Treatments used for laryngeal cancer
This page tells you about the treatments you may have for laryngeal cancer. You can go to information about
Treatments used for laryngeal cancer
A multidisciplinary team (MDT) of medical professionals will decide on the best treatment options for you. The team will discuss the risks and benefits of the different options with you. For early stage cancers of the larynx, the outcomes of surgery and radiotherapy are very similar.
You may have radiotherapy for any stage of cancer of the larynx. Radiotherapy will cure most people with small tumours of the larynx. For larger squamous cell cancers that can't be removed your doctor may recommend radiotherapy with biological therapy or chemotherapy.
Surgery may be laser treatment through the mouth via an endoscope. Or it may be open surgery via an incision in the neck. You may have your larynx partially or completely removed (laryngectomy). If you have the whole larynx removed, you will not be able to speak normally afterwards. There are a number of ways to overcome this. You will also have at least some of the lymph nodes in the area removed.
Chemotherapy or biological therapy
Depending on the size of your tumour, you may have chemotherapy and radiotherapy at the same time. This is called chemoradiation. Chemotherapy may be used to shrink an advanced cancer before surgery or radiotherapy – this is called induction therapy. You may then have more chemotherapy and radiotherapy. For squamous cell cancers that have come back after treatment or have spread to other parts of the body you may have chemotherapy combined with biological therapy as part of clinical trials.
You can view and print the quick guides for all the pages in the Treating laryngeal cancer section.
The main treatments for cancer of the voice box are radiotherapy or surgery. You may also have chemotherapy.
For both early stage and locally advanced cancers of the larynx, you can have radiotherapy or surgery.
You may have both radiotherapy and surgery. Radiotherapy can shrink a large tumour in the larynx and make it easier to remove. Or it can kill off any cancer cells that might have been left behind after surgery. This lowers the risk of the cancer coming back.
Radiotherapy may be used to treat the lymph nodes after surgery, if there is a risk these may contain cancer cells. This may be instead of lymph node dissection.
You may be able to have surgery through the mouth (trans-oral laser surgery). The surgeon uses a narrow, intense beam of light to cut out the cancer. The laser beam works like a surgical knife (scalpel). Laser surgery can be used for both early stage and more advanced cancers of the larynx. This may depend on the position of the tumour in the larynx. For small, early stage cancers you may be able to have laser treatment as day surgery.
Open surgery means having a cut (incision) in your neck. If possible you may be able to have a partial laryngectomy. The aim is to conserve your ability to speak and swallow. If a partial laryngectomy is not possible you may have your larynx completely removed. This is called total laryngectomy. If you have the whole larynx removed, you will not be able to speak normally afterwards. There are a number of different ways to overcome this. If you have a valve (voice prosthesis) put in, your voice may sound clearer than before your operation. You will also have to have a stoma. This is a hole in your neck, made so that you can breathe after you've had your larynx removed. Sometimes this is only temporary after laryngeal surgery, but if you have had your larynx removed the stoma is permanent.
If you have open surgery, your surgeon will examine the larynx and surrounding area during your operation. At least some of the lymph nodes will be removed from around your larynx. This is called neck dissection.
Your surgeon removes the lymph nodes because they may contain cancer cells that have broken away from the main cancer. A pathologist checks the nodes for cancer cells under a microscope. This helps your doctors to work out the stage of your cancer.
If any of your lymph nodes are enlarged and your surgeon is concerned that they contain cancer, your surgeon will remove them, together with all the nodes nearby. You may need to have all the nodes on one side of your neck removed. It reduces the risk of your cancer coming back in the future. But can cause stiffness and weakness of the shoulder.
You may have chemotherapy and radiotherapy at the same time to treat a T2 or T3 cancer. This is called chemoradiation. Or you may have chemotherapy if your cancer of the larynx has come back after radiotherapy. Chemotherapy may be used to shrink an advanced cancer before surgery or radiotherapy – this is called induction therapy.
Each person's tumour has specific biological characteristics which can make the cancer grow. Biological therapies are treatments that can target these characteristics. They can stop the cancer cell from growing and dividing. You may have a biological therapy called cetuximab (Erbitux). You might have cetuximab in the following ways
- Alongside radiotherapy for locally advanced squamous cell laryngeal cancer
- In clinical trials in combination with platinum based chemotherapy for squamous cell cancer that has come back or has spread to other parts of the body
There is a section about biological therapies for cancer of the larynx.
You will be looked after by a team of medical professionals they will work together to decide on the best treatment options for you. You may hear this called the multi disciplinary team (MDT). The team usually includes the following people
- Specialist head and neck surgeons
- Doctors who specialise in radiotherapy and drug treatments for cancer (clinical oncologists)
- Specialist head and neck cancer nurse
- Speech and language therapist
- Social worker
The team will discuss the risks and benefits of the different options with you. You may be able to choose between trans-oral laser surgery, (also called endoscopic resection), or radiotherapy. The outcomes of this type of surgery and radiotherapy are very similar. Some people like to have surgery because it is done in one go. They don't like the idea of radiotherapy treatment 5 days a week for several weeks. Others may prefer radiotherapy which does not require a general anaesthetic. Everyone is different and so your doctors will discuss the treatment options with you.
For more advanced cancer of the larynx the first line of treatment may be a partial laryngectomy, or a combination of radiotherapy and chemotherapy. Both of these treatment options aim to give the best chance of cure as well as preserving the voice box and a normal airway. But for some people the best treatment option is to have a total laryngectomy.
The earlier laryngeal cancer is diagnosed, the easier it is to get it under control and possibly cure it. Your doctors will plan your treatment according to
- The type and position of laryngeal cancer you have
- Whether the cancer has spread (the stage)
- What the cells look like under the microscope (the grade)
- Your general health
In some situations, you may not have a choice of treatment. It may be clear which treatment will work best. For example, your specialist may advise that surgery is best, because of the stage or position of your cancer. But you may be given a choice, especially if you have a small, early tumour. Radiotherapy can work as well as surgery for early stage cancer of the larynx. Radiotherapy used to be better than surgery at giving you a good voice. But with newer surgical techniques, voice quality is very good for early stage cancers.
You may have a combination of treatments. And you may need to see a variety of people from the multidisciplinary team who specialise in different aspects of treatment.
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