Treatments used for laryngeal cancer

You will be looked after by a team of medical professionals looking at your test results and deciding together what they think are the best treatment options in your case. You may hear this called the multi disciplinary team (MDT). The team usually includes the following people

• Specialist head and neck surgeons
• Plastic surgeons
• Doctors who specialise in radiotherapy (clinical oncologists)
• Doctors who specialise in drug treatments for cancer (medical oncologists)
• Specialist head and neck cancer nurse
• Speech and language therapist
• Dietician
• Social worker

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. So for many people, the chance of cure will be the same whether you have surgery or radiotherapy. Some people like to have surgery because it is done in one go and they don't like the idea of a long course of radiotherapy treatment. For other people, it is more important to try to keep their voice box intact, or they may not want to have an anaesthetic. Everyone is different and so your doctors will discuss with you the treatment options in your case.

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 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

For small, early stage cancers of the larynx, you can have radiotherapy or surgery. This will cure most people with small tumours of the larynx. Radiotherapy is the most common treatment. 

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.

For small tumours, you may be able to have endoscopic surgery. This means surgery that is done down your throat, rather than having a cut (incision) in your neck. Laser surgery can be used for early stage cancers of the larynx. The surgeon uses a narrow, intense beam of light to cut out the cancer. The laser beam works like a surgical knife (scalpel). 

For larger tumours 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 be clearer than the hoarse voice you had 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 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 sure 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.

Biological therapies are treatments made from naturally occurring body substances. Or that change how certain substances work in the body. You may have a biological therapy called cetuximab (Erbitux)

• 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 information about biological therapies for cancer of the larynx in this section of CancerHelp UK.

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 doctors from the multidisciplinary team who specialise in different aspects of treatment. This could include specialist surgeons called head and neck surgeons, and cancer specialists (oncologists). You may also need help and support from other health specialists, such as a head and neck cancer clinical nurse specialist, dietician or speech and language therapist.

There are detailed sections about surgery, radiotherapy, chemotherapy and biological therapy for cancer of the larynx in CancerHelp UK.