Symptoms

Key Glossary Terms

Laryngeal/Voice Box
Composed of vocal folds, muscles, and framework cartilages; key for voice, breathing, airway protection

Early Cancer
T1 = affects only one site on larynx, no spread, normal vocal fold motion; T2 = involves more than one site on larynx, vocal fold function abnormal but still moving

Advanced Cancer
T3 = complete non-movement of one vocal fold; T4=invades thyroid cartilage or structures outside of the voice box

TNM Staging
T, tumor type; N, lymph nodes involved; M, spread to other body parts or metastasis

Vocal Folds (also called Vocal Cords)
A pair of specialized tissues in the voice box that vibrates for sound production; comprised of ordered layers of epithelium, superficial lamina propria, vocal ligament, and thyroarytenoid muscle

Glossary

Laryngeal cancer can become symptomatic (evident to the patient or the physician) in different ways, often depending on the exact location of the tumor within the larynx.
The voice box or larynx is divided into 3 levels:

• Upper part: Above the vocal folds (supraglottis)
• Middle part: Includes the vocal folds (glottis)
• Lower part: Approximately 0.5-1 inch below the vocal folds (subglottis)

Key Information

For some reason, laryngeal cancer in the United States is more frequently located in the true vocal folds (glottis), while laryngeal cancer in other countries is more frequently located above the vocal folds (supraglottis). Cancers that are below the vocal folds (subglottic) are usually extensions of cancers arising from structures higher in the larynx (e.g., the vocal folds).

Supraglottic tumors are often found much later than tumors on the vocal folds (glottic tumors) because they result in fewer symptoms until they grow larger.

Patients with supraglottic tumors complain of: trouble swallowing (dysphagia), pain in the ear on the side of the tumor (otalgia), trouble breathing (dyspnea), noisy breathing (stridor), or, later in the disease, voice changes or a lump (mass) in the neck.

Red Flag

• Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway and difficulty passing air.
• Any breathing difficulty needs immediate medical attention.

Tumors on the vocal folds usually present earlier than supraglottic or subglottic tumors. The usual symptom is a prolonged voice change, such as hoarseness, lasting for more than one to two months.

In advanced laryngeal cancer involving the vocal folds, the voice may be breathy due to impaired movement or complete paralysis of one of the vocal folds. Very rarely, the mass is large enough to obstruct the airway, causing noisy sounds on breathing in (stridor).

The patient may also complain of some difficulty breathing or swallowing, the sensation of something in the throat, or coughing up blood.

Key Information

Metastasis Rare in Tumors of the Vocal Folds

There are very few lymphatic channels through which tumor cells on the vocal folds can spread. Therefore, metastasis of tumors on the vocal folds to the neck is quite rare, as opposed to metastasis of supraglottic or subglottic tumors.

The rarest of the laryngeal cancers are those that occur primarily in the subglottis, or below the vocal folds.

Like supraglottic tumors, subglottic tumors often present later than glottic tumors. The symptoms of subglottic tumors usually include trouble breathing because the mass is growing into the airway (blocking the windpipe).

Most tumors in the subglottis arise from downward extension of a glottic or supraglottic cancer. Sometimes subglottic tumors can grow upwards and involve the vocal folds, causing voice changes late in the disease. Subglottic tumors often present with a neck mass; sometimes this neck mass is directly in the midline and not on one side or another.

Red Flag

Pain on Swallowing Worrisome

A symptom that is particularly worrisome is pain that occurs, for no apparent reason, with swallowing, in conjunction with other difficulty swallowing, particularly solid foods.

Tumor Likely if Bleeding

Bleeding or coughing up blood can also be a sign of a tumor in the larynx.