapy (chemoradiation) or with a targeted therapy drug.

Surgery

You may have surgery through your mouth if you have early stage laryngeal cancer. If the tumour is large, you may need surgery to remove part or all of the larynx (laryngectomy).Some people also have surgery to remove cancer that has spread to nearby lymph nodes (a neck dissection).

Chemoradiation

Having chemotherapy at the same time as radiotherapy is called chemoradiation.

It may be given as your main treatment, if the cancer is locally advanced. Or it may be used if the cancer can’t be removed with surgery.

It’s also sometimes used to reduce the risk of the cancer coming back after surgery (adjuvant treatment).

Chemotherapy

Chemotherapy can be given before and after surgery. It can be given on its own or with radiotherapy. It can also be given to slow the growth of the cancer and control symptoms (palliative chemotherapy).

Targeted therapy

Targeted therapy uses drugs to find and attack cancer cells.

There are many different types of targeted therapy. Each type of therapy targets something in or around the cancer cell that is helping it grow and survive.

The most commonly used targeted therapy to treat laryngeal cancer is cetuximab (Erbitux®).

Immunotherapy

The immune system protects the body against illness and infection. Immunotherapy treatments use the immune system to find and attack cancer cells.

The immunotherapy drugs used to treat laryngeal cancer are nivolumab and pembrolizumab.

More about treatments

The treatments can be used alone or in combination with each other.

Macmillan Cancer Support have information to help you understand more about treatments. Learn more about:

• preparing for laryngeal cancer treatment
• having treatment as part of a clinical trial

After laryngeal cancer treatment

Once your treatment has finished, you’ll have regular follow-up appointments with your healthcare team. These may continue for several years.

It’s important to tell your doctor about any new symptoms you have, or any symptoms that are not improving. Don’t wait until your next appointment to tell them.

You may get anxious between appointments. This is natural. It may help to get support from family and friends or a support organisation.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan laryngeal (larynx) cancer forum – you can talk to others affected by laryngeal cancer, ask questions and share your experience

Your feelings after laryngeal cancer treatment

For some people, it may take several months to recover from treatment. It can be difficult to cope if treatment has changed your appearance, voice or how you eat and drink. It’s common to feel overwhelmed by different feelings.

Organisations who offer information and support include:

• Changing Faces – offers advice and information to anyone who is affected by a change in their appearance
• Cancer Laryngectomee Trust – provides support to people who are about to have, or have had a laryngectomy
• National Association of Laryngectomee Clubs – aims to promote the welfare of people who have had a laryngectomy, and their families
• The Swallows – offers face-to-face support groups across the UK and online support groups for people with head and neck cancers, and those that care for them

Don’t include personal information e.g. name, location or any personal health conditions.

After treatment, recovery can take time. Your appearance may change in some ways, and you may need to adjust to changes in everyday things like speaking and eating.

Even if you already live a healthy lifestyle, you might want to make some positive changes after treatment. There are steps you can take to help your body heal and to feel better overall.

Quitting smoking is not easy, but plenty of support is available if you want help giving it up.

Drinking alcohol raises your risk of developing another cancer of the head and neck. Cutting down or stopping altogether can lower this risk.

Eating well after treatment for laryngeal cancer can be hard, but a dietician can guide you through it. Eating well and staying active will help you keep your strength up, give you more energy and leave you feeling better in general.

Therapies such as yoga or meditation may help you feel better, and can ease stress and anxiety. It is worth speaking with your cancer doctor or specialist nurse before trying them, since some therapies do not mix well with certain cancer treatments.

The physical and emotional impact of cancer and its treatment can affect how confident you feel about intimacy, and some people struggle with body image afterward. Laryngeal cancer and its treatment can change how you feel about kissing and sex, though this tends to ease with time.

Some side effects of treatment take a while to settle, and in some cases they never fully go away. Others may only appear some time after treatment has ended. These are known as late effects. Macmillan Cancer Support has more information on the late effects of laryngeal cancer treatment.