Laryngeal Cancer Treatment

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).

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Laryngeal cancer forms in the tissues of the larynx (area of the throat that contains the vocal cords). The larynx includes the supraglottis, glottis (vocal cords), and subglottis. The cancer may spread to nearby tissues or to the thyroid, trachea, or esophagus. It may also spread to the lymph nodes in the neck, the carotid artery, the upper part of the spinal column, the chest, and to other parts of the body (not shown).

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 a person's chance of getting a disease is called a risk factor. Not every person with one or more of these risk factors will develop laryngeal cancer, and it will develop in people who don't have any known risk factors. 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 diagnose and stage laryngeal cancer.

In addition to asking about your personal and family health history, your doctor may perform the following tests and procedures:

• 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 in which the doctor checks the larynx (voice box) with a mirror or a laryngoscope to check for abnormal areas. A laryngoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the throat and voice box. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • 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.
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  Computed tomography (CT) scan of the head and neck. The patient lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.
  

• 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 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.

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 III

In stage III, cancer has formed in the supraglottis, glottis, or subglottis area of the larynx:

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Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).

In stage III cancer of the supraglottis:

• cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in one area of the supraglottis and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in more than one area of the supraglottis or has spread to the area at the base of the tongue or to tissues near the vocal cords. The vocal cords work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and 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 do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in one or both vocal cords and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer has spread to the supraglottis, subglottis, or both, and/or the vocal cords do not work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.

In stage III cancer of the subglottis:

• cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in the subglottis only. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer has spread to one or both vocal cords and the vocal cords may not work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.

After surgery, the stage of the cancer may change and more treatment may be needed.

If the cancer is removed by surgery, a pathologist will examine a sample of the cancer tissue under a microscope. Sometimes, the pathologist’s review will result in a change to the stage of the cancer and more treatment after surgery.

Laryngeal cancer can recur (come back) after it has been treated.

The cancer may come back in the larynx or in other parts of the body, such as lungs, liver, or bone. It is most likely to come back in the first 2 to 3 years.

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.

The following types of 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. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

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External-beam radiation therapy of the head and neck. A machine is used to aim high-energy radiation at the cancer. The machine can rotate around the patient, delivering radiation from many different angles to provide highly conformal treatment. A mesh mask helps keep the patient’s head and neck from moving during treatment. Small ink marks are put on the mask. The ink marks are used to line up the radiation machine in the same position before each treatment.

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.

Hyperfractionated radiation therapy may be used to treat laryngeal cancer. Hyperfractionated 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. Hyperfractionated 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.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This cancer treatment is a type of biologic therapy.

• PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Nivolumab and pembrolizumab are types of PD-1 inhibitors used to treat metastatic or recurrent laryngeal cancer.

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Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).

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.

Treatment for laryngeal cancer may cause side effects.

For information about side effects caused by treatment for cancer, visit 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.

As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated 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).

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