Laryngeal cancers

Stage 0

This stage is highly curable with either stripping to surgically remove the abnormal layer of cells or vaporizing the abnormal cell layer with a laser beam. The patient is then watched closely to see if the cancer returns.

If the cancer comes back, radiation will be used. Between 96% and 100% of patients at this stage will not need extensive surgery. It is important for these patients to realize that continuing to smoke increases the risk that a new cancer will develop.

Stages I and II laryngeal cancers

Most patients with stage I and II laryngeal cancer can be successfully treated without totally removing their larynx. Radiation alone (without surgery) is successful in treating 80% to 90% of patients with stage I laryngeal cancer and 70% to 80% of stage II patients.

Partial laryngectomy may also be used with similar survival results. However, voice results tend to be better with radiation therapy than with partial laryngectomy, and the complication rate for surgery tends to be greater than for radiation treatment alone. Many doctors choose to use radiation therapy for smaller cancers, only using surgery for cancers that come back after treatment. In either case, the treatment not chosen at first may be used later if initial treatment fails.

Selected superficial glottic cancers may be treated by removing the cancerous vocal cord, or even by laser excision.

Supraglottic cancers tend to spread to the neck lymph nodes. If you are having surgery for your tumor, then the surgeon will also likely remove lymph nodes from your neck. If your treatment is to be radiation therapy, you will also receive radiation therapy to your neck.

Stages III and IV laryngeal cancers

Stages III and IV laryngeal cancers generally require combined therapy of either surgery and radiation, or radiation and chemotherapy, or all 3 types of treatment. Surgical treatment of these tumors almost always requires complete removal of the larynx, although a small group of T3 laryngeal cancers may still be treated by partial laryngectomy.

More advanced stage cancers have a higher risk for spread to nearby lymph nodes. These lymph nodes are often removed along with the tumor if surgery is being used to treat the cancer. Radiation therapy, often given with chemo, may be required after surgery, particularly if there is lymph node metastasis.

Instead of using surgery as the first step, many doctors now prefer to start treatment with radiation and chemotherapy. Surgery can then be done to remove any remaining cancer. This approach works as well as surgery alone to treat the cancer, but it gives the patient the chance to save the larynx. If the framework of the larynx (such as the thyroid cartilage) has been destroyed by the cancer, the larynx may never work normally again – no matter what treatment is chosen. In these cases, surgery to remove the larynx may be the best treatment approach.

Cancers that are too large to be completely removed by surgery are often treated with radiation, usually combined with chemotherapy. Several studies continue to look at various methods of combined radiation and chemotherapy to improve outcomes and reduce the need for radical resection of advanced laryngeal cancer.

Hypopharyngeal cancers

These are more difficult to treat than laryngeal cancers. Because they do not cause symptoms early, most are diagnosed in an advanced stage. Tumors in this region have a high likelihood of lymph node metastasis, even when there is no obvious mass in the neck. Because of this risk, radiation therapy of the neck is recommended for patients who have had their hypopharyngeal cancer removed by surgery.

Stages I and II hypopharyngeal cancers

The 2 main options for treating small tumors are radiation and surgery. Larger tumors are treated with surgery.

Surgery would include removing all or part of the pharynx and lymph nodes in the neck. The larynx is sometimes removed as well. Patients who have a high chance of the cancer returning (based on the what is found during surgery) may then be treated with radiation or chemoradiation.

Patients who receive radiation as their main treatment will be assessed after the treatment is complete. If there is still cancer in the hypopharynx, surgery will be done.

Stages III and IV hypopharyngeal cancers

These can be treated with extensive surgery followed by radiation alone or chemoradiation. Another choice is to give chemotherapy as the first treatment. If the cancer goes away with chemo, radiation therapy is given. Lymph nodes in the neck may be removed after radiation. If the tumor shrinks without going away, the patient may receive chemoradiation or treatment with surgery. Further treatment depends upon the results of the prior therapy.

Recurrent laryngeal and hypopharyngeal cancers

Cancer is called recurrent when it come backs after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). Treatment options for patients whose laryngeal or hypopharyngeal cancers come back after treatment depend on what their initial treatment was and on the location of the recurrent cancer (local recurrence or distant recurrence).

Local recurrences in patients who have already had partial laryngectomy can be treated with total laryngectomy or with radiation therapy. If your cancer comes back locally after radiation therapy, the usual treatment is total laryngectomy, but additional radiation therapy is sometimes used. Chemotherapy (perhaps in a clinical trial) is the usual treatment for distant recurrences and for local recurrences that have not responded to combined radiation therapy and surgery.

Last Medical Review: 05/07/2009
Last Revised: 05/07/2009