Vocal cord cancer, also known as glottic cancer, is a type of laryngeal cancer that develops in the vocal cords (vocal folds) located within the voice box (larynx). These paired bands of muscle tissue vibrate to produce sound when air passes through them during speech. Cancer typically begins in the thin, flat squamous cells lining the vocal cords and can spread to nearby structures if left untreated. The condition can affect individuals of various ages and genders.
Vocal Cord Cancer in Singapore
Receiving a diagnosis of vocal cord cancer or experiencing concerning voice changes can be unsettling. The vocal cords play a crucial role in communication, breathing, and protecting your airway, making any cancer affecting this area particularly impactful on daily life. Vocal cord cancer is known to occur in Singapore, with early detection offering improved treatment outcomes. Our ENT Specialist provides comprehensive evaluation and treatment for vocal cord cancer, utilising modern diagnostic techniques and evidence-based treatment approaches tailored to each patient’s specific needs and cancer stage.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Vocal Cord Cancer?
Types of Vocal Cord Cancer
Squamous Cell Carcinoma
Squamous cell carcinoma is the most common type of vocal cord cancer. This cancer originates from the surface epithelial cells of the vocal cords and typically progresses through stages of dysplasia before becoming invasive cancer. Early-stage squamous cell carcinoma confined to the vocal cords may have a favourable prognosis with appropriate treatment. Individual results and timelines may vary.
Verrucous Carcinoma
This rare, slow-growing variant of squamous cell carcinoma appears as a warty growth on the vocal cords. While it rarely metastasises, verrucous carcinoma can be locally destructive and requires careful surgical management to help prevent recurrence.
Adenocarcinoma
Rare in the vocal cords, adenocarcinoma originates from the minor salivary glands in the larynx. This type tends to be more aggressive and may require multimodal treatment approaches.
Sarcomas and Other Rare Types
Chondrosarcoma, fibrosarcoma, and other rare malignancies occasionally affect the vocal cord region. These cancers often arise from the supporting structures rather than the vocal cords themselves and require specialised treatment protocols.
Causes & Risk Factors
Causes
Vocal cord cancer develops from genetic mutations in cells lining the vocal cords. These mutations cause cells to grow uncontrollably and form tumours. While the exact trigger for these mutations isn’t always clear, certain factors may increase risk.
Risk Factors
- Tobacco use: Smoking cigarettes, cigars, or pipes is associated with increased risk
- Alcohol consumption: Heavy drinking, especially combined with smoking, may increase cancer risk
- Age: Cases commonly occur in older adults
- Gender: Men are more likely to develop vocal cord cancer
- Occupational exposures: Long-term exposure to asbestos, paint fumes, or certain chemicals
- Human papillomavirus (HPV): Certain HPV strains are associated with some laryngeal cancers
- Gastro-oesophageal reflux disease (GORD): Chronic acid reflux may contribute to cancer development
- Previous radiation: Prior radiation therapy to the neck area may increase risk
- Poor nutrition: A Diet low in fruits and vegetables may affect susceptibility
- Weakened immune system: Immunosuppression from medications or disease
Signs & Symptoms
Early Symptoms
- Hoarseness or voice changes lasting more than 2-3 weeks
- Rough, scratchy, or breathy voice quality
- Voice fatigue with prolonged speaking
- Decreased vocal range or pitch changes
- Mild throat discomfort or tickling sensation
- Persistent throat clearing
Progressive Symptoms
- Worsening hoarseness despite rest
- Pain when speaking or swallowing
- Referred ear pain (otalgia)
- Persistent cough not related to respiratory infection
- Feeling of something stuck in the throat
- Neck swelling or lumps
- Unexplained weight loss
Advanced Symptoms
- Difficulty breathing or noisy breathing (stridor)
- Complete voice loss
- Severe difficulty swallowing
- Coughing up blood
- Obvious neck masses
- Bad breath (halitosis)
- Severe ear pain
Vocal cord cancer symptoms may appear early because even small tumours can affect voice quality. This may serve as an early indicator, potentially leading to diagnosis at earlier stages, unlike cancers in other parts of the larynx that may develop without obvious symptoms.
Experiencing these symptoms?
Consider seeking medical evaluation if symptoms persist.
Consult with an ENT specialist for proper assessment and guidance.
When to See an ENT Specialist
Seek immediate medical attention if you experience hoarseness lasting more than two weeks, especially if you’re a smoker or have other risk factors. Red flag symptoms requiring urgent evaluation include difficulty breathing, coughing up blood, rapidly progressive voice changes, or neck masses.
During your consultation, the ENT specialist can perform a comprehensive examination, including indirect or direct laryngoscopy, to visualise your vocal cords. The examination is typically well tolerated and provides an immediate visual assessment of any abnormalities.
Early consultation is essential as vocal cord cancer detected in the initial stages may have favourable treatment outcomes with appropriate treatment. Don’t delay seeking evaluation due to fear – modern diagnostic techniques are minimally invasive, and early detection may improve treatment outcomes and help preserve quality of life.
Diagnosis & Testing Methods
Laryngoscopy
Flexible laryngoscopy involves passing a thin, flexible scope through the nose to examine the vocal cords. This office-based procedure can allow visualisation of vocal cord movement and any areas of concern. Videostroboscopy may be used to assess vocal cord vibration patterns.
Biopsy Procedures
Definitive diagnosis requires tissue sampling. Microlaryngoscopy under general anaesthesia allows biopsy of areas of concern while aiming to minimise vocal cord trauma. The procedure provides tissue for histological examination.
Imaging Studies
CT scans can evaluate tumour extent and may detect spread to lymph nodes or cartilage invasion. MRI can provide soft tissue detail for assessing tumour extension. PET-CT scans may help identify distant metastases in advanced cases. Chest X-rays can screen for lung metastases or second primary cancers.
Staging Investigations
Once cancer is confirmed, staging helps determine the treatment approach. This includes assessing tumour size (T stage), lymph node involvement (N stage), and distant spread (M stage). Additional tests may include blood work, pulmonary function tests, and swallowing assessments.
Treatment Options Overview
Radiation Therapy
External beam radiation therapy delivers targeted radiation to the tumour whilst preserving vocal cord function. Treatment typically involves daily sessions. Modern techniques like intensity-modulated radiation therapy (IMRT) aim to minimise damage to surrounding tissues. Early-stage vocal cord cancer may respond to radiation, with voice preservation being a potential outcome.
Endoscopic Laser Surgery
Transoral laser microsurgery uses a CO2 laser to remove tumours whilst aiming to preserve healthy tissue. This minimally invasive approach may suit early-stage cancers and can offer voice preservation outcomes. The procedure requires specialisation and equipment but avoids external incisions and may allow same-day discharge.
Partial Laryngectomy
For selected intermediate-stage cancers, a partial laryngectomy removes the affected vocal cord whilst aiming to preserve the voice box. Vertical partial laryngectomy or supracricoid partial laryngectomy may be options depending on tumour location. Voice quality may change, but speech can remain possible without a permanent tracheostomy.
Total Laryngectomy
Advanced cancers may require complete voice box removal. Whilst this eliminates natural voice, voice rehabilitation techniques, including tracheoesophageal puncture with a voice prosthesis, oesophageal speech, or an electrolarynx, can enable communication. The procedure involves creating a permanent breathing stoma.
Chemotherapy
Chemotherapy may be combined with radiation (chemoradiation) for advanced cancers or organ preservation protocols. Common agents include cisplatin, carboplatin, and 5-fluorouracil. Targeted therapy drugs like cetuximab may be alternatives for patients unable to tolerate traditional chemotherapy.
Voice Rehabilitation
Post-treatment voice therapy with specialised speech therapists aims to support vocal function. Techniques vary based on treatment received but may include breathing exercises, vocal hygiene education, and compensatory strategies. Early intervention may help improve voice outcomes.
Immunotherapy
For recurrent or metastatic disease, immunotherapy drugs like pembrolizumab or nivolumab may be options. These medications help the immune system recognise and attack cancer cells. Some patients may achieve remissions.
Every patient’s condition is unique.
Our ENT Specialist can assess your specific situation and recommend the most suitable treatment.
Complications if Left Untreated
Untreated vocal cord cancer may progressively affect vocal cord tissue, potentially leading to voice changes and airway complications. Local tumour growth can involve surrounding structures, including the thyroid cartilage, cricoid cartilage, and adjacent soft tissues, which may make subsequent treatment more complex.
The cancer may spread to cervical lymph nodes in advanced stages. Without treatment, cancer can potentially spread to other organs such as the lungs, liver, or bones, which may cause various symptoms and affect organ function.
Airway complications from tumour growth may require emergency procedures such as tracheostomy. Involvement of the oesophagus can cause swallowing difficulties, aspiration complications, and nutritional challenges.
Early detection and treatment are essential factors in managing vocal cord cancer. Consultation with an ENT specialist is vital for proper evaluation and management.
Prevention
While not all vocal cord cancers are preventable, risk-reduction strategies may help lower the likelihood of occurrence. Smoking cessation remains an important preventive measure – quitting may reduce risk even for long-term smokers, with potential benefits increasing over time.
Limiting alcohol consumption, particularly avoiding combined tobacco and alcohol use, may help decrease cancer risk. Managing gastroesophageal reflux through dietary modifications, weight management, and appropriate medications may help reduce chronic laryngeal irritation.
Occupational safety measures, including proper ventilation and protective equipment, can help minimise exposure to carcinogenic substances. HPV vaccination in eligible individuals may help prevent HPV-related laryngeal cancers. Regular dental hygiene and the treatment of chronic infections may help reduce the inflammatory burden.
Maintaining a diet rich in fruits and vegetables can provide protective antioxidants. Voice hygiene practices, including adequate hydration, avoiding voice abuse, and treating chronic laryngitis, may help promote vocal cord health. Regular medical check-ups for high-risk individuals may enable early detection of precancerous changes.
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Frequently Asked Questions (FAQ)
What are the survival rates for vocal cord cancer in Singapore?
Survival rates depend on cancer stage at diagnosis. Early-stage vocal cord cancer confined to the vocal cords may have favourable outcomes with appropriate treatment. Regional spread to lymph nodes may reduce survival rates, whilst distant metastases typically result in lower outcomes. Singapore’s healthcare system enables early detection and access to modern treatments, which may contribute to positive outcomes. Individual prognosis depends on multiple factors, including tumour characteristics, overall health, and treatment response.
Can I preserve my voice with vocal cord cancer treatment?
Voice preservation may be possible for many patients, particularly those with early-stage disease. Radiation therapy and endoscopic laser surgery for early cancers may help maintain voice function, though voice quality may change. Even partial laryngectomy procedures may preserve some voice function. Advanced cancers requiring total laryngectomy eliminate natural voice, but various rehabilitation methods can enable effective communication. Your ENT specialist may discuss voice outcomes specific to your treatment options. Voice therapy aims to optimise function regardless of treatment type.
How long does treatment for vocal cord cancer typically take?
Treatment duration varies by approach and stage. Radiation therapy typically spans several weeks with daily sessions. Surgical procedures range from same-day endoscopic procedures to hospital stays for major surgery. Recovery and voice rehabilitation may continue for several months. Chemotherapy protocols typically involve cycles over several months. Follow-up surveillance continues for years after treatment completion. Your specialist may provide a detailed timeline based on your specific treatment plan.
What lifestyle changes are necessary after vocal cord cancer treatment?
Post-treatment lifestyle modifications depend on the treatment received. All patients should avoid tobacco and limit alcohol consumption to help prevent recurrence. Voice rest and gradual voice rehabilitation are essential in the initial phase. Patients with total laryngectomy require stoma care education and humidity management. Swallowing therapy may be needed if function is affected. Regular follow-up examinations can help detect recurrence early. Maintaining good nutrition and hydration supports healing. Many patients may successfully return to work and normal activities with appropriate adjustments.
Is vocal cord cancer hereditary?
Vocal cord cancer is not typically hereditary, though genetic factors may influence susceptibility to carcinogens. Rare genetic syndromes may increase cancer risk generally. A family history of head and neck cancers may indicate shared environmental exposures or a genetic predisposition. Most cases result from environmental factors, particularly tobacco use. Genetic counselling may be considered if multiple family members develop head and neck cancers at a young age. Focusing on modifiable risk factors may provide prevention benefits.
What follow-up care is required after treatment?
Long-term surveillance is important after vocal cord cancer treatment. Regular laryngoscopic examinations initially, extending to annual visits after several years, can help monitor for recurrence. Imaging studies may be performed periodically based on the initial stage and treatment. Thyroid function monitoring may be necessary after radiation therapy. Voice and swallowing assessments aim to ensure functional optimisation. Dental care can help prevent radiation-related complications. Smoking cessation support and nutritional counselling may continue indefinitely. Psychological support can help address adjustment challenges. Your ENT specialist coordinates comprehensive survivorship care.
Conclusion
Vocal cord cancer may offer favourable outcomes when detected and treated appropriately. The characteristic early symptom of hoarseness often enables diagnosis at an early stage when treatment is possible. Treatment approaches in Singapore range from voice-preserving radiation and minimally invasive surgery to comprehensive surgical and systemic therapies for advanced disease. Our ENT Specialist combines experience with modern diagnostic and treatment capabilities to provide individualised care focused on both cancer control and quality-of-life preservation. Early evaluation of voice changes remains vital for outcomes with an ENT in Singapore providing timely assessment and guidance.
Take the First Step Towards Better Health
Living with vocal cord cancer concerns can be challenging, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating vocal cord cancer using current evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He underwent his subspecialty training in Rhinology (Nose & Sinus conditions) and Endoscopic Skull Base Surgery at the renowned St Paul’s Sinus Center, part of the University of British Columbia in Vancouver, Canada. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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