This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

There is a lot for you to think about when choosing the best way to treat or manage your cancer. Often there is more than one treatment to choose from. Take time to think about all of the choices. Two things to consider are the type of cancer and the stage (extent) of the cancer. But your age, your overall health, and your own preferences are also important.

It's often a good idea to get a second opinion, perhaps from a doctor who has treated this type of cancer. A second opinion can give you more information and help you feel better about the treatment plan you choose.

The main types of cancer treatment

The 3 main types of treatments for these cancers are:

• surgery
• radiation
• chemotherapy

Sometimes 2 or more of these treatments are used together. If it doesn't look like the cancer can be cured, the goal of treatment might be to remove or destroy as much of the cancer as possible to delay its spread or return.

If at all possible, the doctor will try to save your larynx and voice. Most experts do not recommend removing the larynx unless there are no other options. People who lose their voice can feel depressed and lonely.

Sometimes treatment is aimed at relieving symptoms. This is called palliative treatment.

Surgery

There are many kinds of surgery used to treat these cancers. Some may remove the cancer. Others help restore the look and function of the head and neck.

Vocal cord stripping: To do this, the doctor uses a long tool to strip away the cancer in the top layers of tissue of the vocal cords. Very early (stage 0 or CIS) cancers are sometimes treated this way. Most people can speak normally again after this operation.

Laser surgery: Lasers can be used to treat some early cancers. An endoscope is used to find the tumor which is then burned or cut out with a laser. If the laser is used to remove part of a vocal cord, it may result in hoarse speech.

Cordectomy: This surgery involves removing all or part of the vocal cords. Taking out part of a vocal cord may result in hoarse speech. Normal speech is no longer possible after both vocal cords are removed.

Partial laryngectomy: Smaller cancers of the larynx can often be removed without taking out the entire voice box. The goal is to leave as much of the voice box as possible while removing the cancer. For small cancers of the vocal cords, the surgeon may be able to remove the cancer by taking out only one vocal cord and leaving the other behind. This allows for some speech to remain.

Total laryngectomy: This surgery involves taking out the whole voice box. The windpipe must be brought up to the front of the neck as a hole (stoma). The person then breathes through this stoma. (See the picture below.) Once the larynx is removed, normal speech is no longer possible.

Possible problems after this surgery include bleeding, development of a fistula (an abnormal opening), development of a narrowing (stricture), and having food or liquid enter the lungs (aspiration).

Illustrations by permission of the Mayo Foundation. From "Looking Forward...A Guidebook for the Laryngectomee" by R.L. Keith, et al, New York, Thieme-Stratton, Inc. and copyrighted by the Mayo Foundation, 1984.

Total or partial pharyngectomy: This surgery is done for cancers of the hypopharynx. All or part of the hypopharynx is removed. The larynx is often removed, too. Surgery may be needed to rebuild the throat. This will help the patient to swallow after the operation.

Reconstructive flap surgeries: These surgeries are used to rebuild the throat after the cancer has been removed. Sometimes a muscle and area of skin may be moved from an area close to your throat, such as the chest, to rebuild the throat after surgery. Tissues from other parts of the body such as a piece of intestine or a piece of arm muscle may also be used to replace parts of your throat.

Neck dissection: Because these cancers often spread to the lymph nodes in the neck, these lymph nodes may need to be removed. This is called a "neck dissection." The amount of tissue to be removed depends on the size of the cancer and how much it has spread.

Tracheotomy: If a tumor is too large to remove or is blocking the windpipe, an opening may be made in the neck to allow you to breathe. The new opening is called a tracheotomy.

Gastrostomy tube (G-tube or feeding tube): Surgery may also be done to help you get the nutrition you need. A patient who cannot swallow enough food may need a feeding tube placed through the skin in the belly (abdomen) directly into the stomach. The feeding tube might be removed if you can swallow and eat well after treatment.

Radiation therapy

Radiation therapy is treatment with high energy rays (such as x-rays) to kill cancer cells or shrink tumors. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor.

External radiation is often the main treatment for laryngeal and hypopharyngeal cancer. It may be used instead of surgery for small cancers that can be destroyed without surgery. It is also used for patients whose health does not permit them to have surgery. Often chemo is given with the radiation.

Treatment is usually given daily, 5 days per week, for about 7 weeks. Other schedules for treatment are being studied.

Radiation can also be used after surgery to kill cancer cells that may have been left behind. Radiation can be used to ease symptoms such as pain, bleeding, and swallowing problems, too. It can be used to ease problems caused by cancer that has spread to bones.

Side effects of radiation

Many people treated with radiation to the neck and throat area have problems with painful sores in the mouth and throat. These sores can make eating and drinking very hard, and can lead to weight loss. The sores heal with time after the radiation has stopped.

Side effects from radiation can also include:

• skin problems
• dry mouth (which can lead to problems with tooth decay)
• sore throat
• hoarseness
• trouble swallowing
• decreased sense of taste
• breathing problems from swelling of the larynx
• tiredness

Most of these side effects go away after treatment is over. Talk to your doctor or nurse if you are having trouble with any side effects. There are often ways to help.

Radiation can worsen any tooth problems that you might already have. Depending on the radiation plan and the health of your teeth, some or all of them may have to be taken out.

Radiation aimed near the salivary glands may cause long-term damage, leading to dry mouth that does not get better with time. A dry mouth can also cause tooth decay. People with dry mouth after radiation must be very careful about their oral health.

Chemotherapy

Chemotherapy (or chemo) is the use of drugs to kill cancer cells. Usually the drugs are given into a vein or by mouth. Once the drugs enter the bloodstream, they spread throughout the body.

Chemo is useful in treating cancer that has spread to organs beyond the head and neck. It has also been used to ease symptoms of tumors that are too large to be completely removed and tumors that radiation treatment has not been able to control. Many doctors now recommend chemo along with radiation as the main treatment for large larynx cancer instead of laryngectomy (see below).

Chemo can have some side effects. These side effects will depend on the type of drugs given, the amount taken, and how long treatment lasts. Common side effects are:

• nausea and vomiting
• loss of appetite
• hair loss
• mouth sores
• a higher chance of infection (from a shortage of white blood cells)
• bleeding or bruising after minor cuts or injuries (caused by a shortage of blood platelets)
• shortness of breath
• tiredness (from low red blood cell counts or from other things)

Most side effects go away after treatment ends. Anyone who has problems with side effects should talk with their doctor or nurse, as there are often ways to help.

Targeted therapy

Targeted therapy is term used for drugs that are aimed at certain parts of the cancer cell that are needed for a cancer to grow. Targeted cancer therapies do not damage bone marrow or blood cells like most standard chemo drugs do. They can be used alone or along with other drugs and cancer treatments. Targeted therapy is still fairly new compared to other forms of cancer treatment.

Cetuximab (Erbitux^®) is the first targeted therapy approved for use in laryngeal and hypopharyngeal cancers. When cetuximab was added to radiation treatment, it helped patients with advanced cancers live longer. This drug does not cause problems with nausea, vomiting, or low blood counts like regular chemo drugs. The most common side effects of cetuximab are skin rash and more rarely, problems from allergic reactions that occur while the drug is being given into the vein.

Studies of other targeted therapy drugs to treat laryngeal and hypopharyngeal cancers are going on now.

Chemo with radiation therapy (chemoradiotherapy)

Chemo given at the same time as radiation can shrink tumors better than either treatment alone. Studies are going on to find out whether this combination can control advanced disease that is confined to the head and neck area. This treatment may help people avoid operations that cause loss of natural speech.

Last Medical Review: 05/27/2009
Last Revised: 05/27/2009