Laryngeal Cancer Treatment- Cancer/Oncology

Laryngeal Cancer Treatment (PDQ®)–Patient Version was originally published by the National Cancer Institute.

KEY POINTS

• Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx.
• Use of tobacco products and drinking too much alcohol can affect the risk of laryngeal cancer.
• Signs and symptoms of laryngeal cancer include a sore throat and ear pain.
• Tests that examine the throat and neck are used to help detect (find), diagnose, and stage laryngeal cancer.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx.

The larynx is a part of the throat, between the base of the tongue and the trachea. The larynx contains the vocal cords, which vibrate and make sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a person's voice.

There are three main parts of the larynx:

• Supraglottis: The upper part of the larynx above the vocal cords, including the epiglottis.
• Glottis: The middle part of the larynx where the vocal cords are located.
• Subglottis: The lower part of the larynx between the vocal cords and the trachea (windpipe).

Most laryngeal cancers form in squamous cells, the thin, flat cells lining the inside of the larynx.

Laryngeal cancer is a type of head and neck cancer.

Use of tobacco products and drinking too much alcohol can affect the risk of laryngeal cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Signs and symptoms of laryngeal cancer include a sore throat and ear pain.

These and other signs and symptoms may be caused by laryngeal cancer or by other conditions. Check with your doctor if you have any of the following:

• A sore throat or cough that does not go away.
• Trouble or pain when swallowing.
• Ear pain.
• A lump in the neck or throat.
• A change or hoarseness in the voice.

Tests that examine the throat and neck are used to help detect (find), diagnose, and stage laryngeal cancer.

The following tests and procedures may be used:

• Physical exam of the throat and neck: An exam to check the throat and neck for abnormal areas. The doctor will feel the inside of the mouth with a gloved finger and examine the mouth and throat with a small long-handled mirror and light. This will include checking the insides of the cheeks and lips; the gums; the back, roof, and floor of the mouth; the top, bottom, and sides of the tongue; and the throat. The neck will be felt for swollen lymph nodes. A history of the patient’s health habits and past illnesses and medical treatments will also be taken.
• Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The sample of tissue may be removed during one of the following procedures:
  • Laryngoscopy : A procedure to look at the larynx (voice box) for abnormal areas. A mirror or a laryngoscope (a thin, tube-like instrument with a light and a lens for viewing) is inserted through the mouth to see the larynx. A special tool on the laryngoscope may be used to remove samples of tissue.
  • Endoscopy : A procedure to look at organs and tissues inside the body, such as the throat, esophagus, and trachea to check for abnormal areas. An endoscope (a thin, lighted tube with a light and a lens for viewing) is inserted through an opening in the body, such as the mouth. A special tool on the endoscope may be used to remove samples of tissue.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
• PET-CT scan: A procedure that combines the pictures from a positron emission tomography (PET) scan and a computed tomography (CT) scan. The PET and CT scans are done at the same time with the same machine. The combined scans give more detailed pictures of areas inside the body than either scan gives by itself. A PET-CT scan may be used to help diagnose disease, such as cancer, plan treatment, or find out how well treatment is working.
• Bone scan : A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.
• Barium swallow : A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

Certain factors affect prognosis (chance of recovery) and treatment options.

Prognosis (chance of recovery) depends on the following:

• The stage of the disease.
• The location and size of the tumor.
• The grade of the tumor.
• The patient's age, gender, and general health, including whether the patient is anemic.

Treatment options depend on the following:

• The stage of the disease.
• The location and size of the tumor.
• Keeping the patient's ability to talk, eat, and breathe as normal as possible.
• Whether the cancer has come back (recurred).

Smoking tobacco and drinking alcohol decrease the effectiveness of treatment for laryngeal cancer. Patients with laryngeal cancer who continue to smoke and drink are less likely to be cured and more likely to develop a second tumor. After treatment for laryngeal cancer, frequent and careful follow-up is important.

Stages of Laryngeal Cancer

KEY POINTS

• After laryngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the larynx or to other parts of the body.
• There are three ways that cancer spreads in the body.
• Cancer may spread from where it began to other parts of the body.
• The following stages are used for laryngeal cancer:
  • Stage 0 (Carcinoma in Situ)
  • Stage I
  • Stage II
  • Stage III
  • Stage IV

After laryngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the larynx or to other parts of the body.

The process used to find out if cancer has spread within the larynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnose laryngeal cancer are often also used to stage the disease.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if laryngeal cancer spreads to the lung, the cancer cells in the lung are actually laryngeal cancer cells. The disease is metastatic laryngeal cancer, not lung cancer.

The following stages are used for laryngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the larynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I laryngeal cancer depends on where cancer began in the larynx:

• Supraglottis: Cancer is in one area of the supraglottis only and the vocal cords can move normally.
• Glottis: Cancer is in one or both vocal cords and the vocal cords can move normally.
• Subglottis: Cancer is in the subglottis only.

Stage II

In stage II, cancer is in the larynx only. Stage II laryngeal cancer depends on where cancer began in the larynx:

• Supraglottis: Cancer is in more than one area of the supraglottis or surrounding tissues.
• Glottis: Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally.
• Subglottis: Cancer has spread to one or both vocal cords, which may not move normally.

Stage III

Stage III laryngeal cancer depends on whether cancer has spread from the supraglottis, glottis, or subglottis.

In stage III cancer of the supraglottis:

• cancer is in the larynx only and the vocal cords cannot move, and/or cancer is in tissues next to the larynx. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in one area of the supraglottis and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller and the vocal cords can move normally; or
• cancer is in more than one area of the supraglottis or surrounding tissues and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller.

In stage III cancer of the glottis:

• cancer is in the larynx only and the vocal cords cannot move, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in one or both vocal cords and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller and the vocal cords can move normally; or
• cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally. Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller.

In stage III cancer of the subglottis:

• cancer is in the larynx and the vocal cords cannot move; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in the subglottis and in one lymph node on the same side of the neck as the original tumor; the lymph node is 3 centimeters or smaller; or
• cancer has spread to one or both vocal cords, which may not move normally. Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller.

Stage IV

Stage IV is divided into stage IVA, stage IVB, and stage IVC. Each substage is the same for cancer in the supraglottis, glottis, or subglottis.

• In stage IVA:
  • cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller; or
  • cancer has spread to one lymph node on the same side of the neck as the original tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters, or has spread to more than one lymph node anywhere in the neck with none larger than 6 centimeters. Cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. The vocal cords may not move normally.
• In stage IVB:
  • cancer has spread to the space in front of the spinal column, surrounds the carotid artery, or has spread to parts of the chest. Cancer may have spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size; or
  • cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest. The vocal cordsmay not move normally.
• In stage IVC, cancer has spread to other parts of the body, such as the lungs, liver, or bone.

Recurrent Laryngeal Cancer

Recurrent laryngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer is most likely to come back in the first 2 to 3 years. It may come back in the larynx or in other parts of the body.

Treatment Option Overview

KEY POINTS

• There are different types of treatment for patients with laryngeal cancer.
• Three types of standard treatment are used:
  • Radiation therapy
  • Surgery
  • Chemotherapy
• New types of treatment are being tested in clinical trials.
  • Targeted therapy
  • Radiosensitizers
• Treatment for laryngeal cancer may cause side effects.
• Patients may want to think about taking part in a clinical trial.
• Patients can enter clinical trials before, during, or after starting their cancer treatment.
• Follow-up tests may be needed.

There are different types of treatment for patients with laryngeal cancer.

Different types of treatment are available for patients with laryngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types of standard treatment are used:

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:

• External radiation therapy uses a machine outside the body to send radiation toward the cancer.

• Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat laryngeal cancer.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. A blood test to check the thyroid hormone level in the body may be done before and after therapy to make sure the thyroid gland is working properly.

Hyper fractionated radiation therapy may be used to treat laryngeal cancer. Hyper fractionated radiation therapy is radiation treatment in which a smaller than usual total daily dose of radiation is divided into two doses and the treatments are given twice a day. Hyper fractionated radiation therapy is given over the same period of time (days or weeks) as standard radiation therapy. New types of radiation therapy are being studied in the treatment of laryngeal cancer.

Surgery

Surgery (removing the cancer in an operation) is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:

• Cordectomy: Surgery to remove the vocal cords only.
• Supraglottic laryngectomy: Surgery to remove the supraglottis only.
• Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.
• Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient's ability to talk.
• Total laryngectomy: Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. This is called a tracheostomy.
• Thyroidectomy: The removal of all or part of the thyroid gland.
• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor in the larynx.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavitysuch as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.

Monoclonal antibodies are a type of targeted therapy being studied in the treatment of laryngeal cancer. Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances in the blood or tissues that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

Cetuximab is a type of monoclonal antibody that is being studied in the treatment of laryngeal cancer. It works by binding to a protein on the surface of the cancer cells and stops the cells from growing and dividing.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.

Treatment for laryngeal cancer may cause side effects.

For information about side effects caused by treatment for cancer, see our Side Effects page.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

• Stage I Laryngeal Cancer
• Stage II Laryngeal Cancer
• Stage III Laryngeal Cancer
• Stage IV Laryngeal Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Stage I Laryngeal Cancer

Treatment of stage I laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis, treatment may include the following:

• Radiation therapy.
• Supraglottic laryngectomy.

If cancer is in the glottis, treatment may include the following:

• Radiation therapy.
• Laser surgery.
• Cordectomy.
• Partial laryngectomy, hemilaryngectomy, or total laryngectomy.

If cancer is in the subglottis, treatment may include the following:

• Radiation therapy with or without surgery.
• Surgery alone.

Stage II Laryngeal Cancer

Treatment of stage II laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis, treatment may include the following:

• Radiation therapy to the tumor and nearby lymph nodes.
• Supraglottic laryngectomy which may be followed by radiation therapy.

If cancer is in the glottis, treatment may include the following:

• Radiation therapy.
• Laser surgery.
• Partial laryngectomy, hemilaryngectomy, or total laryngectomy.

If cancer is in the subglottis, treatment may include the following:

• Radiation therapy with or without surgery.
• Surgery alone.

Stage III Laryngeal Cancer

Treatment of stage III laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis, treatment may include the following:

• Chemotherapy and radiation therapy given together.
• Chemotherapy followed by chemotherapy and radiation therapy given together. Laryngectomy may be done if cancer remains.
• Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
• Surgery, which may be followed by radiation therapy.

If cancer is in the glottis, treatment may include the following:

• Chemotherapy and radiation therapy given together.
• Chemotherapy followed by chemotherapy and radiation therapy given together. Laryngectomy may be done if cancer remains.
• Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
• Surgery, which may be followed by radiation therapy.
• A clinical trial of radiation therapy alone compared with radiation and targeted therapy (cetuximab).
• A clinical trial of immunotherapy, chemotherapy, radiosensitizers, or radiation therapy.

If cancer is in the subglottis, treatment may include the following:

• Laryngectomy plus total thyroidectomy and removal of lymph nodes in the throat, usually followed by radiation therapy.
• Radiation therapy followed by surgery if cancer comes back in the same area.
• Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
• Chemotherapy followed by chemotherapy and radiation therapy given together. Laryngectomy may be done if cancer remains.
• A clinical trial of radiation therapy alone compared with radiation and targeted therapy (cetuximab).
• A clinical trial of immunotherapy, chemotherapy, radiosensitizers, or radiation therapy.

Stage IV Laryngeal Cancer

Treatment of stage IV laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis or glottis, treatment may include the following:

• Chemotherapy and radiation therapy given together.
• Chemotherapy followed by chemotherapy and radiation therapy given together. Laryngectomy may be done if cancer remains.
• Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
• Surgery followed by radiation therapy. Chemotherapy may be given with the radiation therapy.
• A clinical trial of radiation therapy alone compared with radiation and targeted therapy (cetuximab).
• A clinical trial of immunotherapy, chemotherapy, radiosensitizers, or radiation therapy.

If cancer is in the subglottis, treatment may include the following:

• Laryngectomy plus total thyroidectomy and removal of lymph nodes in the throat, usually followed by radiation therapy with or without chemotherapy.
• Chemotherapy and radiation therapy given together.
• A clinical trial of radiation therapy alone compared with radiation and targeted therapy (cetuximab).
• A clinical trial of immunotherapy, chemotherapy, radiosensitizers, or radiation therapy.

Treatment Options for Recurrent Laryngeal Cancer

Treatment of recurrent laryngeal cancer may include the following:

• Surgery with or without radiation therapy.
• Radiation therapy.
• Chemotherapy.
• A clinical trial of chemotherapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life.

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