Laryngeal cancer is a malignant tumour that develops in the tissues of the larynx, the organ responsible for voice production, breathing, and protecting the airway during swallowing. The larynx contains your vocal cords and is divided into three central regions: the supraglottis (above the vocal cords), glottis (vocal cords area), and subglottis (below the vocal cords). Laryngeal cancer may occur more commonly among men, particularly those who are older. Most laryngeal cancers are squamous cell carcinomas, originating from the thin, flat cells lining the inside of the larynx.
Laryngeal Cancer in Singapore
A diagnosis of laryngeal cancer can be overwhelming, bringing concerns about your voice, breathing, and overall health. As one of the head and neck cancers affecting the larynx (voice box), this condition requires specialised care and a comprehensive treatment approach. Modern diagnostic tools and treatment options are available to help manage laryngeal cancer. ENT specialists can provide thorough evaluations and treatment plans, working closely with patients throughout their cancer journey. Individual results and treatment outcomes may vary.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is Laryngeal Cancer?
Types of Laryngeal Cancer
Glottic Cancer
Glottic cancer starts in the vocal cords and is a common form of laryngeal cancer. This type often causes early voice changes, which may allow detection at earlier stages. Because the tumour grows on the vocal cords, even small growths can cause noticeable hoarseness, prompting patients to seek medical attention sooner.
Supraglottic Cancer
Supraglottic cancer develops above the vocal cords in the upper portion of the larynx and represents a significant portion of laryngeal cancer cases. These tumours may grow larger before causing symptoms, as they don’t immediately affect voice production. Patients often experience throat discomfort, difficulty swallowing, or ear pain before voice changes occur.
Subglottic Cancer
The rarest form of laryngeal cancer, subglottic cancer, develops below the vocal cords. These tumours typically remain symptomless until they reach an advanced stage, often presenting with breathing difficulties or noisy breathing (stridor) as the first noticeable symptom.
Causes & Risk Factors
Causes
Laryngeal cancer arises from genetic mutations in laryngeal cells, resulting in uncontrolled cell growth. Prolonged exposure to carcinogens may play a significant role. Tobacco smoke contains carcinogens that directly contact the laryngeal tissues. Combined tobacco and alcohol use may create a synergistic effect, potentially increasing cancer risk.
Risk Factors
- Tobacco use: Smoking cigarettes, cigars, or pipes may increase risk
- Heavy alcohol consumption: Regular excessive drinking may increase the risk
- Age: Cases commonly occur in older adults
- Gender: Men are more likely to develop laryngeal cancer
- Occupational exposures: Asbestos, wood dust, paint fumes, and certain chemicals
- Human papillomavirus (HPV): Certain strains linked to some laryngeal cancers
- Gastroesophageal reflux disease (GERD): Chronic acid exposure may increase risk
- Previous radiation therapy: Prior neck radiation for other conditions
- Poor nutrition: Diets low in fruits and vegetables
- Weakened immune system: From medications or medical conditions
Signs & Symptoms
Early Stage Symptoms
- Persistent hoarseness lasting more than 3 weeks
- Mild throat discomfort or tickling sensation
- Slight change in voice quality or pitch
- Occasional coughing without other cold symptoms
- Feeling of something stuck in the throat
- Mild difficulty swallowing liquids or solids
Advance Stage Symptoms
- Severe hoarseness or complete voice loss
- Persistent sore throat not relieved by medication
- Ear pain, especially on one side
- Difficulty breathing or noisy breathing
- Significant weight loss without trying
- Persistent bad breath (halitosis)
- Coughing up blood-tinged sputum
Late Stage Symptoms
- Visible neck mass or swelling
- Severe breathing difficulties requiring urgent care
- Inability to swallow solid foods
- Constant pain in the throat or neck
- Extreme fatigue and weakness
Enlarged lymph nodes in the neck
Symptom progression varies by tumour location. Glottic tumours cause voice changes early, whilst supraglottic and subglottic tumours may grow considerably before producing noticeable symptoms.
Experiencing persistent hoarseness or throat symptoms? Don’t wait for them to worsen.
Schedule a consultation with an ENT specialist to evaluate and develop a treatment plan.
When to See an ENT Specialist
Seek immediate medical attention if you experience hoarseness lasting more than three weeks, especially if you smoke or drink regularly. Other warning signs include difficulty breathing, coughing up blood, unexplained neck lumps, or severe difficulty swallowing. Voice changes in individuals with risk factors need evaluation.
During your first consultation, an ENT specialist typically reviews your detailed medical history, focusing on your symptoms, risk factors, and overall health. The examination includes visual inspection of your throat and neck, followed by laryngoscopy to directly view your larynx. This initial assessment determines whether further tests are needed.
Early detection can help improve treatment outcomes for laryngeal cancer. Treatment outcomes may vary depending on the stage and individual factors. Don’t delay seeking medical evaluation if you have concerning symptoms, particularly if you have multiple risk factors.
Diagnosis & Testing Methods
Flexible Nasolaryngoscopy
This office-based procedure involves passing a thin, flexible scope through the nose to examine the larynx. The procedure aims to provide visualisation of any abnormalities. A local anaesthetic spray may help make the examination more comfortable, and patients can typically return to normal activities afterwards.
Direct Laryngoscopy with Biopsy
Performed under general anaesthesia, this procedure allows examination of the larynx using rigid scopes. Suspicious areas may be biopsied for histological analysis. The tissue samples undergo pathological examination to determine the presence, type, and grade of cancer.
Imaging Studies
CT scans provide cross-sectional images showing tumour size, location, and potential spread to nearby structures. MRI scans offer soft-tissue contrast, which can help assess cartilage involvement. PET-CT scans may detect metabolically active cancer cells throughout the body, helping to stage the disease. These imaging studies may take time to complete, and results may be available at different times.
Additional Tests
Chest X-rays may screen for lung metastases or concurrent lung problems. Blood tests can assess overall health and organ function before treatment. Voice assessment may document baseline vocal function. Swallowing studies can evaluate any dysfunction that may require attention during treatment planning.
Treatment Options Overview
Radiation Therapy
External beam radiation therapy delivers targeted radiation to destroy cancer cells while aiming to preserve surrounding healthy tissue. Treatment may involve daily sessions, each lasting a specific duration. Radiation therapy can be used for laryngeal cancers and may help protect voice function. Modern techniques like intensity-modulated radiation therapy (IMRT) aim to minimise side effects by conforming radiation doses to the tumour shape.
Chemotherapy
Systemic chemotherapy uses medications to target cancer cells throughout the body. Common drugs include cisplatin, carboplatin, and 5-fluorouracil, often given in combinations. Treatment cycles may occur at regular intervals, allowing recovery time between sessions. Chemotherapy may be used alone for palliative care, combined with radiation (chemoradiation) for organ preservation, or before surgery (neoadjuvant) to help reduce tumour size.
Endoscopic Laser Surgery
Transoral laser microsurgery removes tumours through the mouth using specialised lasers and microscopes. This minimally invasive approach may be suitable for certain cancers, particularly those limited to the vocal cords. The procedure aims to preserve voice quality while providing cancer treatment. Recovery may be faster than traditional surgery, with some patients able to return home the same day or after overnight observation.
Partial Laryngectomy
Several partial laryngectomy procedures remove only the cancerous portion of the larynx. Vertical partial laryngectomy removes one vocal cord while aiming to preserve the other. Supraglottic laryngectomy removes structures above the vocal cords to maintain voice function. These procedures aim to treat cancer while preserving as much normal function as possible. Recovery may involve hospitalisation and temporary tracheostomy in some cases.
Total Laryngectomy
Complete removal of the larynx may become necessary for certain cancers or when other treatments are not suitable. This procedure creates a permanent breathing stoma in the neck and separates breathing from swallowing pathways. While natural voice is lost, various voice restoration methods exist, including oesophageal speech, electrolarynx devices, and tracheo-oesophageal puncture with voice prosthesis. Comprehensive rehabilitation helps patients adapt to anatomical changes and regain communication abilities.
Targeted Therapy
Medications like cetuximab target specific proteins on cancer cells, aiming to block growth signals. These drugs work differently from traditional chemotherapy and may have different side effect profiles. Targeted therapy may be combined with radiation or chemotherapy for certain cancers. Treatment involves regular infusions, with duration depending on response and tolerance.
Immunotherapy
Checkpoint inhibitors like pembrolizumab and nivolumab help the immune system recognise and attack cancer cells. These medications may be suitable for certain recurrent or metastatic laryngeal cancers that have progressed despite other treatments. Infusions are given at regular intervals, potentially continued if effective. Individual responses vary, and 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 laryngeal cancer may progressively affect laryngeal structures, potentially leading to voice changes and breathing difficulties. Tumours can invade surrounding tissues, including the thyroid gland, oesophagus, and major blood vessels. Airway compromise may require emergency tracheostomy to maintain breathing.
Cancer spread to lymph nodes can create visible neck masses and may increase the risk of distant metastasis. Sites of spread may include the lungs, liver, and bones. Advanced disease may cause pain, difficulty eating, leading to malnutrition, and aspiration pneumonia from swallowing dysfunction. Untreated laryngeal cancer can be life-threatening.
Quality of life may deteriorate as the disease advances. Communication can become challenging, social isolation may increase, and basic functions like eating can become difficult. Early consultation can help assess treatment options and potential outcomes.
Prevention
Whilst not all laryngeal cancers are preventable, risk-reduction strategies may help lower your risk of developing this disease. Tobacco cessation remains an important preventive measure. Quitting smoking at any age may reduce risk, with potential benefits increasing over time. Singapore offers various smoking cessation programmes through polyclinics and hospitals.
Limiting alcohol consumption to moderate levels may further reduce risk. Combining tobacco cessation with alcohol moderation may provide enhanced risk reduction.
Workplace safety measures can help protect against occupational carcinogens. Use appropriate protective equipment when exposed to chemicals, dust, or fumes. Regular workplace health screenings can help identify early problems. Maintaining good vocal hygiene, treating chronic acid reflux, and consuming a diet rich in fruits and vegetables may provide additional protection. HPV vaccination may reduce the risk of HPV-related laryngeal cancers, though evidence continues to evolve.
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Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.
Frequently Asked Questions (FAQ)
What are the survival rates for laryngeal cancer in Singapore?
Outcomes depend on cancer stage at diagnosis. Early-stage laryngeal cancers may have more favourable outcomes with appropriate treatment. Advanced stages require more intensive treatment approaches. Your ENT specialist can discuss your specific situation based on tumour characteristics, overall health, and chosen treatment approach. Regular follow-up and adherence to treatment plans may help optimise outcomes.
Will I lose my voice permanently after laryngeal cancer treatment?
Voice preservation depends on tumour location, size, and treatment type. Radiation therapy and endoscopic laser surgery for early cancers may preserve a normal or near-normal voice. Partial laryngectomy procedures may maintain voice function, though quality may change. Total laryngectomy results in loss of natural voice, but various restoration methods can enable communication. Speech therapy may help optimise voice outcomes regardless of treatment type.
Can laryngeal cancer come back after treatment?
Recurrence risk exists with all cancers. Regular follow-up examinations help detect changes early, when additional treatment options may still be available. Various factors may influence recurrence risk. Maintaining healthy lifestyle habits and attending all follow-up appointments may help with ongoing monitoring. If cancer recurs, various treatment options may remain available depending on the location and prior treatments.
What lifestyle changes will I need to make during and after treatment?
During treatment, you may need to modify diet consistency if swallowing becomes difficult, maintain oral hygiene to help prevent infections, and avoid irritants like smoke and strong fumes. Adequate nutrition and hydration may support healing and treatment tolerance. After treatment, changes may include dietary modifications, voice rest periods, and stoma care for laryngectomy patients. Your healthcare team may guide appropriate adaptations. Support groups may help navigate lifestyle adjustments.
Are there clinical trials available for laryngeal cancer in Singapore?
Singapore’s hospitals and cancer centres may conduct clinical trials investigating treatments for head and neck cancers. Trials may involve drug combinations, surgical techniques, or radiation protocols. Eligibility depends on specific trial criteria, including cancer stage, previous treatments, and overall health. Your ENT specialist can discuss available options and whether participation may suit your situation. This treatment is administered as part of a comprehensive plan supervised by a healthcare professional.
Conclusion
Laryngeal cancer presents significant challenges, yet modern treatment approaches may offer hope through effective management and preservation of essential functions such as speech and swallowing. Early detection plays a key role in improving outcomes and may help reduce the need for more intensive treatment. Understanding your diagnosis and working closely with specialists ensures a well-informed and supportive care journey.
Singapore offers comprehensive laryngeal cancer care, including advanced diagnostics, targeted therapies, and rehabilitation support. With guidance from an ENT specialist in Singapore, patients may benefit from tailored treatment plans that align with their medical needs and personal goals. With appropriate treatment and ongoing support, many individuals can effectively manage laryngeal cancer and maintain quality of life.
Take the First Step Towards Better Health
Living with laryngeal cancer concerns can be challenging, but you don’t have to face it alone. Our ENT Specialist has experience diagnosing and treating laryngeal cancer using current diagnostic and therapeutic 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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A Specialist Clinic for Sinus, Snoring & ENT
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Mount Elizabeth Novena Hospital
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