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C32 covers primary malignant neoplasms of the larynx, including the glottis, supraglottis, subglottis, laryngeal cartilage, overlapping laryngeal sites, and unspecified laryngeal sites. Tobacco exposure and heavy alcohol use are major risk factors.
Common Histologies
- Squamous cell carcinoma accounts for most laryngeal cancers.
- Less common tumors include verrucous carcinoma, salivary-type carcinoma, neuroendocrine carcinoma, chondrosarcoma, and other sarcomas.
- Tumors involving laryngeal cartilage may represent direct invasion by squamous cell carcinoma or, less commonly, a primary cartilaginous malignancy.
Common Symptoms
Presentation varies by subsite:
- Glottic tumors: (C32.0) persistent hoarseness or voice change, often leading to earlier detection
- Supraglottic tumors: (C32.1) dysphagia, odynophagia, referred otalgia, throat discomfort, aspiration, or neck mass
- Subglottic tumors: (C32.2) dyspnea, stridor, cough, or progressive airway obstruction
- Advanced disease may cause hemoptysis (R04.2), weight loss (R63.4), pain (G89.29), impaired vocal-cord mobility (J38.00), or airway compromise (R06.1)
Diagnosis
Evaluation commonly includes:
- Complete head and neck examination and flexible fiberoptic laryngoscopy
- Direct laryngoscopy with biopsy for histopathologic confirmation
- Assessment of vocal-cord mobility and airway patency
- Contrast-enhanced CT or MRI of the neck to define local extent, cartilage invasion, and nodal disease
- Chest imaging and, when indicated, FDG-PET/CT to assess distant disease or synchronous malignancy
Staging
Laryngeal cancer is staged using the TNM system. Primary-tumor criteria differ for supraglottic, glottic, and subglottic cancers and consider subsite spread, vocal-cord mobility, paraglottic or pre-epiglottic space involvement, cartilage invasion, and extension beyond the larynx. Cervical nodal status and distant metastases are staged separately.
Molecular Markers
Routine diagnosis is primarily histologic. Unlike oropharyngeal squamous cell carcinoma, HPV or p16 status does not define a separate staging system for laryngeal carcinoma and should not be interpreted as an equivalent surrogate without appropriate clinical context. Broader biomarker testing, including PD-L1 or genomic profiling, may be considered in recurrent or metastatic disease when it could guide systemic therapy.
Common Treatments
Treatment depends on subsite, stage, functional status, airway and swallowing considerations, and patient preference:
- Early-stage disease may be treated with endoscopic resection, partial laryngeal surgery, or definitive radiation therapy.
- Locally advanced disease may require concurrent chemoradiation, total laryngectomy with neck management, or other multimodality treatment.
- Surgery may be followed by radiation or chemoradiation based on adverse pathologic features.
- Recurrent or metastatic disease may be managed with salvage surgery, re-irradiation in selected cases, systemic therapy, immunotherapy, and symptom-directed or palliative care.
- Speech, swallowing, nutritional, pulmonary, dental, and tobacco- or alcohol-cessation support are important components of care.
Scope Note
C32 identifies the anatomic site of a primary malignant neoplasm of the larynx, with child codes distinguishing glottic, supraglottic, subglottic, cartilage, overlapping, or unspecified sites. It does not encode histologic type, grade, TNM stage, biomarker status, treatment, or recurrence status. It also does not represent a secondary metastatic deposit in the larynx; secondary malignancy and distant metastatic sites are classified separately. Relevant tobacco exposure, environmental smoke exposure, or alcohol-use conditions may also be captured separately when documented.