The goals of treatment of early glottic cancer are eradication of tumor and preservation of function, including phonatory and swallowing function. Many case series suggest that transoral laser microsurgery, open surgical procedures, and radiation have comparable rates of local control, ultimate local control after salvage therapy, laryngeal preservation, and survival, although there may be differences in cost and voice outcomes. Tumor factors, patient factors, and physician and patient preferences should dictate the choice of therapy.