Laryngeal cancer natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2], Faizan Sheraz, M.D. [3]
Overview
If left untreated, laryngeal cancer produces few symptoms early in the course. Once the tumor has expanded from its site of origin, it may obstruct the airway. Common complications of laryngeal cancer include airway obstruction, neck disfigurement, and speaking difficulties. The prognosis varies with the type and stage of laryngeal cancer. Stage 4 squamous cell carcinoma of larynx has the most unfavorable prognosis.
Natural history
The natural history of laryngeal carcinoma depends on the site:[1]
Supraglottic tumors
- More aggressive
- Direct extension into the pre-epiglottic space, lateral hypopharynx, glossoepiglottic fold and the tongue base and lymph nodes
Glottic tumors
- Well differentiated
- Less aggressive, they tend to grow slow
- Metastasize late in the disease
- Extend superiorly into the ventricular walls or inferiorly into the subglottic airway
Subglottic tumors
- Uncommon
- Extends into the mediastinum
Complications
Common complications of laryngeal cancer include:
- Airway obstruction
- Disfigurement of the neck or face
- Loss of voice and speaking difficulties
- Metastasis
- A small percentage of patients (5%) will not be able to swallow and will need to be fed through a feeding tube
Prognosis
Laryngeal cancers can be cured in 90% of patients if detected early. If the cancer has spread to surrounding tissues or lymph nodes in the neck, 50 - 60% of patients can be cured. If the cancer has metastasized to parts of the body outside the head and neck, the cancer is not curable and treatment is aimed at prolonging and improving quality of life. After treatment, patients generally need therapy to help with speech and swallowing.
5-Year Survival
- Between 2004 and 2010, the 5-year relative survival of patients with laryngeal cancer was 62.6%.[2]
- When stratified by age, the 5-year relative survival of patients with laryngeal cancer was 61.5% and 58.2% for patients <65 and ≥ 65 years of age respectively.[2]
- The survival of patients with laryngeal cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of laryngeal cancer:[2]
| Stage | 5-year relative survival (%), (2004-2010) |
| All stages | 60% |
| Localized | 75.1% |
| Regional | 43.4% |
| Distant | 35.1% |
| Unstaged | 55.7% |
- Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of laryngeal cancer by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[2]
References
- ↑ Ferlito A (March 1995). "The natural history of early vocal cord cancer". Acta Otolaryngol. 115 (2): 345–7. PMID 7610838.
- ↑ 2.0 2.1 2.2 2.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.