Treating Laryngeal and Hypopharyngeal Cancers by Stage
Most of the time, the treatment of laryngeal or hypopharyngeal cancer is based on its stage – how far it has spread in the body. But other factors, such as your overall health, may also affect treatment options. Talk to your doctor if you have any questions about the treatment plan he or she recommends.
These cancers are almost always glottic (vocal cord) cancers that are found early because of voice changes. They are nearly always curable with either vocal cord stripping, laser surgery, or radiation therapy. The patient is then watched closely to see if the cancer returns. If the cancer comes back after stripping or laser surgery, radiation can be used.
Almost all people at this stage can be cured without extensive surgery. But it is important for them to realize that if they smoke, continuing to do so increases the risk that a new cancer will develop.
Stage I and II laryngeal cancers
Most people with stage I and II laryngeal cancers can be treated successfully without totally removing their larynx.
Either radiation alone (without surgery) or partial laryngectomy can be used in most people. Voice results tend to be better with radiation therapy than with partial laryngectomy, and the complication rate tends to be lower for radiation treatment. Many doctors use radiation therapy for smaller cancers, only using surgery for cancers that come back after treatment.
The treatment for glottic (vocal cord) cancers and supraglottic cancers (those starting above the vocal cords) is slightly different.
Some early glottic cancers may be treated by removing the cancerous vocal cord, or even by laser surgery. Radiation or surgery is usually enough to treat most glottic cancers unless there are signs that the treatment might not have cured the cancer (such as finding cancer cells at the edge of the surgery specimen). If you need further treatment after surgery, your options might include radiation therapy, chemoradiation, or more extensive surgery.
Supraglottic cancers are more likely to spread to the neck lymph nodes, so the nodes are often treated as well. If you are having surgery for your tumor, then the surgeon will also probably remove lymph nodes from your neck. If your treatment is radiation therapy alone, you will also get radiation to the lymph nodes in the neck. If, after surgery, the cancer is found to have features that make it more likely to come back, further treatment such as radiation therapy, chemoradiation, or more extensive surgery may be recommended.
Stage III and IV laryngeal cancers
The main options for initial treatment are surgery or chemotherapy with radiation. Radiation therapy alone (or with the targeted drug cetuximab/Erbitux) may be an option for people who cannot tolerate more intensive treatments.
Surgery for these tumors is almost always complete removal of the larynx (total laryngectomy), but a small portion of these cancers may still be treated by partial laryngectomy.
These cancers have a higher risk of spreading to nearby lymph nodes in the neck than earlier-stage cancers, so these lymph nodes are often removed along with the tumor if surgery is being done. Radiation therapy, often given with chemo, may be needed after surgery, particularly if the cancer has spread to the lymph nodes or has other features that make it more likely to come back.
Instead of using surgery as the first step, many doctors now prefer to start treatment with chemoradiation (radiation and chemotherapy given together). If any cancer remains after treatment, surgery can then be done to try to remove it. This treatment can be hard to take, but it works as well as total laryngectomy in treating the cancer, while giving a 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, the best treatment approach may be surgery to remove the larynx.
Another option may be to start with chemotherapy alone, which also is known as induction chemotherapy. If the tumor shrinks, radiation therapy or chemoradiation is then given. If the tumor doesn’t shrink, surgery is usually the next treatment. But because some studies have shown better results when radiation is part of the initial treatment, not all doctors agree with the approach of starting with chemotherapy alone.
Cancers that are too large or have spread too far to be completely removed by surgery are often treated with radiation, usually combined with chemotherapy or the targeted drug cetuximab (Erbitux). Sometimes, if the tumor shrinks enough, surgery of lymph nodes in the neck may be an option. But for many advanced cancers, the goal of treatment is often to stop or slow the growth of the cancer for as long as possible and to help relieve any symptoms it may be causing.
These cancers are often harder to treat than laryngeal cancers. Because they do not cause symptoms early, most are already at an advanced stage when they are diagnosed. Tumors in this region also have a high likelihood of spreading to the lymph nodes, even when there is no obvious mass in the neck. Because of this risk, treatment of the lymph nodes in the neck is often recommended.
Stage I hypopharyngeal cancers
Surgery includes removing all or part of the pharynx (throat) as well as lymph nodes on both sides of the neck. The larynx often needs to be removed as well. People who have a high chance of the cancer returning (based on what is found during surgery) may then be treated with radiation or chemotherapy combined with radiation (chemoradiation).
Some patients with small tumors may get radiation as their main treatment. The cancer is assessed again after the treatment is complete and if there is any cancer remaining, surgery is done.
Stages II, III, and IV hypopharyngeal cancers
There are 3 main options to treat these cancers.
The first is surgery to remove the pharynx, larynx, and lymph nodes in the neck. This is usually followed by radiation alone or radiation with chemo, especially if there is a high chance of the cancer returning (based on what is found during surgery).
Another option is to be treated first with both radiation and the chemo drug cisplatin (chemoradiation). If any cancer remains after treatment, surgery can then be done to try to remove it.
The third option is to get chemotherapy as the first treatment, also known as induction chemotherapy. This is usually followed by radiation therapy or chemoradiation, depending on how much the tumor shrinks. If the tumor does not shrink, surgery might be done. If the lymph nodes in the neck remain enlarged after treatment, they can be removed with a lymph node dissection.
Cancers that are too large or have spread too far to be completely removed by surgery are often treated with radiation, usually combined with chemo or cetuximab. Sometimes, if the tumor shrinks enough, surgery of lymph nodes in the neck may be an option. But for many advanced cancers, the goal of treatment is often to stop or slow the growth of the cancer for as long as possible and to help relieve any symptoms it may be causing.
Last Medical Review: April 8, 2014 Last Revised: August 8, 2016
- Surgery for Laryngeal and Hypopharyngeal Cancers
- Radiation Therapy for Laryngeal and Hypopharyngeal Cancers
- Chemotherapy for Laryngeal and Hypopharyngeal Cancers
- Targeted Therapy for Laryngeal and Hypopharyngeal Cancers
- Treating Laryngeal and Hypopharyngeal Cancers by Stage
- Treating Recurrent Laryngeal and Hypopharyngeal Cancers