Laryngeal Cancer Treatment

Laryngeal Cancer Treatment

What is laryngeal cancer?

Laryngeal cancer affects your larynx, part of your throat. Your larynx helps you speak, breathe and swallow. It contains your vocal cords.

Cancer affecting your larynx or vocal cords happens when cells grow uncontrollably in your larynx. As these cancerous (malignant) cells multiply, they invade tissues and damage your body.

Laryngeal cancer can form in any of the three main parts of your larynx:

Supraglottis (upper part): More than one in three laryngeal cancers (35%) start here.
Glottis (middle part): More than half of laryngeal cancers (60%) start here, where your vocal cords are.
Subglottis (lower part): About 5% of laryngeal cancers — 1 in 20 — start here.

How common is laryngeal cancer?

Laryngeal cancer is part of a group of head and neck cancers. Every year, approximately 12,500 people in the U.S. are diagnosed with laryngeal cancer. About 4,000 people die from it each year.

Symptoms and Causes

What are the symptoms of laryngeal cancer?

It’s easy to mistake the first signs of laryngeal cancer for other conditions. The most common symptom — hoarseness that doesn’t improve after a few weeks — is easy to mistake as a sign of a cold. If you experience the following symptoms, talk to a healthcare provider for an accurate diagnosis:

Sore throat or cough that doesn’t improve.
Voice changes, such as hoarseness, that don’t improve after two weeks.
Pain or other difficulties when you swallow.
Lump in your neck or throat.
Trouble making voice sounds (dysphonia).
Ear pain.

If you have these symptoms, seek medical attention right away:

Trouble breathing (dyspnea).
Breathing that’s noisy and high-pitched (stridor).
The feeling that something’s in your throat (globus sensation).
Coughing up blood (hemoptysis).

What causes laryngeal cancer?

Some forms of HPV (human papillomavirus), a sexually transmitted infection (STI), can cause laryngeal cancer.

You also have a much higher chance of developing it if you use tobacco or drink alcohol frequently.

What are the risk factors for laryngeal cancer?

Smoking or using other tobacco products greatly increases your risk of developing laryngeal cancer. Drinking alcohol, especially a lot of it (more than one drink daily) also raises your risk. And using alcohol and tobacco together increases your risk even more.

Other risk factors of laryngeal cancer include:

Age: Laryngeal cancer happens more in people age 55 and older.
Sex: Men and people assigned male at birth are about five times more likely to develop this cancer, possibly because smoking and heavy alcohol consumption happen more among this group.
History of head and neck cancer: About 1 in 4 (25%) people who have had head and neck cancer will get it again.
Job: People exposed to certain substances at work are at higher risk. These substances include sulfuric acid mist, wood dust, nickel, asbestos or manufacturing mustard gas. People who work with machines are also at higher risk of developing cancer in their larynx.

Diagnosis and Tests

How is laryngeal cancer diagnosed?

A healthcare provider will ask you about your symptoms and medical history. They’ll do a physical exam, examining your throat and neck. After the initial exam, you’ll most likely need other tests to confirm a diagnosis.

What tests help diagnose laryngeal cancer?

Diagnostic tests include:

Imaging scans: CT or MRI scans provide detailed images of the inside of your body. They can show a tumor’s size and where it’s located. A chest X-ray can show if cancer has spread to your lungs.
Laryngoscopy: During a laryngoscopy, a provider uses a thin, lighted tube called an endoscope to examine your larynx.
PET scan: During a PET scan, a provider injects a small, safe dose of a radioactive substance into your vein. The substance highlights areas with cancer cells.
Biopsy: During a biopsy, a provider removes a small piece of abnormal tissue from your larynx to examine under a microscope. A specialist called a pathologist will examine the cells and look for certain protein markers. Some types of cancer treatments only work on cancer cells with specific protein markers.

What are the stages of laryngeal cancer?

Part of a diagnosis involves staging the cancer. Your care team will figure out how severe the disease is — how far the tumor has grown and if and where it has invaded tissues in your body.

Stages of laryngeal cancer include:

Early laryngeal cancer: In stages 0, 1 and 2, the tumor is small. Cancer hasn’t spread beyond your larynx.
Advanced laryngeal cancer: In stages 3 and 4, the tumor has grown larger. It’s affected your vocal cords or invaded your lymph nodes or other areas of your body.

Where does laryngeal cancer spread first?

Laryngeal cancer that spreads beyond your larynx may invade your thyroid, windpipe (trachea), esophagus, tongue, lungs, liver and bones.

Management and Treatment

What is the treatment for laryngeal cancer?

Treatment for laryngeal cancer includes:

Radiation therapy: Radiation oncologists deliver high-energy radiation beams to kill cancer cells. The radiation targets only the tumor to minimize damage to surrounding healthy tissue.
Chemotherapy: Medical oncologists use medications to kill or slow the growth of cancer cells. People often get chemotherapy intravenously (through a vein). Chemo can cause side effects during treatment that a medical oncologist can help you manage.
Immunotherapy: This treatment uses your immune system, your body’s natural defenses, to help fight cancer. Immunotherapy is also called biologic therapy.
Targeted therapy: This treatment targets cancer cells with specific types of proteins, preventing the cells from multiplying.
Surgery: For early laryngeal cancer, surgery can remove the tumor while preserving your larynx (and your ability to speak and swallow). For advanced cancer, surgeons often need to do a laryngectomy, surgery that removes your entire larynx.

You may have more than one treatment. For example, people sometimes have chemotherapy or radiation therapy after surgery to destroy any remaining cancer cells.

What laryngeal surgery procedures are available?

Surgery removes cancer. The goal of laryngeal cancer surgery is to remove the tumor while preserving your larynx’s function. The surgeon may need to remove part or all of your larynx. Surgical procedures include:

Cordectomy: Removes part or all of a vocal cord, usually through your mouth.
Supraglottic laryngectomy: Removes the supraglottis (the upper part of your larynx), either through your neck or through your mouth.
Hemilaryngectomy: Removes half of your larynx, preserving your voice.
Partial laryngectomy: Removes part of your larynx so you retain your ability to talk.
Total laryngectomy: Removes your entire larynx, through your neck.
Thyroidectomy: Removes all or part of your thyroid gland.
Laser surgery: Removes a tumor in a bloodless procedure using a laser beam.

How does the care team figure out the best treatment for laryngeal cancer?

For early laryngeal cancer, your care team will likely recommend surgery or radiation therapy. Research has shown that both are effective. Your team will base the decision on several factors, including:

Which treatment will preserve your ability to speak and swallow.
Your preferences, wishes and ability to follow the treatment plan.
Your age.
Other conditions you may have.
Demands on your voice, including for your job.
How your voice sounds.
If you currently smoke or previously smoked.
Your ability to breathe.
Support from your loved ones.

Prevention

How can I prevent laryngeal cancer?

You can’t prevent all cancer. But you can lower your risk for developing cancer, including laryngeal cancer, with healthy behaviors:

Quit smoking and avoid tobacco products.
Limit alcohol consumption and get treatment for alcohol use disorder.
Eat a healthy diet.

Is there screening for laryngeal cancer?

There’s no regular screening test for laryngeal cancer. But talk to a healthcare provider if you have hoarseness, other voice changes or a persistent cough. Early detection catches cancer early, when it’s easiest to treat.

Outlook / Prognosis

What happens after laryngeal cancer treatment?

After your treatment, you’ll continue to have follow-up appointments with your healthcare provider to make sure you’re recovering well. Your provider will:

Treat any pain.
Help you manage swallowing problems or mucositis (ulcers in your digestive tract).
Discuss your diet to make sure you’re eating and swallowing with no problems.
Prescribe physical therapy for scarring in your neck or trouble opening your mouth.

What’s the outlook for people with laryngeal cancer?

Your outlook depends on several factors, such as your cancer’s stage, your age and overall health. Generally, early laryngeal has a better cure rate. Advanced cancer that spreads to other areas has a poorer survival rate.

But even advanced laryngeal cancer can be cured. If it comes back, it usually happens within the first two or three years after treatment. After five years, there’s a very low risk of cancer returning. But if you smoke or have alcohol use disorder and don’t stop using these substances, you’re at higher risk of developing new cancers in this region.

Will I have a stoma?

If you have a total laryngectomy, your surgeon will put a new airway in your throat called a stoma. The stoma helps you breathe. It may be permanent or temporary. To take care of your stoma:

Check it daily to make sure it’s clean and mucus-free.
Clean mucus from the stoma by coughing it out or using saline spray and cloth.
Keep it moist with saline spray.
Clean the stoma area with mild soap and water.
Don’t submerge the stoma in water.
Cover the stoma to keep dust out, using a scarf or a special stoma cover. And keep it covered when shaving or in the shower.

Living With

How do I take care of myself if I have a total laryngectomy?

If you smoke, it’s important to quit. Don’t smoke before or during treatment, and stay tobacco-free even after you finish treatment. People who smoke after treatment have a higher chance of developing another type of cancer. But people who stop smoking have a much lower risk of cancer. Smoking also prevents you from healing completely, and it may worsen treatment side effects.

Will I be able to use my voice after laryngeal cancer treatment?

If you had a total laryngectomy (surgeons removed your larynx), you’ll need to learn a new way to speak. A speech therapist can help. If the surgeon only removed part of your larynx, your voice may feel hoarse at first, but you’ll likely regain your voice. Still, it may feel and sound different from before.

Other treatments, like radiotherapy may cause you to lose your voice temporarily, but it usually returns once your larynx has had time to heal.

What questions should I ask my doctor?

If you’ve been diagnosed with laryngeal cancer, ask your healthcare provider: