Early vocal cord cancers are usually detected because of hoarseness. The most important adverse prognostic factors for laryngeal cancers include increasing T stage and N stage. Although most early lesions can be cured by either radiation therapy or surgery, radiation therapy may be reasonable to preserve the voice, leaving surgery for salvage. This observation is being evaluated in a randomized clinical trial. Locally advanced lesions, especially those with large clinically involved lymph nodes, are poorly controlled with surgery, radiation therapy, or combined modality treatment.
Distant metastases are also common even if the primary tumor is controlled.
Intermediate lesions have intermediate prognoses, depending on site, T stage, N stage, and performance status. Patients treated for laryngeal cancers are at highest risk of recurrence in the first 2 to 3 years. Recurrences after 5 years are rare and usually represent new primary malignancies. Close, regular follow-up is crucial to maximize the chance for salvage. Hong WK, Lippman SM, Itri LM, et al.