Laryngeal carcinoma is a malignant tumor of the larynx that occurs most commonly in older men. Smoking and alcohol consumption are the most important risk factors. Based on the location of the tumor, laryngeal carcinomas may be classified as glottic (involving the vocal cords), supraglottic, or subglottic carcinomas. Glottic carcinoma, which is the most common form, presents early with hoarseness and is usually associated with a good prognosis. Supraglottic and subglottic carcinomas present late and are therefore associated with a poor prognosis. Direct laryngoscopy is required to visualize the tumor and assess vocal cord mobility. Imaging of the neck may be required to determine the extent of the tumor and check for spread to cervical lymph nodes. The method of treatment depends on the site and stage of the tumor. Early stages are treated by either radiotherapy or endoscopic laser resection with the goal of preserving the voice. Late stages require some form of laryngectomy. After laryngectomy patients must undergo vocal rehabilitation, which involves using vibrations in the pharynx to produce speech sounds.
- Glottic carcinoma/vocal cord carcinoma (most common form: approximately 60% of cases)
- Supraglottic carcinoma (approximately 40% of cases)
- Subglottic carcinoma (approximately 1% of cases)
- Direct laryngoscopy reveals irregular, nodular, or ulcerative lesions
- Imaging: CT, MRI, and/or ultrasound of the neck to assess tumor size and spread to surrounding tissue (e.g., lymph nodes)
- Laryngeal amyloidosis
- Laryngeal adenocarcinoma
The differential diagnoses listed here are not exhaustive.
- Early stages: radiotherapy or transoral endoscopic laser resection
- Advanced stages: (with lymph node; and/or distant organ metastasis): laryngectomy
Voice rehabilitation after laryngectomy: The patient can be trained to produce speech from vibration in the pharynx by one of the following means:
- Esophageal speech
- Voice prosthesis
- Electronic speaking aid