Aerodigestive cancers: laryngeal cancer

Cancers of the larynx account for approximately 12,000 new cancer cases per year in the United States. The most common risk factors are tobacco and alcohol use, but human papillomavirus (HPV) has been identified in 26.6% of laryngeal cancers. Symptoms develop as the tumor infiltrates the vocal cords and/or surrounding structures, and patients commonly present with hoarseness or cough. Histologically, the vast majority of tumors are squamous cell carcinomas, which, for staging purposes, are categorized by subsite. These develop most often from the glottis, followed by the supraglottis and subglottis. Survival rates for early- and late-stage disease range from 56% to 93% and 29% to 56%, respectively. Unlike with other head and neck cancers, the prognostic significance of HPV-related laryngeal cancer is unclear. Advances in organ-preserving surgical techniques allow patients to maintain physiologic functions without compromising survival rates, especially for early-stage disease. Patients requiring more intensive treatment, including total laryngectomy and chemoradiation, will experience significant morbidity and lifestyle changes. The ability to communicate using a voice prosthesis is of primary importance, and the prosthesis must be tailored to each patient's needs and preferences. For patients with metastatic or nonresectable disease, palliative care should be considered.