• Atypia and early cancer lesions reduce the ability of vocal folds to vibrate during speaking and singing. This results in voice complaints frequently described by patients as:
  • Gradual and progressive hoarseness
  • Rough, irregular quality to voice
  • Inability to project voice
  • Effortful phonation
  • Voice fatigue, especially at the end of the day
• Hoarseness: Hoarseness, common in both vocal fold atypia and early cancer, starts gradually and is usually progressive, changing little over months or years. Often friends, or family members, first detect a change in voice quality, rather than patients (who hear their own voices daily).
• Common cold can spur symptoms: Hoarseness and other symptoms may present just after a cold. The common cold does not cause the cancer, but rather causes a sudden worsening of voice quality.

Breathing symptoms are rare but can occur in patients with vocal fold atypia and early cancer. When a lesion mushrooms outwards – rather than burrowing deep into the vocal fold – the passage of air through the voice box can be blocked. Breathing symptoms might also be caused by another problem present at the same time.

• Difficult breathing (dyspnea): A patient's labored breathing may be first noticed by a family member while the patient is sleeping. Dyspnea may also occur during physical exercise – even during a simple activity such as walking up stairs – when airflow demands are greater.
• Noisy breathing (stridor): Stridor results from a narrowing of the opening between the vocal folds (glottis).

Red Flag

• Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway.
• Stridor is a sign of difficulty passing air.
• Any breathing difficulty needs immediate medical attention.

Patients may have difficulty maintaining adequate breath support – often described by patients as a feeling that their voice trails off due to "lack of air behind it." This feeling may be due to a lesion blocking the smooth flow of air into the windpipe or because much more air is required to drive the vocal folds into vibration.

In rare instances when the lesion surface becomes eroded or irritated, it may bleed, causing patients to cough up small amounts of blood. This condition is known as hemoptysis.

Smoking is the single greatest risk factor for developing vocal-fold atypia and cancer. However, individuals who have smoked for many years often have a low, rough, scratchy quality to their voice – frequently referred to as "smoker's laryngitis." Unfortunately, smoker's laryngitis makes it harder to detect hoarseness due to vocal fold atypia or cancer in smokers.

Red Flag

A scratchy, low voice in a smoker should not be simply dismissed as "smoker's laryngitis," since vocal fold cancer, a potentially life-threatening disease, might be present.