The global, regional, national burden of laryngeal cancer and its attributable risk factors (1990-2019) and predictions to 2035

Burden of laryngeal cancer in China caused by smoking from 1990 to 2021 and predictions for 2035: An age-period-cohort analysis of global burden of disease study 2021

INTRODUCTION

Smoking is a major risk factor for laryngeal cancer (LC). Understanding the impact of smoking on the changing disease burden of LC is crucial for LC prevention in China and provides a scientific basis for formulating targeted LC prevention and control strategies, contributing to the achievement of the 'Healthy China 2030' goals.

METHODS

Data on LC attributable to smoking in China, stratified by sex, age, and year, were obtained from the 2021 Global Burden of Disease (GBD) study to conduct a secondary data analysis. Joinpoint regression was used to analyze trends in the burden of LC attributable to smoking in China from 1990 to 2021. Age-period-cohort (APC) analysis was employed to compare and analyze trends in the age, period, and cohort effects on the disease burden. Finally, Bayesian age-period-cohort (BAPC) analysis was used to predict trends in LC mortality and disability-adjusted life years (DALYs) from 2022 to 2035.

RESULTS

From 1990 to 2021, the overall burden of LC attributable to smoking in China increased. The number of deaths in males rose from 9128 to 14219, and in females from 790 to 1054. DALYs increased by 39.85% in males and 22.21% in females. Despite the rise in absolute burden, age-standardized mortality rates (ASMR) and age-standardized DALY rates (ASDR) declined, with reductions exceeding 50% in females. Joinpoint regression analysis revealed a decline-stabilization-decline trend in age-standardized rates among males, while females exhibited a continuous decline. According to the APC model, the age effect on disease burden increased with age, while period and cohort risk ratios generally declined. Net drift analysis showed a decline in mortality and DALY rates attributable to smoking, more pronounced in females than males, with local drift values <0 for both sexes. Predictions indicate that by 2035, male LC deaths will reach 17205, and female deaths 1373; however, ASMR and ASDR will continue to decline, with male ASMR dropping to 2.44 per 100000 and female ASMR to 0.16 per 100000.

CONCLUSIONS

Over the past three decades, the burden of LC attributable to smoking in China has shown an increasing trend, with sex and age disparities. This burden is expected to continue rising over the next fourteen years. Therefore, it is imperative to strengthen smoking prevention and cessation efforts, particularly targeting high-risk groups. Additionally, continued emphasis on education and awareness regarding LC is necessary to facilitate early detection and intervention, thereby effectively reducing the disease burden attributable to smoking.

Global, regional and national burden and trends of larynx cancer among adults aged 55 and older from 1990 to 2021: results from the global burden of disease study 2021

BACKGROUND

Laryngeal cancer (LC), as a common head and neck tumor, significantly impacts the quality of life. Utilizing data from the 2021 Global Burden of Disease (GBD) study, we sought to delve deeply into the global LC burden experienced by individuals aged 55 and older from 1990 to 2021 at the global, regional, and national levels. This research encompassed three key indicators: incidence rate, mortality, and disability-adjusted life years (DALYs).

METHODS

Based on the GBD 2021 database, we selected data from 204 countries and regions covering the period from 1990 to 2021 for individuals aged 55 and above. We analyzed LC's performance in terms of incidence, mortality, and DALYs, calculating the age-standardized rates and the mean average annual percent change (AAPC) at global, regional, and national levels. In our analysis of global trends, we carefully considered multiple variables including age, sex, and the socio-demographic index (SDI). Furthermore, we assessed potential risk factors for LC-associated DALYs and made prospective predictions for the possible scenario by 2035.

RESULTS

Globally, the age-standardized DALY rate of LC among adults aged 55 years and older has undergone significant changes. Specifically, this rate dropped sharply from 245.89 cases per 100,000 people in 1990 to 153.76 cases per 100,000 people in 2021, with an AAPC showing a decreasing trend of -2.916. Simultaneously, the age-standardized incidence rate and mortality rate also exhibited a similar downward trend. From a regional perspective, South Asia ranked highest in relevant indicators in 2021, reporting a death toll of 29,258.96, confirmed cases of 34,234.23, and DALYs related to LC reaching 709,622.00. In contrast, the figures in Oceania were the lowest, with only 26.23 deaths, 29.53 incident cases, and 609.09 DALYs. When divided according to the quintiles of the SDI, in 2021, the medium-high SDI led in incidence rates, while the low SDI ranked last. However, in terms of mortality and DALY rates, medium-low SDI topped the list, with high SDI being the lowest. In terms of gender differences, in 2021, the age-standardized DALY rate of LC in males was approximately 7.13 times that of females, with the former reaching 282.12 cases per 100,000 people and the latter only 39.59 cases per 100,000 people. Among all age groups, a notable decrease was observed in the age-specific incidence rate and DALY for adults aged 60-64 years, with AAPC values of -0.123 (95% CI: -0.130 to -0.116) and - 3.553 (95% CI: -3.620 to -3.486), respectively. Similarly, the mortality rate for adults aged 65-69 years also showed a significant decline, with an AAPC of -0.123 (95% CI: -0.127 to -0.118). Additionally, tobacco has been revealed as the most important risk factor affecting the mortality and DALY of LC in adults aged 55 years and older. Looking ahead, it is predicted that by 2035, the incidence rate, mortality rate, and DALY rate of LC among people over 55 years old will continue to decline.

CONCLUSIONS

Despite the current data and future predictions indicating a decline in the global age-standardized incidence rate, the absolute number of estimates continues to increase. Therefore, we advocate that cancer prevention strategies should place greater emphasis on vigorously addressing modifiable risk factors, particularly for the male population, which requires special attention and scientific intervention.

Dysphagia in head and neck cancer patients with evidence of esophageal dysmotility on manometry

OBJECTIVES

Dysphagia is a well-known complication of head and neck cancer (HNC) treatment that significantly impacts daily life for survivors. This study aims to characterize esophageal dysmotility identified on high resolution manometry (HRM) in HNC survivors with dysphagia.

METHODS

A retrospective chart review of 30 patients who underwent HRM treated for dysphagia between August 1st 2020 to February 2nd, 2023, was conducted. Patients with dysphagia, at least one HRM, and treated in a HNC dysphagia clinic were included. HRM reports were analyzed using Chicago Classification Version 4.0 (CCV4). EGJ outflow obstruction (EGJOO) was validated using endoscopy or radiographic findings. Data was summarized using mean for continuous variables and frequencies for categorical variables.

RESULTS

Of the 30 patients included in our study, 18 (60.0 %) showed evidence of CCV4 dysmotility. The most common subtypes were found to be ineffective motility (n = 6, 33.3 %), followed by EGJOO (n = 5, 27.8 %). Absent contractility and hypercontractile esophagus showed the same frequency (n = 3, 16.7 %), as did achalasia type 1 and type 2 (n = 1, 5.6 %).

CONCLUSION

Oropharyngeal and pharyngoesophageal dysphagia are well recognized causes of dysphagia, while esophageal dysmotility is an understudied cause of dysphagia in the HNC population. In this study of patients undergoing HRM for workup of their dysphagia after HNC, 60% had evidence of a CCV4 motility disorder, with the most common subtypes being ineffective motility and EGJOO. Therefore, HRM, the gold standard of diagnosis for esophageal dysmotility, should be considered in HNC patients who have symptoms suspicious for dysmotility.

Global, regional, and national burden of anxiety disorders during the perimenopause (1990-2021) and projections to 2035

PURPOSE

Perimenopause is associated with an increased risk of anxiety disorders, largely due to hormonal changes affecting the body's regulatory feedback mechanisms. This study aims to provide a comprehensive analysis of the global burden of anxiety disorders among perimenopausal women.

METHODS

Data from the 2021 Global Burden of Disease (GBD) database were utilized to assess disability-adjusted life years associated with anxiety disorders linked to perimenopause. We calculated trends using the estimated average percent change, and future projections were made using the Bayesian age-period-cohort model to estimate disability-adjusted life year trends for anxiety disorders from 2022 to 2035.

RESULTS

Between 1990 and 2021, the global age-standardized disability-adjusted life year rate for anxiety disorders among perimenopausal women increased from 625.51 (95% uncertainty interval: 429.1-891.09) to 677.15 (95% uncertainty interval: 469.45-952.72), indicating a rising trend with an estimated average percent change of 0.081 (95% confidence interval: 0.0043-0.143). Regional differences were noted, with anxiety disorder burdens varying across areas with different sociodemographic index levels. Projections suggest that by 2035, the global burden of anxiety disorders in perimenopausal women will rise to 1,180.43 per 100,000, a 40.67% increase compared with 2021 levels.

CONCLUSION

The burden of anxiety disorders during perimenopause is a growing global concern, with a significant increase anticipated in the coming years. Targeted prevention and intervention strategies are urgently needed to mitigate this rising burden and improve mental health outcomes during perimenopause.

Diagnostic accuracy of deep learning-based algorithms in laryngoscopy: a systematic review and meta-analysis

PURPOSE

Laryngoscopy is routinely used for suspicious vocal cord lesions with limited performance. Accumulated studies have demonstrated the bright prospect of deep learning in processing medical imaging. In this study, we perform a systematic review and meta-analysis to investigate diagnostic utility of deep learning in laryngoscopy.

METHODS

The study was performed according to the Primary Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We comprehensively retrieved articles from the PubMed, Scopus, Embase, and Web of Science up to July 14, 2024. Eligible studies with application of deep learning algorithm in laryngoscopy were assessed and enrolled by two independent investigators. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio with 95% confidence intervals (CIs) were calculated using a random effects model.

RESULTS

We retained 9 eligible studies adding up to 106,175 endoscopic images for the meta-analysis. The pooled sensitivity and specificity to diagnose laryngeal cancer were 0.95(95% CI: 0.85-0.98) and 0.96 (95% CI: 0.91-0.98). The area under the curve of deep learning was 0.99 (95%CI: 0.97-0.99).

CONCLUSION

Deep learning demonstrated excellent diagnostic efficacy in assessing laryngeal cancer with laryngoscope images in current studies, which manifests its potential of aiding endoscopist for laryngeal cancer diagnosis and clinical decision making.

Occupational exposure to diesel exhaust and head and neck cancer: a systematic review and meta-analysis of cohort studies

Exposure to diesel exhaust (DE) and other fossil fuels in the workplace can cause several health effects including cancer. We conducted a systematic review and meta-analysis of cohort studies examining the association between occupational DE exposure and the risk of head and neck cancer (HNC), including cancer of the oral cavity, pharynx and larynx. We included cohort studies mentioned in the Monograph of the International Agency for Research on Cancer, 2014, on DE. Forest plots of relative risk (RR) were constructed for HNC overall and its anatomical subtypes. A random-effects model was used to address heterogeneity between studies. Fifteen articles were included after removing duplicates and irrelevant reports. The summary RR for DE exposure was 1.08 [95% confidence interval (CI) = 1.01-1.17, P heterogeneity = <0.001] for HNC overall, 0.98 (95% CI = 0.87-1.11) for oral cavity, 1.05 (95% CI = 0.77-1.43) for pharyngeal, 1.15 (95% CI = 0.96-1.38) for oral cavity and pharyngeal combined, and 1.13 (95% CI = 1.03-1.24) for laryngeal cancer. There were elevated RRs for incidence studies of HNC (RR = 1.13; 95% CI = 1.05-1.22, P  = 0.001), European studies (RR = 1.13; 95% CI = 1.05-1.23, P  = 0.001), and female studies (RR = 1.77; 95% CI = 1.31-2.39, P  = 0.003). Our study suggested an association between occupational DE exposure and the risk of HNC, particularly laryngeal cancer. Although residual confounding cannot be ruled out, our results support the importance of controlling occupational DE exposure.

The trend analysis of HIV and other sexually transmitted infections among the elderly aged 50 to 69 years from 1990 to 2030

Background

The HIV and other sexually transmitted infections (STI) excluding HIV among the elderly population urgently require more attention and in-depth study. We aimed to present and predict the worldwide of its burden from 1990 to 2030 using data from the Global Burden of Disease (GBD) study.

Methods

Leveraging the 2019 GBD study, we investigated the average annual percentage change (AAPC) of HIV and other STI in incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates for individuals aged 50-69 across different age groups, genders, sociodemographic index (SDI) regions, and nations. The incidence of STI in the population from 2020 to 2030 was explored by Bayesian age-period-cohort (BAPC) prediction model.

Results

The HIV incidence rate experienced its fastest growth 1990-1992, peaked in 1996, and gradually declined thereafter, with the 2019 rate being lower than that of 1990. The prevalence rate didn't present a sharp turning point. After 2006, its growth rate accelerated. Both DALYs and mortality rates plateaued high between 2002 and 2005, followed by a decline. The decline was steepest from 2005-2012, yet the rate of decrease slowed noticeably from 2012-2019.When segmented by age, HIV was more prevalent among those aged 55-59 and 50-54, with the 50-54 age group witnessing the fastest decline in incidence rates. However, the fastest growth in prevalence rates was seen among the 60-64 and 65-69 age groups. The other STI incidence rate declined from 1990-1996, increased up to 2006, declined until 2015, and then saw a resurgence with accelerated growth thereafter. The prevalence rate showcased varied trends, with a notable increase in the past five years. The highest growth in incidence rate was among the 65-69 age group. We predict that the incidence rate of STI will increase in the future.

Conclusions

Overall, despite the evident decline in incidence, mortality rates, and DALYs, the prevalence of HIV and other STI among the elderly is rising, and both demonstrated significant trend variations across different ages, genders, SDI regions, and nations. Comprehensive sexual health education, clinical care and adjustments in health service strategies based on the evolving trends of HIV and other STI among the elderly are paramount.

Insights From the National Inpatient Sample (2016-2019) on Laryngeal Cancer Incidence and Trends

BACKGROUND

Laryngeal cancer has a significant impact on speech, swallowing, and quality of life. This study aims to analyze laryngeal cancer trends using the National Inpatient Sample (NIS) database, providing insights into its epidemiology.

METHODS

Data from the NIS database was analyzed for a cohort of 14,282 laryngeal cancer cases from 2016 to 2019. Baseline characteristics and demographic parameters, including primary expected payer, age groups, hospital types, and geographic regions, were examined. Descriptive statistics and trend analysis were conducted.

RESULTS

 The cohort showed consistent annual case numbers (range: 3739-3948). The highest case numbers were in the 40-64 age group (average 1998 cases/year), followed by the 65-80 age group (average 1473 cases/year). Medicare was the most common primary expected payer, followed by Medicaid, private insurance, self-pay, and no charge. The cohort was roughly three times more skewed toward males, with an average of 2936 male cases per year compared to 885 female cases. Notable trends included significant positive correlations with time for urban teaching hospitals, the South region, older age group (65-80 years), and Asian or Pacific Islander individuals. However, the overall correlation between case numbers and time was not statistically significant. The primary expected payer and deaths exhibited moderate correlations with time but did not reach statistical significance.

CONCLUSION

This study provides insights into the baseline characteristics and trends in laryngeal cancer incidence. The observed demographic shifts highlight the need for further investigation into underlying factors influencing case distribution. Understanding these trends can guide targeted interventions for prevention, early detection, and treatment of laryngeal cancer.

Clinical application of CT-based radiomics model in differentiation between laryngeal squamous cell carcinoma and squamous cell hyperplasia

Objective

To evaluate the clinical application of the CT-based radiomics prediction model for discriminating SCC and SCH.

Methods

A total of 254 clinical samples were selected from 291 patients with larynx-occupying lesions who underwent primary surgery. All lesions were validated via histopathological examination at The Second Hospital of Jilin University between June 2004 and December 2019. All patients were randomly allocated to the training (n = 177) and validation (n = 77) cohorts. After the acquisition of CT images, manual 3D tumor segmentation was performed using the CT images of the arterial, venous, and non-contrast phases via ITK-SNAP software. Subsequently, radiomics features were extracted using A.K. software. Based on the above features, three different diagnostic models (CTN, CTA+CTV, and CTN+CTA+CTV) were constructed to classify squamous cell carcinoma (SCC) and squamous cell hyperplasia (SCH). Additionally, receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were measured to evaluate the diagnostic characteristics and clinical safety of the proposed three prognostic models.

Results

In the radiomic prediction Model 1 (CTN), the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the training cohorts in differentiating SCC and SCH were 0.883, 0.785, 0.645, 1.000, 1.000, and 0.648, while in the testing cohorts, these values were 0.852, 0.792, 0.66, 1.000, 1.000, and 0.652, respectively. In the radiomic prediction Model 2 (CTA+CTV), the AUC, accuracy, sensitivity, specificity, PPV, and NPV values of the training cohorts were 0.965, 0.91, 0.916, 0.9, 0.933, and 0.875, respectively, while in the testing cohorts, the corresponding values were 0.902, 0.805, 0.851, 0.733, 0.833, and 0.759, respectively. In the radiomic prediction Model 3(CTN+CTA+CTV), the AUC, accuracy, sensitivity, specificity, PPV, and NPV values of the training cohorts were 0.985, 0.944, 0.953, 0.929, 0.953, and 0.929, while in the testing cohorts, the corresponding values were 0.965, 0.857, 0.894, 0.8, 0.875, and 0.828, respectively.

Conclusion

The radiomic prediction Model 3, based on the arterial-venous-plain combined scan phase of CT, achieved promising diagnostic performance, expected to be regarded as a preoperative imaging tool in classifying SCC and SCH to guide clinicians to develop individualized treatment programs.

Survival Outcomes of Non-squamous Cell Carcinoma and Rare Squamous Cell Carcinoma Variants of the Larynx

The literature focuses primarily on laryngeal differentiated squamous cell carcinoma (SCC), and only a limited number of studies have evaluated the outcomes of rare variants of SCC (vSCC) and non-SCC malignancies (nSCC). To our knowledge, this is the first study to compare the survival outcomes of these two groups. We retrospectively reviewed the records of 816 patients who underwent laryngeal surgery from January 2010 to November 2022. Forty-nine (6.2%) were identified as having unusual larynx malignancies and categorized in the nSCC or vSCC groups. The patients' clinicopathological features were then recorded. We compared the two groups' overall survival (OS) and recurrence-free survival (RFS) outcomes. Thirty-three (4.2%) patients had vSCC, and 16 (2%) had nSCC. Forty-two (85.7%) were male, and the mean age was 58.57 years. The median follow-up time was 69 months. The 5-year OS rate was 71.4% in the nSCC group vs. 87.9% in the vSCC group (p = .055). Only surgical margin (HR: 4.68; 95% CI:1.13-19.37, p = .033) was an independent prognostic factor for OS in the multivariable analysis. The 5-year RFS rate was 50% for the nSCC group compared to 90.9% for the vSCC group (p < .001). In the multivariable analysis, surgical margin positivity (HR: 21.0, 95% CI 3.97-98.1, p < .001), and lymphovascular invasion (HR: 0.043, 95% CI 0.005-0.357, p = .004) were independent prognostic factors for RFS. Although OS did not show a statistical difference, nSCC malignancies of the larynx demonstrated worse OS and RFS outcomes than vSCC malignancies.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03934-8.

Elucidating the clonal relationship of esophageal second primary tumors in patients with laryngeal squamous cell carcinoma

Laryngeal cancer ranks as the second most prevalent upper airway malignancy, following Lung cancer. Although some progress has been made in managing laryngeal cancer, the 5-year survival rate is disappointing. The gradual increase in the incidence of second primary tumors (SPTs) plays a crucial role in determining survival outcomes during long-term follow-up, and the esophagus was the most common site with a worse prognosis. In clinical practice, the treatment of esophageal second primary tumors (ESPT) in patients with laryngeal squamous cell carcinoma (LSCC) has always been challenging. For patients with synchronous tumors, several treatment modalities, such as radiotherapy, chemotherapy and potentially curative surgery are necessary but are typically poorly tolerated. Secondary cancer therapy options for metachronous patients are always constrained by index cancer treatment indications. Therefore, understanding the clonal origin of the second primary tumor may be an important issue in the treatment of patients. LSCC cells demonstrate genetic instability because of two distinct aetiologies (human papillomavirus (HPV)-negative and HPV-positive) disease. Various etiologies exhibit distinct oncogenic mechanisms, which subsequently impact the tissue microenvironment. The condition of the tissue microenvironment plays a crucial role in determining the destiny and clonal makeup of mutant cells during the initial stages of tumorigenesis. This review focuses on the genetic advances of LSCC, the current research status of SPT, and the influence of key carcinogenesis of HPV-positive and HPV-negative LSCC on clonal evolution of ESPT cells. The objective is to gain a comprehensive understanding of the molecular basis underlying the clonal origins of SPT, thereby offering novel perspectives for future investigations in this field.

Downward trends in the global burden of congenital complete hearing loss in children younger than five years from 1990 to 2030

Background

The global epidemiological data on congenital hearing loss in children is sparse. We aimed to analyse the trends in the burden of complete hearing loss caused by congenital birth defects in children younger than five years from 1990 to 2030.

Methods

Using data from the Global Burden of Disease (GBD) Study 2019, we reported the counts and rates of prevalence and years lived with disability (YLD) by age, sex, and sociodemographic index (SDI). We also forecasted the prevalence rates until 2030 through the autoregressive integrated moving average (ARIMA) and Bayesian age-period-cohort (BAPC) models.

Results

We observed a global prevalence rate of 15.4 (95% uncertainty interval (UI) = 5.8 to 33.8) and a YLD rate of 3.3 (95% UI = 1.1 to 7.1) per 100 000 population in 2019, with both showing downward trends from 1990 to 2019. Regionally, Oceania had the highest prevalence (47.2; 95% UI = 18.8 to 96.6) and YLD (10; 95% UI = 3.2 to 22.8) rates, while Central Europe had the lowest rates. Nationally, the prevalence (85.0; 95% UI = 36.8 to 166.8) and YLD (17.9; 95% UI = 6.6 to 36.9) rates were highest in Myanmar and lowest in Peru. Only the United States of America (2.6%; 95% UI = -4.6 to 14.4) and Norway (0.6%; 95% UI = -6.7 to 16.2) showed upward trends. Compared to girls, the prevalence and YLD rates were higher for boys at global, regional, and five SDI quintile levels, except for Eastern Sub-Saharan Africa. At the global level, downward trends were predicted in prevalence rates from 2019 to 2030 between boys and girls.

Conclusions

Although the global burden of childhood congenital complete hearing loss showed inequalities across locations, sexes, and age groups, we found decreases in the global prevalence rates between 1990 and 2019 and predicted decreases from 2019 to 2030. Better prevention of infectious aetiologies, improving genetic diagnoses, and hearing restoration could alleviate this burden.

Causes of death after laryngeal cancer diagnosis: A US population-based study

BACKGROUND

Several reports examined the survival of laryngeal cancer (LC) patients, most of these studies only focused on the prognosis of the disease, and just a small number of studies examined non-cancer-related causes of death. The objective of the current study is to investigate and quantify the most common causes of deaths following LC diagnosis.

METHODS

The data of 44,028 patient with LC in the United States diagnosed between 2000 and 2018 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) program and analyzed. We stratified LC patients according to various demographic and clinical parameters and calculated standardized mortality ratios (SMRs) for all causes of death.

RESULTS

Over the follow-up period, 25,407 (57.7%) deaths were reported. The highest fatalities (11,121; 43.8%) occurred within 1-5 years following LC diagnosis. Non-cancer causes of death is the leading cause of death (8945; 35.2%), followed by deaths due to laryngeal cancer (8,705; 34.3%), then other cancers deaths (7757; 30.5%). The most common non-cancer causes of death were heart diseases (N = 2953; SMR 4.42), followed by other non-cancer causes of death (N = 1512; SMR 3.93), chronic obstructive pulmonary diseases (N = 1420; SMR 4.90), then cerebrovascular diseases (N = 547; SMR 4.28). Compared to the general population, LC patients had a statistically significant higher risk of death from all reported causes.

CONCLUSIONS

Non-cancer causes of death is the leading cause of death in LC patients, exceeding deaths attributed to LC itself. These findings provide important insight into how LC survivors should be counselled regarding future health risks.

Laryngeal Anatomy, Molecular Biology, Cause, and Risk Factors for Laryngeal Cancer

Laryngeal cancer is declining in incidence in many parts of the world, as smoking becomes a less common habit. However, challenging cases of laryngeal cancer still exist and require expertise from otolaryngologists. This article reviews the relevant anatomy and lymphatic drainage pathways of the larynx because they pertain to cancer spread. The molecular and immune landscapes of laryngeal cancer, which are tightly linked to smoking, are also discussed.