Laryngeal Cancer Health Article

Treatment team

An otolaryngologist and an oncologist (cancer specialist) generally lead the treatment team. They are supported by radiologists to interpret CT and MRI scans, a head and neck surgeon, and nurses with special training in assisting cancer patients.

A speech pathologist is often involved in treatment, both before surgery to discuss various options for communication if the larynx is removed, and after surgery to teach alternate forms of voice communication. A social worker, psychologist, or family counselor may help both the patient and the family meet the changes and challenges that living with laryngeal cancer brings.

At any point in the process, the patient may want to get a second opinion from another doctor in the same specialty. This is a common practice and does not indicate a lack of faith in the original doctor, but simply a desire for more information. Some insurance companies require a second opinion before surgery is done.

Clinical staging, treatments, and prognosis

Staging

Once cancer of the larynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. In cancer of the larynx, the definitions of the early stages depend on where the cancer started.

STAGE I.

The cancer is only in the area where it started and has not spread to lymph nodes in the area or to other parts of the body. The exact definition of stage I depends on where the cancer started, as follows:

• Supraglottis: The cancer is only in one area of the supraglottis and the vocal cords can move normally.
• Glottis: The cancer is only in the vocal cords and the vocal cords can move normally.
• Subglottis: The cancer has not spread outside of the subglottis.

STAGE II.

The cancer is only in the larynx and has not spread to lymph nodes in the area or to other parts of the body. The exact definition of stage II depends on where the cancer started, as follows:

• Supraglottis: The cancer is in more than one area of the supraglottis, but the vocal cords can move normally.
• Glottis: The cancer has spread to the supraglottis or the subglottis or both. The vocal cords may or may not be able to move normally.
• Subglottis: The cancer has spread to the vocal cords, which may or may not be able to move normally.

STAGE III.

Either of the following may be true:

• The cancer has not spread outside of the larynx, but the vocal cords cannot move normally, or the cancer has spread to tissues next to the larynx.
• The cancer has spread to one lymph node on the same side of the neck as the cancer, and the lymph node measures no more than 3 centimeters (just over 1 inch).

STAGE IV.

Any of the following may be true:

• The cancer has spread to tissues around the larynx, such as the pharynx or the tissues in the neck. The lymph nodes in the area may or may not contain cancer.
• The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches).
• The cancer has spread to other parts of the body.

RECURRENT.

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the larynx or in another part of the body.

Treatment

Treatment is based on the stage of the cancer as well as its location and the health of the individual. Generally, there are three types of treatments for cancer of the larynx. These are surgery, radiation, and chemotherapy. They can be used alone or in combination based in the stage of the caner. Getting a second opinion after the cancer has been staged can be very helpful in sorting out treatment options and should always be considered.

SURGERY.

The goal of surgery is to cut out the tissue that contains malignant cells. There are several common surgeries to treat laryngeal cancer.

Stage III and stage IV cancers are usually treated with total laryngectomy. This is an operation to remove the entire larynx. Sometimes other tissues around the larynx are also removed. Total laryngectomy removes the vocal cords. Alternate methods of voice communication must be learned with the help of a speech pathologist.

Smaller tumors are sometimes treated by partial laryngectomy. The goal is to remove the cancer but save as much of the larynx (and corresponding speech capability) as possible. Very small tumors or cancer in situ are sometimes successfully treated with laser excision surgery. In this type of surgery, a narrowly targeted beam of light from a laser is used to remove the cancer.

Advanced cancer (Stages III and IV) that has spread to the lymph nodes often requires an operation called a neck dissection. The goal of a neck dissection is to remove the lymph nodes and prevent the cancer from spreading. There are several forms of neck dissection. A radical neck dissection is the operation that removes the most tissue.

Several other operations are sometimes performed because of laryngeal cancer. A tracheotomy is a surgical procedure in which an artificial opening is made in the trachea (windpipe) to allow air into the lungs. This operation is necessary if the larynx is totally removed. A gastrectomy tube is a feeding tube placed through skin and directly into the stomach. It is used to give nutrition to people who cannot swallow or whose esophagus is blocked by a tumor. People who have a total laryngectomy usually do not need a gastrectomy tube if their esophagus remains intact.

RADIATION.

Radiation therapy uses high-energy rays, such as x rays or gamma rays, to kill cancer cells. The advantage of radiation therapy is that it preserves the larynx and the ability to speak. The disadvantage is that it may not kill all the cancer cells. Radiation therapy can be used alone in early stage cancers or in combination with surgery. Sometimes it is tried first with the plan that if it fails to cure the cancer, surgery still remains an option. Often, radiation therapy is used after surgery for advanced cancers to kill any cells the surgeon might not have removed.

There are two types of radiation therapy. External beam radiation therapy focuses rays from outside the body on the cancerous tissue. This is the most common type of radiation therapy used to treat laryngeal cancer. With internal radiation therapy, also called brachytherapy, radioactive materials are placed directly on the cancerous tissue. This type of radiation therapy is a much less common treatment for laryngeal cancer.

External radiation therapy is given in doses called fractions. A common treatment involves giving fractions five days a week for seven weeks. Clinical trials are underway to determine the benefits of accelerating the delivery of fractions (accelerated fractionation) or dividing fractions into smaller doses given more than once a day (hyperfractionation). Side effects of radiation therapy include dry mouth, sore throat, hoarseness, skin problems, trouble swallowing, and diminished ability to taste.

CHEMOTHERAPY.

Chemotherapy is the use of drugs to kill cancer cells. Unlike radiation therapy, which is targeted to a specific tissue, chemotherapy drugs are either taken by mouth or intravenously (through a vein) and circulate throughout the whole body. They are used mainly to treat advanced laryngeal cancer that is inoperable or that has metastasized to a distant site. Chemotherapy is often used after surgery or in combination with radiation therapy. Clinical trials are underway to determine the best combination of treatments for advanced cancer.

The two most common chemotherapy drugs used to treat laryngeal cancer are cisplatin and fluorouracil (5-FU). There are many side effects associated with chemotherapy drugs, including nausea and vomiting, loss of appetite (anorexia), hair loss (alopecia), diarrhea, and mouth sores. Chemotherapy can also damage the blood-producing cells of the bone marrow, which can result in low blood cell counts, increased chance of infection, and abnormal bleeding or bruising.

Prognosis

Cure rates and survival rates can predict group outcomes, but can never precisely predict the outcome for a single individual. However, the earlier laryngeal cancer is discovered and treated, the more likely it will be cured.

Cancers found in stage 0 and stage 1 have a 75% to 95% cure rate depending on the site. Late stage cancers that have metastasized have a very poor survival rate, with intermediate stages falling somewhere in between. People who have had laryngeal cancer are at greatest risk for recurrence (having cancer come back), especially in the head and neck, during the first two to three years after treatment. Check-ups during the first year are needed every other month, and four times a year during the second year. It is rare for laryngeal cancer to recur after five years of being cancer-free.

Alternative and complementary therapies

Alternative and complementary therapies range from herbal remedies, vitamin supplements, and special diets to spiritual practices, acupuncture, massage, and similar treatments. When these therapies are used in addition to conventional medicine, they are called complementary therapies. When they are used instead of conventional medicine, they are called alternative therapies.

Complementary or alternative therapies are widely used by people with cancer. One large study published in the Journal of Clinical Oncology in July, 2000 found that 83% of all cancer patients studied used some form of complementary or alternative medicine as part of their cancer treatment. No specific alternative therapies have been directed toward laryngeal cancer. However, good nutrition and activities that reduce stress and promote a positive view of life have no unwanted side effects and appear to be beneficial in boosting the immune system in fighting cancer.

Unlike traditional pharmaceuticals, complementary and alternative therapies are not evaluated by the United States Food and Drug Administration (FDA) for either safety or effectiveness. These therapies may have interactions with traditional pharmaceuticals. Patients should be wary of "miracle cures" and notify their doctors if they are using herbal remedies, vitamin supplements or other unprescribed treatments. Alternative and experimental treatments normally are not covered by insurance.