Chemotherapy (chemo) uses anti-cancer drugs that are injected into a vein or given by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment potentially useful for cancers that have metastasized (spread) to organs beyond the head and neck.
Chemo may be used in different situations for laryngeal and hypopharyngeal cancers.
- It is often given along with radiation as the main treatment for more advanced cancers of the larynx. This treatment, called chemoradiation, can allow some patients to avoid laryngectomy and retain the ability to speak.
- It may be used (as part of chemoradiation) after a cancer is removed with surgery, to try to kill any small areas of cancer that may remain and lower the chance the cancer will come back. This is called adjuvant treatment.
- Chemotherapy is also sometimes used to help relieve symptoms from cancers that are too large or have spread too far to be completely removed with surgery.
Conventional chemotherapy
Standard chemo drugs work by attacking cells that are dividing quickly, including cancer cells. The chemo drugs used most often for cancers of the larynx and hypopharynx include:
- Cisplatin
- Carboplatin
- 5-fluorouracil (5-FU)
- Docetaxel (Taxotere®)
- Paclitaxel (Taxol®)
- Bleomycin
- Methotrexate
- Ifosfamide
Depending on the situation (including the extent of the cancer, the person's overall health, and whether chemo is combined with radiation therapy), these drugs may be used alone or they may be combined with 1 or 2 other chemo drugs.
Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Each chemotherapy cycle typically lasts for a few weeks.
Possible side effects
Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemo, which can lead to side effects. Side effects depend on the specific drugs used, their dose, and the length of treatment. Common side effects of chemo include:
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Mouth sores
- Diarrhea
- An increased chance of infection (from a shortage of white blood cells)
- Problems with bleeding or bruising (from a shortage of blood platelets)
- Fatigue or shortness of breath (from low red blood cell counts)
Along with the risks above, some side effects are seen more often with certain chemo drugs. For example, 5-FU often causes diarrhea. Cisplatin can cause nerve damage (called neuropathy), leading to hearing loss as well as numbness and tingling in the hands and feet. This often improves once treatment is stopped, but it can persist a long time in some cases.
Although most side effects improve once treatment is stopped, some can last a long time or even be permanent. If your doctor plans treatment with chemo you should be sure to discuss the drugs that will be used and the possible side effects. Once chemo is started, let your health care team know if you have side effects, so they can be treated. There are ways to prevent or treat many of the side effects of chemotherapy. For example, many good drugs are available to help prevent or treat nausea and vomiting.
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