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Although a large number of tumors, polyps, and various assorted "bumps" can present themselves in the voice box (or "larynx", pronounced "lare-inx") the most common form of cancer is called Squamous Cell Carcinoma or Squamous Cancer.
But before we can intelligently discuss this topic, you're going to have to understand that the larynx or voice box, is very much like three different structures that are right in line with eachother. First, there are the true vocal cords, the things that actually allow you to talk. The true vocal cords are also called the "glottis". Cancers here are called "carcinoma of the true cords" or "glottic carcinoma or cancer". Next, there is the part of the voice box that is above the true cords or glottis. For obvious reasons, this is called the "supraglottic larynx". The structures here have names like epiglottis, ary-epiglottic folds, arytenoid cartilages, false cords, etc. You don't have to memorize all that. Just remember that a voice box cancer that is found above the true vocal cords or glottis is called a supraglottic cancer. Finally, there is a squamous cancer that will begin underneath the true vocal cords. These are called sub-glottic cancers.
The reason I have spent so much time explaining this is that the treatment plan for glottic, subglottic, and supraglottic cancers varies greatly. We will discuss treatment of these cancers in different sites of the voice box, but let me tell you right up front that there are sometimes distinct differences of opinion about the proper treatment plan for a patient and you may find qualified experts on both sides of the question. I can only tell you our treatment philosophy and then be certain to inform you of the other options that are available even though we may disagree with them.
Finally, neck lymph node involvement in voice box cancer is quite variable. Metastatic cancer in lymph nodes of patients with true cord cancer is extremely rare. The reverse is true for patients with supraglottic cancers, where it has sometimes been estimated that 40% of these patients will have some spread of cancer to the lymph nodes of the neck upon diagnosis. Management of the lymph nodes will be included in whatever treatment plan is felt to be appropriate for that patient. This will involve surgery and/or radiation therapy.
While there are some reputable centers where surgical removal of a small cancer of the vocal cord is the treatment of choice, in my training, under Dr. Gilbert Fletcher, often considered the Father of Head and Neck Radiation Oncology, we treated them all with radiation therapy and had a cure rate of at least 90%. And of the 10% who failed, about 70% of those patients could be saved by performing surgery as a second treatment. That means that this form of treatment can cure about 97% of those patients with a small but serious cancer. I believe that is a pretty good statistic. One also avoids surgery in most cases and although I am a Head and Neck Surgeon, I believe any time you can avoid an operation you don't need, the better off you are.
As I said earlier, there are two sides to these issues and there are centers who would treat an early cancer of the vocal cord by removing that cord, and their results are said to be quite acceptable. So this is a treatment option for some patients.
As a true cord cancer grows it can begin to involve the local muscles that allow the vocal cord to move. When this happens, it is a sign of a more advanced and aggressive tumor. It is my opinion that when the tumor has advanced to the point that one or both vocal cords are paralyzed, then removal of the voice box is the most prudent treatment plan. This surgery is usually followed by planned post-operative radiation therapy. Again, to be fair, there are some centers where some type of partial voice box removal might be recommended or radiation alone might be used to be followed by removal of the voice box if the first treatment were to be unsuccessful. We do not recommend this form of treatment. Perhaps that is because we only see patients from other institutions who are dissatisfied with their care because the treatment failed even though the overall statistics at those institutions were actually acceptable. But I think the main reason we believe in primary surgical treatment for late true cord cancers is because our success rate has been so very high and the quality of life for our patients seems so very good. Please don't misunderstand that to mean we have perfect results. We don't. Some people have died from voice box cancer in our practice, often patients with delay in diagnosis or previous treatment elsewhere.
Cancer of the Supraglotic Larynx
Treatment of early cancer of the supraglotic larynx is perhaps even more controversial. Radiation therapy will cure in the neighborhood of 80-85% of these. Some authors will recommend a partial laryngectomy for these tumors, often times followed by radiation therapy. There is not really time nor space to debate this question here in more detail. I think you should be certain to get an opinion from both sides of this issue so that you can decide for yourself what is the best and most appropriate treatment plan for you.
Subglottic Squamous Cell Cancer
Finally, subglottic squamous cell cancer is an uncommon type of voice box cancer accounting for perhaps a bit more than 1% of all laryngeal cancers. Surgery remains the cornerstone of treatment for these, although radiation therapy may also play a role in its treatment.
Cancer of the voice box is a very serious problem and it carries with it a great deal of fear and sometimes depression on the part of the patient involved. This is natural and to be expected. But please bear in mind that advances in speech therapy after removal of the voice box continues to make great strides and a very satisfactory voice of one kind or another is most often attained. I can't begin to number the patients of ours who are delighted that they are still around to let their grandchildren hear grandpa's "funny voice" and show it off to their friends. Life is not over after losing one's voice box. Sure, it changes a little, but it is life, it's still fun, and your family is glad you're still around.
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