Treatment by stage for laryngeal cancer

Stage 0 is really a pre cancerous stage. It is also called carcinoma in situ (CIS). The cancer cells are all contained in the top layer of the skin like covering of the larynx (the mucosa). It is unusual to have a larynx cancer diagnosed this early, as there are unlikely to be any symptoms at this stage.

If the affected area is very small, your doctor may completely remove it when a biopsy is taken. Or you may have laser treatment given by a flexible tube put down your throat, to kill off the affected cells.

It is possible for the abnormal cells to come back. If this happens, your doctor may suggest an endoscopic excision. This means putting a long rigid tube, with a camera and light inside it (an endoscope) down your throat. The surgeon uses surgical instruments or a laser through the endoscope to remove your cancer.

If the cancer cells come back again after this treatment, your doctor may suggest taking off all of the tissue (the mucosa) covering the affected vocal cord. Your surgeon may call this procedure stripping the mucosa. The surgeon will send all the removed tissue to the laboratory to make sure that a border of healthy tissue has also been removed. If the lab report says you have stage 0 laryngeal cancer, and there is a clear margin of healthy tissue surrounding the cancer, the affected area is gone. You may not need any more treatment. Radiotherapy can also be used instead of surgery to treat this stage of laryngeal cancer.

If there is no border of healthy cells after stripping the mucosa, this means there could be cancer cells left behind. Your specialist may suggest either further surgery to remove more tissue or a course of radiotherapy. If the cancer cells have started to grow down into the layer below, this becomes a stage 1 cancer and will need radiotherapy after the surgery.

You may have endoscopic laryngeal surgery or radiotherapy as your main treatment for stage 1 cancer of the larynx. With endoscopic surgery, you won't have a wound on your neck because the surgeon operates by putting a tube with a tiny, built in camera down your throat. If the cancer is in the area above your vocal cords, your surgeon will do everything possible to leave the vocal cords unharmed.

You may have radiotherapy to treat stage 2 laryngeal cancer. Or you may have the option of endoscopic laser surgery or a partial laryngectomy. If your doctors think there is any risk of the cancer coming back, they may suggest radiotherapy after your surgery 

If the cancer is in the area below the vocal cords, then you may have a total laryngectomy with radiotherapy afterwards. The radiotherapy lowers the risk of the cancer coming back. Or your doctor may treat you with radiotherapy alone.

Doctors usually treat stage 3 laryngeal cancer using radiotherapy with chemotherapy. Other treatment options may include

• Surgery to completely remove the larynx, followed by radiotherapy
• Radiotherapy, possibly with surgery afterwards
• Radiotherapy and biological therapy

Generally, if your cancer is a small T3 (less than 3 cubic centimetres) you will probably be able to have radiotherapy on its own, with the aim of keeping your larynx intact.

If your cancer is bigger than that, you will probably have to have a total laryngectomy and may need radiotherapy afterwards. 

If you are reasonably fit and have a cancer that is stage T2 or T3 your doctor may suggest radiotherapy with chemotherapy after surgery. This means that your cancer is still contained within the larynx. 

If a squamous cell cancer has spread into tissues close to the larynx and it cannot be removed, your doctor may recommend chemotherapy or biological therapy alongside radiotherapy. Research has shown that adding chemotherapy or biological therapy to radiotherapy can increase the chance of curing stage 3 laryngeal cancers.

Stage 4 means the cancer has spread. Treatment won't cure it but your doctor may suggest treatment to remove part of the tumour or to shrink and control the cancer for some time. With cancer of the larynx that has spread into the surrounding area, it is usual to have a laryngectomy to remove the cancer and surrounding lymph nodes, followed by radiotherapy. If you cannot have surgery for medical reasons, you may have radiotherapy with chemotherapy or biological therapy instead.

You may have radiotherapy and chemotherapy to shrink the cancer before you have surgery. Some people do not need surgery after this, so it can be kept in reserve in case the cancer comes back.

If you have cancer above your vocal cords it may be possible for you to have your larynx partly removed and then radiotherapy to treat any cancer cells left behind.

Your treatment depends on the treatment you had first time round. If the cancer comes back after radiotherapy, you will probably be asked to have a total laryngectomy.

If you had surgery the first time round, then you are most likely to have radiotherapy. You may have chemotherapy or biological therapy alongside radiotherapy.

You may have a fine needle aspiration (FNA) biopsy before you have treatment. This is because it can sometimes be difficult to tell if a new lump in the treatment area is scar tissue or a cancer that has come back.

This means treatment to control symptoms caused by a disease. Palliative treatment won't cure your cancer, but it may slow it down a bit. If your cancer has spread too far to be cured, or has come back after it was first treated, your doctor may suggest radiotherapy, chemotherapy, biological therapy or some combination of these. The aim of this treatment is to shrink the cancer and help to control the symptoms it causes.