Risk of Cancer with Laryngeal Polyps
Benign laryngeal polyps (vocal cord polyps) are not associated with an increased risk of cancer and are reactive, non-neoplastic lesions. 1, 2
Nature of Laryngeal Polyps
Laryngeal polyps are benign, reactive lesions characterized by:
- Polypoid squamous mucosa with subepithelial hyalinization and edematous stroma 2
- No malignant potential in their typical presentation 1
- Common association with voice overuse, smoking, or gastroesophageal reflux 1
The key distinction is that solitary laryngeal polyps carry no cancer risk, unlike certain polyposis syndromes affecting other parts of the gastrointestinal tract. 3
Critical Differential Diagnosis
While typical vocal cord polyps are benign, laryngoscopy is essential to distinguish them from:
- Laryngeal cancer: Case-control studies show GERD may be a risk factor for laryngeal cancer, and laryngoscopic examination helps differentiate inflammatory lesions from malignancy 1
- Rare benign mesenchymal tumors (myxomas, spindle cell lipomas) that can present as polyps but require complete excision to prevent local recurrence 2, 4, 5
- Inflammatory pseudotumors (plasma cell polyps) that are benign but require histologic confirmation 6
Management Approach
All patients with laryngeal polyps require direct visualization via laryngoscopy to confirm the diagnosis and exclude malignancy. 1
Key management principles include:
- Laryngoscopic examination to assess for erythema, edema, or irregular surface features that might suggest malignancy 1
- Histopathologic confirmation if the lesion appears atypical or fails to respond to conservative management 2, 5
- Surgical excision for symptomatic polyps, with complete removal to prevent recurrence of rare variants like myxomas 5
Common Pitfalls to Avoid
Do not confuse laryngeal polyps with juvenile polyposis syndrome (JPS), which affects the gastrointestinal tract and carries a 39-68% lifetime colorectal cancer risk. 3, 7 The term "juvenile polyp" refers to a specific histologic type in the GI tract, not laryngeal lesions.
Beware of assuming all "polyps" are benign without histologic confirmation, as rare mesenchymal tumors can masquerade as simple polyps and require complete excision with surrounding normal tissue to prevent local recurrence 5
The presence of persistent hoarseness, especially in smokers, warrants thorough laryngoscopic evaluation to exclude laryngeal cancer, which is associated with tobacco and alcohol use 1