Laryngeal Cancer
Voice box cancer · Glottic cancer · Supraglottic cancer · Laryngeal squamous cell carcinoma | ICD-10 C32
Laryngeal cancer is a squamous cell carcinoma of the voice box, usually arising on the vocal cords (glottic), above them (supraglottic) or below (subglottic). It is strongly caused by tobacco and alcohol and is concentrated in Eastern/Southern Europe, the Caribbean and parts of South America. Persistent hoarseness is the classic early sign, and voice-preserving treatment is often possible.
Glottic cancers tend to cause hoarseness while still small, so they are often diagnosed earlier than other head and neck cancers and can be cured with a single modality — either radiotherapy or a voice-sparing partial laryngectomy. Supraglottic cancers are more likely to present late with a neck lump, swallowing pain or referred ear pain because the rich lymph drainage of the supraglottis allows early nodal spread.
The central treatment decision in locally advanced disease is larynx preservation with concurrent chemoradiotherapy versus total laryngectomy with postoperative radiotherapy. Both can be curative; the choice depends on tumour extent, cartilage invasion, vocal cord fixation, airway status, lung function, swallowing function and the patient's ability to complete and tolerate chemoradiotherapy.
Where in the world is laryngeal cancer common?
189,191 new laryngeal cancer cases worldwide were estimated worldwide in 2022 (ASR 1.9 per 100,000 (men 3.5, women 0.4); 165,794 cases in men and 23,397 in women). about 103,359 deaths in 2022 (ASR 1.0 per 100,000).
Glottic tumours predominate in registry data, accounting for 65–96% of male laryngeal cancers in registries reporting subsite.
| Region / country | What the data show |
|---|---|
| Caribbean & Cuba | Cuba had the highest estimated male ASR worldwide (14.8/100,000) in the GLOBOCAN 2022 comparison, reflecting historical heavy smoking and alcohol exposure. |
| Eastern Europe | Moldova (12.2) and Romania (10.3) had the next-highest male ASRs; Hungary, Slovakia, Lithuania, Belarus and Russia also carry high burdens, and Lithuania and Belarus show rising male trends. |
| Southern & Western Europe | Spain has long reported some of the highest regional rates (approaching 20/100,000 in some series), with France, Italy and Portugal (Azores registry ASR 11.8) also elevated. |
| Brazil & parts of South America | Brazil recorded 7,191 male cases in 2022 and is among the countries with the largest absolute burden; Colombia shows an increasing male trend. |
| South Asia | India has a substantial burden linked to bidi smoking and smokeless tobacco; the Karul registry reported male ASR 10.6. |
| China | China had the largest absolute number of male cases (27,169 in 2022), so Chinese head and neck units see high volumes of both partial and total laryngectomy. |
What are the risk factors?
- Cigarette, cigar, pipe or bidi smoking — the dominant and most preventable cause
- Heavy alcohol use, which acts synergistically with tobacco
- Combined tobacco and alcohol exposure (the highest cumulative risk)
- Occupational exposures: asbestos, sulfuric acid mist, diesel fumes, coal dust and machining fluids
- Gastro-oesophageal reflux disease and diets low in fruit and vegetables (weaker associations)
- Male sex and older age; most cases are diagnosed in the 60–70 age group
What are the signs and symptoms?
- Hoarseness or a change in voice lasting more than 2–3 weeks (classic for glottic cancer)
- Persistent sore throat, pain on swallowing or pain referred to one ear
- A lump in the neck (more typical of supraglottic tumours)
- Difficulty swallowing, choking or coughing when eating
- Coughing up blood, noisy breathing (stridor) or progressive breathlessness in advanced disease
- Unexplained weight loss and reduced exercise tolerance
Two-to-three-week rule: any head or neck symptom that persists beyond two to three weeks should be examined by an ENT specialist with an endoscope — pain is usually a late feature, not an early one.
How is it diagnosed and staged?
- Flexible laryngoscopy / stroboscopy in clinic to visualise vocal cord mobility and lesion extent
- Direct laryngoscopy and biopsy under general anaesthesia for tissue diagnosis
- Contrast CT or MRI of the larynx and neck to assess cartilage, paraglottic space and nodes
- FDG PET-CT and chest imaging for advanced disease; FNA of suspicious neck nodes
- Assessment of airway, pulmonary function, nutrition, speech/swallow baseline and dental status
- Multidisciplinary tumour board review to decide larynx preservation versus surgery
TNM staging separates glottic, supraglottic and subglottic primaries. Vocal cord fixation, cartilage invasion and subglottic extension upstage a tumour and reduce the chance of a functional partial laryngectomy; T4a disease with cartilage invasion is usually treated with total laryngectomy or definitive chemoradiotherapy depending on functional criteria.
What are the treatment options?
- Carcinoma in situ and T1–T2 glottic cancer: definitive radiotherapy or transoral laser / partial laryngectomy — both aim to preserve voice
- Selected supraglottic T1–T2: supraglottic partial laryngectomy or radiotherapy with neck management
- Locally advanced resectable disease: total laryngectomy with neck dissection followed by risk-adapted radiotherapy or chemoradiotherapy
- Larynx-preservation protocols: concurrent cisplatin-based chemoradiotherapy, or induction chemotherapy (TPF) followed by radiotherapy in responders
- Postoperative concurrent chemoradiotherapy for positive margins or extranodal extension
- Recurrent/metastatic disease: PD-1 immunotherapy, chemotherapy, targeted therapy or clinical trials; best supportive care when appropriate
Decisions should be made by a multidisciplinary tumour board, with speech, swallowing and appearance considered alongside cancer control. See how treatment changes with stage →
What is the prognosis?
Early glottic cancer has excellent control: single-modality treatment is associated with roughly 70–90% five-year survival in guideline summaries, and many patients keep a serviceable voice. Overall global five-year survival is around 60%, falling sharply for advanced T4, node-positive or metastatic disease. Continuing to smoke after treatment increases recurrence and second-primary risk.
Survival figures are population averages from registry data, not predictions for an individual. See the follow-up schedule →
Can it be prevented?
- Stop smoking completely — the single most effective measure, and important even after diagnosis
- Reduce or stop heavy alcohol use, particularly in combination with tobacco
- Use respiratory protection and workplace controls for asbestos, acid mist, dust and fumes
- Have hoarseness lasting more than 2–3 weeks assessed by an ENT specialist with laryngoscopy
- Maintain good nutrition and manage reflux; neither substitutes for tobacco cessation
Prevention by region: HPV vaccine, areca nut, tobacco and UV →
Treatment in China for international patients
Because China has one of the world’s largest absolute numbers of laryngeal cancer cases, specialist units perform high volumes of transoral laser surgery, partial laryngectomy, total laryngectomy and neck dissection, with speech rehabilitation and tracheoesophageal voice restoration available.
- Bring the biopsy slides, laryngoscopy images/video, contrast CT or MRI on DICOM, and any pulmonary function and swallowing assessments.
- Ask explicitly whether the plan is voice-preserving (radiotherapy / partial laryngectomy) or total laryngectomy, and what functional outcome is expected for speech and swallowing.
- If total laryngectomy is planned, ask about primary or secondary tracheoesophageal puncture, voice prosthesis availability in your home country and stoma care training.
- Request the radiotherapy dose record and pathology details (margins, cartilage invasion, extranodal extension) in English for your local team.
Cost guidance: As an illustrative planning range, transoral laser or partial laryngectomy is often budgeted at ¥50,000–¥110,000 (about US$7,000–15,000); total laryngectomy with neck dissection and reconstruction ¥90,000–¥180,000; definitive chemoradiotherapy ¥100,000–¥200,000. These are budgeting figures, not a quotation.
Compare the pathway, records checklist and aftercare planning on the international patients page.
All 14 questions about laryngeal cancer
Each question has its own page with a direct answer, practical detail and the sources behind it — the same structure used on Dr. Liu’s Chinese knowledge base.
Understanding the disease
3 questionsWhat the tumour is, where in the world it is common, who gets it and why.
Symptoms & diagnosis
3 questionsThe warning signs, the biopsy, the scans and what staging actually means.
Treatment
3 questionsSurgery, radiotherapy, chemotherapy, immunotherapy and organ-preserving options.
Side effects & recovery
1 questionWhat treatment feels like, how side effects are managed, and rehabilitation.
Prognosis & follow-up
1 questionSurvival figures in context, recurrence risk and the follow-up schedule.
Prevention & risk
2 questionsHPV vaccination, tobacco and areca nut, UV protection and occupational exposure.
Treatment in China
1 questionWhat international patients should prepare, timelines, costs and aftercare.
Frequently asked questions
What is laryngeal cancer?
Laryngeal cancer is a squamous cell carcinoma of the voice box, usually arising on the vocal cords (glottic), above them (supraglottic) or below (subglottic). It is strongly caused by tobacco and alcohol and is concentrated in Eastern/Southern Europe, the Caribbean and parts of South America. Persistent hoarseness is the classic early sign, and voice-preserving treatment is often possible.
Where in the world is laryngeal cancer most common?
Laryngeal Cancer is not evenly distributed: the highest-burden regions are Caribbean & Cuba, Eastern Europe and Southern & Western Europe. In 2022 there were 189,191 new laryngeal cancer cases worldwide worldwide (ASR 1.9 per 100,000 (men 3.5, women 0.4); 165,794 cases in men and 23,397 in women), with marked country-to-country variation driven by local exposures such as tobacco, areca nut, oncogenic viruses, ultraviolet radiation and occupational carcinogens.
What are the risk factors for laryngeal cancer?
The main recognised risk factors for laryngeal cancer are cigarette, cigar, pipe or bidi smoking — the dominant and most preventable cause, heavy alcohol use, which acts synergistically with tobacco and combined tobacco and alcohol exposure (the highest cumulative risk). Risks differ by region: Caribbean & Cuba has a distinctive exposure pattern, so a patient's country of residence is part of the risk assessment. Having a risk factor does not mean a person will develop cancer.
What are the early signs of laryngeal cancer?
The common early signs are hoarseness or a change in voice lasting more than 2–3 weeks (classic for glottic cancer), persistent sore throat, pain on swallowing or pain referred to one ear, a lump in the neck (more typical of supraglottic tumours) and difficulty swallowing, choking or coughing when eating. Head and neck tumours often cause mild, one-sided symptoms that mimic a cold, a dental problem or a sore throat. Any symptom in the head or neck that persists for more than two to three weeks needs an ENT examination rather than repeated antibiotics.
How is laryngeal cancer diagnosed and staged?
Diagnosis requires a tissue biopsy read by a head and neck pathologist, supported by endoscopic examination and contrast CT or MRI of the neck; PET-CT is added when nodal or distant spread is suspected. Staging uses the AJCC TNM system and guides whether surgery, radiotherapy, chemoradiotherapy or systemic therapy is the primary treatment.
What are the treatment options for laryngeal cancer?
Treatment is stage- and site-specific, and usually combines carcinoma in situ and T1–T2 glottic cancer: definitive radiotherapy or transoral laser / partial laryngectomy — both aim to preserve voice, selected supraglottic T1–T2: supraglottic partial laryngectomy or radiotherapy with neck management and locally advanced resectable disease: total laryngectomy with neck dissection followed by risk-adapted radiotherapy or chemoradiotherapy. Early-stage disease is generally treated with one modality (surgery or radiotherapy), while locally advanced disease needs combined modality treatment planned by a multidisciplinary team.
What is the prognosis for laryngeal cancer?
Early glottic cancer has excellent control: single-modality treatment is associated with roughly 70–90% five-year survival in guideline summaries, and many patients keep a serviceable voice. Overall global five-year survival is around 60%, falling sharply for advanced T4, node-positive or metastatic disease. Continuing to smoke after treatment increases recurrence and second-primary risk.
Can laryngeal cancer be prevented?
Many cases are preventable. The most useful steps for laryngeal cancer are stop smoking completely — the single most effective measure, and important even after diagnosis, reduce or stop heavy alcohol use, particularly in combination with tobacco and use respiratory protection and workplace controls for asbestos, acid mist, dust and fumes. Prevention works best before exposure begins, but stopping tobacco, areca nut and heavy alcohol use still lowers risk after many years of use.
Will I lose my voice or my voice box if I have laryngeal cancer?
Not necessarily. Early glottic cancer is usually cured with radiotherapy or a voice-sparing partial laryngectomy, and many patients retain a usable voice. Total laryngectomy is generally reserved for advanced tumours with cord fixation, cartilage invasion or disease that recurs after organ-preserving treatment.
Is chemoradiotherapy as good as removing the larynx for advanced disease?
For selected patients with locally advanced laryngeal cancer, concurrent cisplatin-based chemoradiotherapy can preserve the larynx with survival comparable to total laryngectomy. It is not suitable for everyone: extensive cartilage invasion, a destroyed larynx, severe aspiration, poor lung function or an inability to tolerate chemotherapy may favour surgery.
Why is laryngeal cancer so common in Eastern Europe, Cuba and parts of South America?
The pattern largely follows historical smoking and heavy alcohol exposure. Cuba (14.8/100,000), Moldova (12.2) and Romania (10.3) had the highest estimated male ASRs in 2022, while Spain, France, Italy, Hungary, Portugal and Brazil have long-standing high rates. In many high-income countries male rates are now falling as smoking declines.
Does hoarseness always mean laryngeal cancer?
No. Most hoarseness comes from laryngitis, reflux, voice strain, nodules or a vocal cord palsy. However, any hoarseness lasting more than two to three weeks — especially in a smoker or heavy drinker over 40 — should be examined with laryngoscopy, because a small glottic cancer is highly curable when found early.
What changes after a total laryngectomy?
After total laryngectomy the windpipe is brought out to a permanent stoma in the neck, so breathing and smelling happen through the stoma rather than the nose and mouth. The food and air passages are separated, so swallowing is usually preserved after healing, but natural voice is lost and must be replaced with a voice prosthesis, electrolarynx or oesophageal speech.
What does laryngeal cancer treatment in China cost for international patients?
Illustrative planning ranges are ¥50,000–¥110,000 (about US$7,000–15,000) for transoral laser or partial laryngectomy, ¥90,000–¥180,000 for total laryngectomy with neck dissection, and ¥100,000–¥200,000 for definitive chemoradiotherapy. Voice prostheses, long-term stoma supplies and rehabilitation are usually additional.
Sources for this topic
- Global Cancer Observatory (GLOBOCAN 2022)
- Global Cancer Facts & Figures, 5th Edition (GLOBOCAN 2022 tables)
- Nivolumab Risk Management Plan — epidemiological characteristics of SCCHN (GLOBOCAN 2022 summary)
- Global burden and international trends in laryngeal cancer incidence (GLOBOCAN 2022 and CI5-XII)
- Global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2022
- NCCN Guidelines for Patients: Head and Neck Cancers
- Head and Neck Cancers (patient information)
- Cancer Stat Facts: Oral Cavity and Pharynx Cancer
Ask about laryngeal cancer treatment in China
Send your pathology report, biomarker results and imaging for a written preliminary opinion before making travel plans.
What to send Contact the clinicMedical disclaimer: This knowledge base is general information for people researching head and neck tumours, not a diagnosis or treatment plan. It does not replace an examination by a qualified physician. Survival figures are population averages, not predictions for an individual. Treatment and cost estimates for China are illustrative only and must be confirmed in writing after your records have been reviewed. If you have a symptom lasting more than two to three weeks, see a doctor promptly.