What is the most common type of laryngeal (voice box) cancer?

Most Common Type of Laryngeal Cancer

Squamous cell carcinoma is the most common type of laryngeal cancer, accounting for more than 95% of all laryngeal malignancies, with the glottic region being the most common site of occurrence (60-65% of cases). 1, 2

Epidemiology and Distribution

• Laryngeal cancer is divided into three anatomical regions with distinct distribution patterns:

  • Glottic region: 60-65% of laryngeal cancers 2
  • Supraglottic region: 30-35% of laryngeal cancers 2
  • Subglottic region: 5% of laryngeal cancers 2

• Squamous cell carcinoma (SCC) represents the overwhelming majority of laryngeal malignancies, with approximately 99% of all primary laryngeal carcinomas being SCC 3

Clinical Significance of Glottic Laryngeal Cancer

• Glottic laryngeal cancer has several distinctive characteristics:
  • Early symptomatology (hoarseness) leads to earlier diagnosis compared to other head and neck cancers 2
  • Sparse lymphatic drainage results in less frequent regional nodal spread in early-stage disease 2
  • Excellent cure rates of 80-90% for early-stage disease 2
  • Nodal involvement significantly worsens survival rates 2

Risk Factors

• Major risk factors for laryngeal squamous cell carcinoma include:
  • Tobacco use and alcohol consumption (responsible for 75-85% of cases) 2, 1
  • Other less significant risk factors include radiation exposure, chronic infection, long-term immunosuppression, poor oral hygiene, and poor nutrition 2
  • HPV infection is less common in laryngeal cancer compared to oropharyngeal cancer (HPV-positive SCCHN outside the oropharynx is rare at <6%) 2

Diagnostic Considerations

• Key symptoms prompting evaluation include:

  • Persistent hoarseness (particularly important for glottic cancer) 2
  • Chronic pain in the throat 2
  • Painful or difficult swallowing 2
  • Neck masses 2

• Diagnostic workup typically includes:

  • Complete physical examination with neck palpation 2
  • Flexible head and neck fibreoptic endoscopy 2
  • Pathological confirmation is mandatory 2
  • Imaging studies to determine extent of disease 2

Prognostic Factors

• The 5-year relative survival for laryngeal SCC is approximately 61%, which is better than oral cavity (49%), oropharyngeal (41%), and hypopharyngeal (25%) SCC 2

• Despite therapeutic advances, the overall 5-year survival rate for laryngeal cancer remains around 50%, with many patients presenting with advanced disease at diagnosis 4, 5

• Tumor characteristics, particularly supraglottic subsite and nodal metastases, significantly affect survival outcomes 5

Treatment Considerations

• Treatment options vary based on stage and location:

  • Early-stage glottic cancer can be treated with either surgery (partial laryngectomy) or radiation therapy with similar effectiveness 2
  • Advanced laryngeal cancer typically requires multimodality treatment approaches 2
  • Laryngeal preservation strategies have gained importance in recent decades 1, 6

• Treatment selection should prioritize both oncologic outcomes and functional preservation (voice, swallowing) 2, 6