This study analyzed trends in the incidence and mortality of laryngeal cancer (LC) in China from 2004 to 2018, provided projections up to 2033, and identified contributing factors influencing these trends. LC data were obtained from the Chinese Cancer Registry Annual Reports for 2004 to 2018. Estimated Annual Percent Change (EAPC) and 95% confidence intervals (CI) were calculated using Joinpoint Regression Software to evaluate trends. LC incidence and mortality rates in registry areas, combined with national population data, were used to estimate new cases and deaths. Projections were made to 2033, and a decomposition analysis identified factors influencing trends. From 2004 to 2018, the age-standardized incidence rate (ASIR) of LC decreased from 1.29 to 1.14 per 100,000, with an EAPC of -1.75% (95% CI: -2.36% to -1.12%). The age-standardized mortality rate (ASMR) also declined from 0.67 to 0.61 per 100,000, with an EAPC of -0.76% (95% CI: -1.28% to -0.25%). Mortality among males aged 60-69, however, showed a significant increase. Population growth and aging contributed to the rise in LC cases and deaths, while epidemiological factors partially offset these increases. By 2033, ASIR and ASMR for males and ASIR for females are projected to decrease, while ASMR for females is expected to rise. ASIR and ASMR in China showed a declining trend from 2004 to 2018, with further decreases projected through 2033. Yet, rising mortality in older males underscores the need for targeted prevention and early detection. Population aging and growth are key drivers of the LC burden, although epidemiological improvements have helped mitigate case increases. Comprehensive public health strategies remain essential to reduce LC impact in China.