Laryngeal Cancer and Precancerous Lesions

Our approach

Two principles guide this work. The first is that cancer treatment decisions come first and are not compromised for the sake of voice. The second is that, among options with equivalent oncological outcomes, the one that preserves voice and swallowing most fully is the right choice. A laryngologist is well placed to hold both, because the organ being treated is the one we work on every day, and because the functional consequences of each surgical decision are ones we manage afterwards.

We also take a defined position on speed. A hoarse voice lasting more than a few weeks warrants a look at the vocal folds, and a suspicious lesion warrants a tissue diagnosis without delay. Waiting to see whether a voice improves is reasonable for a short period, and unreasonable beyond it.

Treatment decisions are made within a multidisciplinary framework, alongside radiation and medical oncology and pathology, so that surgery, radiotherapy, and systemic treatment are weighed together rather than sequentially. Surgery, including for advanced disease, is performed here.

Who this is for

This page is for patients and referring physicians dealing with:

What the treatment involves

Diagnosis begins with endoscopic examination and stroboscopy, which shows how the lesion affects vocal fold vibration and often suggests how deeply it has invaded. A biopsy under general anaesthesia gives the tissue diagnosis, and imaging assesses the extent of disease and the neck.

For precancerous lesions and early glottic cancer, transoral laser microsurgery is the usual approach: the lesion is removed through the mouth, with no external incision, using a microscope and laser. The aim is complete removal with the smallest margin that is oncologically safe, because how much tissue is taken determines the voice afterwards. Radiotherapy is an alternative for some early cancers, with broadly comparable cure rates, and the choice is made with the patient and the oncology team.

More advanced disease calls for larger operations, which may include partial laryngectomy where the larynx and its function can be preserved, total laryngectomy where it cannot, and neck dissection where the disease has spread to lymph nodes. Reconstruction, swallowing rehabilitation, and voice restoration after laryngectomy are planned as part of the operation rather than left as an afterthought.

Evidence and experience

Transoral laser surgery, open partial laryngectomy, and radiotherapy are all established treatments with a large comparative literature. Head and neck oncology is part of the director's published research, including work on prognostic markers in laryngeal cancer, oncological outcomes after supracricoid laryngectomy, patterns of nodal spread, and swallowing function after total laryngectomy. See Publications.

What to expect afterwards

Cure rates for early glottic cancer are high, and most of these patients keep their larynx. Voice after treatment depends on how much tissue was removed or how radiation affected the vocal fold; it is often good, sometimes noticeably changed, and rarely identical to before.

After larger operations the picture is different and we say so directly. Partial laryngectomy preserves a voice but usually changes it, and swallowing needs deliberate rehabilitation. Total laryngectomy removes the voice box, and speech is restored by other means, which takes work and time. These are significant changes to daily life, and we discuss them fully before surgery rather than after.

Surveillance continues for years after treatment, because recurrence and second primary tumours are possible and are most treatable when found early. We are explicit with every patient about the surveillance schedule and about what to report between visits. We do not promise a specific outcome, and we do not soften a poor prognosis when there is one.