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Laryngeal and Hypopharyngeal Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find some basic information about these diseases and the parts of the body they may affect. This is the first page of Cancer.Net’s Guide to Laryngeal and Hypopharyngeal Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

About the larynx

The larynx, commonly called the voice box, is a tube-shaped organ in the neck. It is located at the top of the windpipe or trachea. The front walls protrude from the neck to form what most people call the Adam’s apple.

The larynx is important for breathing, talking, and swallowing. It contains the vocal folds (vocal cords) that vibrate to make sound for speech production. During breathing, the larynx opens like a valve to allow air to pass into the lungs. During swallowing, the vocal folds come together and, with a flap of tissue called the epiglottis, protect the airway and prevent food from entering to the lungs.

There are three parts of the larynx:

  • Glottis. The middle section that holds the vocal folds.

  • Supraglottis. The area above the vocal folds.

  • Subglottis. The area below the vocal folds that connects the larynx to the windpipe.

About the hypopharynx

The hypopharynx, also called the gullet, is the lower part of the throat. It surrounds the larynx. The pharynx, more commonly known as the throat, is a hollow tube about five inches long that starts behind the nose (nasopharynx) and ends at the level of the larynx (laryngopharynx). The pharynx leads into the esophagus, which is the tube that goes to the stomach.

About cancer in the larynx or hypopharynx

Cancer can develop in any part of the larynx or hypopharynx. Cancer begins when healthy cells change and grow uncontrollably, forming a mass called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.

About 95% of all cancers of the larynx and hypopharynx are categorized as squamous cell carcinomas. This means they began in the flat, squamous cells that form the linings of these organs.

Normal Larynx

Normal Larynx Tissue
Click to Enlarge

Larynx - Squamous Cell Carcinoma

Larynx - Squamous Cell Carcinoma
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These images used with permission by the College of American Pathologists.

Laryngeal and hypopharyngeal cancers are two of the main types of cancer in the head and neck region, a grouping called head and neck cancer. This section covers both laryngeal cancer and hypopharyngeal cancer because treatments are often similar; however, these are two separate types of cancer. Go to the Medical Illustrations page to see a drawing of these structures.

Looking for More of an Overview?

If you would like additional introductory information, explore these related items. Please note these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics, and it helps explain how many people are diagnosed with these types of cancer and general survival rates. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find information about how many people are diagnosed with these types of cancer each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Laryngeal cancer

Laryngeal cancer is one of the most common types of head and neck cancer. This year, an estimated 13,430 adults (10,550 men and 2,880 women) in the United States will be diagnosed with laryngeal cancer.

It is estimated that 3,620 deaths (2,890 men and 730 women) from this disease will occur this year.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for laryngeal cancer depends on the location of the cancer (glottis, supraglottis, or subglottis, as explained in the Overview section) and the stage.

  • Glottis. Survival rates for people with cancer in the glottis range from 90% when the cancer is found at the earliest stage to 44% in the most advanced stage, when the cancer has spread to other parts of the body.

  • Supraglottis. For cancer in the supraglottis, the rates are 59% for the earliest stage to 34% for the most advanced stage.

  • Subglottis. For cancer in the subglottis, survival rates range from 65% at the earliest stage to 32% at the most advanced stage.

Hypopharyngeal cancer

Each year, an estimated 3,400 adults (2,725 men and 675 women) in the United States will be diagnosed with hypopharyngeal cancer.

Survival rates for hypopharyngeal cancer vary based on a variety of factors, particularly the stage. If the cancer is found at an early, localized stage, the 5-year survival rate of people with hypopharyngeal cancer is 53%. If the cancer has spread to nearby areas and/or lymph nodes (stages II and III), the 5-year survival rate is 36% to 39%. If the cancer has spread to distant parts of the body, the 5-year survival rate is 24%.

It is important to remember that statistics on how many people survive these cancers are an estimate. The estimate comes from data based on thousands of people with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long anyone will live with laryngeal or hypopharyngeal cancer. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s (ACS) publication, Cancer Facts & Figures 2016, and the ACS website.

Laryngeal and Hypopharyngeal Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find a basic drawing of the main body parts affected by these cancers. To see other pages, use the menu on the side of your screen.

 

For medical illustrations showing the different stages of laryngeal and hypopharyngeal cancer, please visit the Stages and Grades section.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing these cancers and what people can do to lower their risk. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Laryngeal and Hypopharyngeal Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find out more about the factors that increase the chance of developing these types of cancer and what people can do to lower their risk. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

These two factors greatly increase the risk of developing laryngeal and hypopharyngeal cancer:

  • Tobacco. Use of tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor for head and neck cancer. Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Secondhand smoke may also increase a person’s risk.

  • Alcohol. Frequent and heavy consumption of alcohol increases the risk of both laryngeal and hypopharyngeal cancer. Using tobacco and alcohol together increases this risk even more.

Other factors that can raise a person’s risk of developing laryngeal and hypopharyngeal cancer include:

  • Gender. Men are four to five times more likely than women to develop laryngeal and hypopharyngeal cancer.

  • Age. People over 55 are at higher risk, although younger people may also develop these types of cancer.

  • Race. Black and white people are more likely to develop laryngeal and hypopharyngeal cancer than Asian Americans and Hispanic Americans.

  • Occupational inhalants. Exposure to asbestos, wood dust, paint fumes, and certain chemicals may increase a person’s risk of developing laryngeal and hypopharyngeal cancer.

  • Poor nutrition. A diet low in vitamins A and E can raise a person’s risk of laryngeal and hypopharyngeal cancer. Foods that are rich in these vitamins may help prevent the disease.

  • Gastroesophageal reflux disease (GERD). Chronic reflux of stomach acid into the larynx and pharynx may be associated with laryngeal and hypopharyngeal cancer. However, no specific causal relationship has been shown. This may or may not be associated with the symptoms of heartburn.

  • Plummer-Vinson syndrome. This rare condition involves iron deficiency and causes difficulty swallowing. The presence of this disease increases the risk of hypopharyngeal cancer.

  • Poor oral hygiene. Poor care of one’s teeth by not brushing regularly and using dental floss, can increase the risk of head and neck cancer. Dental checkups twice each year are recommended for all people at risk for these types of cancer.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause these types of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Stopping the use of tobacco products is the most important thing a person can do, even for people who have been smoking for many years. Talk with your doctor for more information about your personal risk of cancer.

The next section in this guide is Screening, and it explains how tests may find cancer before signs or symptoms appear. Or, use the menu on the side of your screen to choose another section to continue reading this guide. 

Laryngeal and Hypopharyngeal Cancer - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find out more about how people may be screened for this type of cancer, including risks and benefits of screening. To see other pages, use the menu on the side of your screen.

Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer before signs or symptoms appear. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for laryngeal and hypopharyngeal cancer

People who use alcohol and tobacco should receive a general screening examination at least once a year even if they are not experiencing any symptoms. This is a simple and quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination.

The next section in this guide is Symptoms and Signs, and it explains what body changes or medical problems this disease can cause. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with laryngeal or hypopharyngeal cancer may experience the following symptoms or signs. Sometimes, people with laryngeal or hypopharyngeal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer.

  • Hoarseness or other voice changes that do not go away within two weeks. This is often an early symptom.

  • An enlarged lymph node or lump in the neck

  • Airway obstruction, difficulty breathing, and noisy breathing

  • Persistent sore throat or a feeling that something is caught in the throat

  • Difficulty swallowing that does not go away

  • Ear pain

  • Chronic bad breath

  • Choking

  • Unexplained weight loss

  • Fatigue

If you are concerned about one or more of the symptoms or signs on this list, please talk with a doctor and/or dentist, especially if they don’t go away or get worse. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

Because many of these symptoms can also be caused by other noncancerous health conditions, it is always important to receive regular health and dental screenings, especially for those who routinely drink alcohol or use tobacco products or have used them in the past. See the Screening section for more information.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms. When detected early, laryngeal and hypopharyngeal cancer can often be treated successfully while preserving the function of the larynx and/or hypopharynx.

The next section in this guide is Diagnosis, and it explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing these types of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition

  • Type of cancer suspected

  • Signs and symptoms

  • Previous test results

The following tests may be used to diagnose laryngeal or hypopharyngeal cancer:

  • Physical examination. The doctor will feel for any lumps in the neck, lip, gums, and cheeks. The doctor will inspect the nose, mouth, throat, and tongue for abnormalities and often use a mirror for a clearer view of these structures. Although there is no specific blood test that detects laryngeal or hypopharyngeal cancer, several laboratory tests, including blood and urine tests, may be done to help determine the diagnosis and learn more about the disease.

  • Laryngoscopy. A laryngoscopy can be performed in three ways:

    • Indirect laryngoscopy. Before an indirect laryngoscopy, the doctor often sprays the throat with a local anesthetic to numb the area and prevent gagging. The doctor then uses a small, long-handled mirror to see the vocal folds.

    • Fiber optic laryngoscopy. During this procedure, the doctor inserts a lighted tube through the person’s nose or mouth and down the throat to view the larynx and hypopharynx.

    • Direct laryngoscopy. This procedure is done in an operating room, and the person receives a sedative or general anesthetic to block the awareness of pain. The doctor then views the larynx and hypopharynx using an instrument called a laryngoscope. A sample of tissue for a biopsy (see below) is often taken during a direct laryngoscopy. Frequently, the doctor will recommend a triple endoscopy, a procedure done under general anesthesia to examine the ear, nose, and throat area, as well as the trachea and the bronchus, which are located next to the lung and the esophagus.

  • Videostroboscopy. This fiber optic video technique is used so the doctor can see the larynx. It is performed in the same way as an indirect laryngoscopy (see above). It is used to view the vocal folds and can detect motion abnormalities and other changes in vibration that are often important for determining whether a tumor is cancerous. Videostroboscopy helps determine the location and size of a tumor, as well as how the tumor has affected the function of the larynx and hypopharynx.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. For instance, during a fine needle aspiration biopsy, cells are withdrawn using a thin needle inserted directly into the tumor. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests will help decide whether your treatment options include a type of treatment called targeted therapy (see the Treatment Options section).

The following imaging tests may be used to determine the extent of the cancer:

  • X-ray/barium swallow. An x-ray is a way to create a picture of the structures inside the body using a small amount of radiation. Sometimes, the patient will be asked to swallow barium, which coats the mouth and throat, to enhance the image on the x-ray. This is called a barium swallow. A barium swallow is used to identify abnormalities along the throat and esophagus. A special type of barium swallow, called a modified barium swallow, may be needed to evaluate difficulties with swallowing.

    A dentist may take extensive x-rays of the teeth, mandible (jawbone), and maxilla (upper jaw), including a panorex, which is a panoramic view of the mouth. If there are signs of cancer, the doctor may recommend a computed tomography scan (see below).

  • Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of soft tissue, such as the tonsils and the base of the tongue. MRI can also be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a liquid to swallow.

  • Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This test can detect the spread of cancer to the liver or the cervical lymph nodes in the neck.

  • Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. For people with head and neck cancer, a bone scan is recommended if there are signs that the cancer has spread to the bone.

  • Integrated positron emission tomography (PET)-CT scan. A PET scan is usually combined with a CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET-CT scan creates pictures of organs and tissues in the body. First, a technician injects you with a small amount of a radioactive substance. Your organs and tissues pick it up. Areas that use more energy pick up more. Cancer cells pick up a lot, because they tend to use more energy than healthy cells. Then a scan shows where the substance is in your body.

    A CT scan uses X-rays to create a three-dimensional picture of the inside of the body. It shows anything abnormal, including tumors. You might get dye first, so the pictures show more detail.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease and how the cancer cells look under a microscope. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as what the cancer cells look like under a microscope. This is called the stage and grade. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for both laryngeal cancer and hypopharyngeal cancer.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below and has been divided into an outline of tumors of the larynx and tumors of the hypopharynx.

Tumors of the larynx

TX: The primary tumor cannot be evaluated.

T0: No evidence of a tumor is found.

Tis: This is a stage called carcinoma (cancer) in situ. It is a very early cancer where cancer cells are found only in one layer of tissue.

When describing T1 to T4 tumors, doctors divide the larynx into three regions: the glottis, the supraglottis, and the subglottis (see the Overview section).

Glottis tumor of the larynx

T1: The tumor is limited to the vocal folds, but it does not affect the movement of the folds.

  • T1a: The tumor is only in the right or left vocal fold.

  • T1b: The tumor is in both vocal folds.

T2: The tumor has spread to the supraglottis and/or the subglottis. T2 also describes a tumor that affects the movement of the vocal fold, without paralyzing the fold.

T3: The tumor is limited to the larynx and paralyzes at least one of the vocal folds.

T4: The tumor has spread beyond the larynx.

  • T4a: The tumor has spread to the thyroid cartilage and/or the tissue beyond the larynx.

  • T4b: The tumor has spread to the area in front of the spine (prevertebral space), chest area, or encases the arteries.

Supraglottis tumor of the larynx

T1: The tumor is located in a single area above the vocal folds that does not affect the movement of the vocal folds.

T2: The tumor started in the supraglottis but has spread to the mucous membranes that line other areas, such as the base of the tongue.

T3: The tumor is limited to the larynx with vocal fold involvement and/or has spread to surrounding tissue.

T4: The tumor has spread beyond the larynx.

  • T4a: The tumor has spread through the thyroid cartilage and/or the tissue beyond the larynx.

  • T4b: The tumor has spread to the area in front of the spine (prevertebral space), chest area, or encases the arteries.

Subglottis tumor of the larynx

T1: The tumor is limited to the subglottis.

T2: The tumor has spread to the vocal folds and may or may not affect the movement of the folds.

T3: The tumor is limited to the larynx and affects the vocal folds.

T4: The tumor has spread beyond the larynx.

  • T4a: The tumor has spread to the cricoids, the ring-shaped cartilage near the bottom of the larynx, or thyroid cartilage and/or the tissue beyond the larynx.

  • T4b: The tumor has spread to the area in front of the spine, chest area, or encases the arteries.

Tumors of the hypopharynx

T1: The tumor is small, no larger than 2 centimeters (cm), and is limited to a single site in the lower throat.

T2: The tumor involves more than one site in the lower throat, but does not touch the voice box, or the tumor measures between 2 cm and 4 cm.

T3: The tumor is larger than 4 cm or has spread to the larynx.

T4a: The tumor has spread into nearby structures, such as the thyroid, the arteries that carry blood to the brain, or the esophagus.

T4b: The tumor has spread to the prevertebral fascia (space in front of the spinal cord), encases the arteries, or involves mediastinal (chest-area) structures.

Node (N)

The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the head and neck are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. Since there are many nodes in the head and neck area, careful assessment of lymph nodes is an important part of staging.

For tumors of the larynx and hypopharynx:

NX: The regional lymph nodes cannot be evaluated.

N0: There is no evidence of cancer in the regional nodes.

N1: The cancer has spread to a single node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller.

N2: Describes any of the following conditions:

  • N2a: The cancer has spread to a single lymph node on the same side as the primary tumor and is larger than 3 cm, but not larger than 6 cm.

  • N2b: The cancer has spread to more than one lymph node on the same side as the primary tumor, and none measure larger than 6 cm.

  • N2c: The cancer has spread to more than one lymph node on either side of the body, and none measure larger than 6 cm.

N3: The cancer found in the lymph nodes is larger than 6 cm.

Metastasis (M)

The "M" in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis.

For both laryngeal and hypopharyngeal cancer:

MX: Distant metastasis cannot be evaluated.

M0: The cancer has not spread to other parts of the body.

M1: The cancer has spread to other parts of the body.

Cancer stage grouping

Doctors assign the stage of the laryngeal or hypopharyngeal cancer by combining the T, N, and M classifications.

Stage 0: This stage describes a carcinoma in situ (Tis) with no spread to lymph nodes (N0) or distant metastasis (M0).

Stage 0 Laryngeal

Stage I: This stage describes a small tumor (T1) with no spread to lymph nodes (N0) or distant metastasis (M0).

Stage I Laryngeal

Stage II: This stage describes a tumor that has spread to some nearby areas (T2) but has not spread to lymph nodes (N0) or to distant parts of the body (M0).

Stage II Laryngeal

Stage III: This stage describes any larger tumor (T3) with no spread to regional lymph nodes (N0) or metastasis (M0), or a smaller tumor (T1, T2) that has spread to regional lymph nodes (N1) but has no sign of distant metastasis (M0).

Stage III Laryngeal

Stage IVA: This stage describes any invasive tumor (T4a) that either has no lymph node involvement (N0) or that only has spread to a single same-sided lymph node (N1), but without distant metastasis (M0). It is also used to describe any tumor (any T) with more significant spread to the lymph nodes (N2) but no distant metastasis (M0).

Stage IVA Laryngeal

Stage IVB: This stage describes any cancer (any T) with extensive spread to lymph nodes (N3) but no distant metastasis (M0). For laryngeal cancer, it is also used for a very advanced localized tumor (T4b), with or without lymph node involvement (any N), but no distant metastasis (M0).

Stage IVB Laryngeal

Stage IVC: This stage indicates there is evidence of distant spread (any T, any N, M1).

Stage IVC Laryngeal

Recurrent: Recurrent cancer is cancer that has come back after treatment.  If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Grade (G)

Doctors also describe these types of cancer by their grade (G), which describes how much cancer cells look like healthy cells when viewed under a microscope. The doctor compares the cancerous tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the cancer looks similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the cancerous tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor. The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The grade cannot be evaluated.

G1: The cells look more like normal tissue (well differentiated).

G2: The cells are moderately differentiated.

G3: The cells don’t resemble healthy tissue (poorly differentiated).

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org. Please note that AJCC’s Eighth Edition (2017) has been released; related changes to the information provided above are underway. Please check back soon for updated staging definitions or talk with your doctor about whether these changes affect your diagnosis.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will learn about the different ways doctors use to treat people with these types of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best known treatments available) for these specific types of cancers. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new approach to treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Your doctor can help you review all treatment options. For more information, see the About Clinical Trials and Latest Research sections.

Treatment overview

Laryngeal and hypopharyngeal cancer can often be successfully eliminated, especially if they are found early. Although eliminating the cancer is the primary goal of treatment, preserving the function of the affected organs is also very important. When doctors plan treatment, they consider how the treatment plan might affect the person’s quality of life, including how the person feels, looks, talks, eats, and breathes. Cancers of the larynx and hypopharynx and their treatments can significantly impact these functions, so decisions should be made carefully.

In cancer care, different types of doctors and other specialists often work together to create a patient’s overall treatment plan, which combines different types of treatments. This is called a multidisciplinary team. An evaluation should be done by each specialist before any treatment begins.

The team may include medical and radiation oncologists, surgeons, otolaryngologists (ear, nose, and throat doctors), maxillofacial prosthodontists (specialists who perform restorative surgery to the head and neck areas), dentists, physical therapists, speech pathologists, audiologists, and psychiatrists. Diagnostic radiologists and pathologists also are an integral part of the treatment team because they assist with diagnosis and staging. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

There are three main treatment options for laryngeal and hypopharyngeal cancer: radiation therapy, surgery, and chemotherapy. One or a combination of these therapies may be used to treat the cancer. Surgery and radiation therapy are the most common treatments used for both laryngeal and hypopharyngeal cancer. Chemotherapy may be used in combination with radiation therapy to increase the chance of destroying cancer cells.

Descriptions of these common treatment options are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A newer method of external radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells.

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Radiation therapy can be the main treatment for head and neck cancer or used after surgery to destroy small pockets of cancer that could not be removed during the operation.

Before beginning radiation therapy for any head and neck cancer, people should receive a thorough examination from an oncologic dentist. An oncologic dentist is a dentist with experience caring for the dental and oral health of people with cancer. Since radiation therapy can cause tooth decay, damaged teeth may need to be removed before treatment begins. Often, tooth decay can be prevented with proper treatment from a dentist. Learn more about dental health during cancer treatment.

It is also important that people receive counseling and evaluation from a speech pathologist who has experience caring for people with head and neck cancer. Since radiation therapy may cause swelling and scarring, the voice and swallowing are often affected. Speech pathologists can provide people with exercises and techniques to prevent long-term speech and swallowing problems.

In addition, radiation therapy to the head and neck may cause redness or skin irritation to the treated area, swelling, dry mouth or thickened saliva from damage to salivary glands (which can be temporary or permanent), bone pain, nausea, fatigue, mouth sores and/or sore throat, and dental problems (usually preventable, see above). Other side effects may include pain or difficulty swallowing; hoarseness or changes in the voice; loss of appetite, due to a change in sense of taste; hearing loss due to a buildup of fluid in the middle ear or nerve damage; buildup of earwax, which dries out because of the radiation therapy’s effect on the ear canal; and scarring (fibrosis). Talk with your doctor or nurse about how any side effects you may experience will be managed.

Radiation therapy may also cause a condition called hypothyroidism, in which the thyroid gland (located in the neck) slows down and causes the person to feel tired and sluggish. Every person who receives radiation therapy to the neck area should have his or her thyroid checked regularly.

Most long-term side effects of radiation therapy can be prevented or reduced. It is important that all members of the multidisciplinary treatment team see the patient before radiation therapy begins in order to prevent or reduce long-term problems. Learn more about the basics of radiation therapy.

Surgery

During surgery, a surgical oncologist removes the cancerous tumor and some healthy tissue around it, called a margin. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove the entire tumor and leave negative margins. Having negative margins mean that there is no trace of cancer in the healthy tissue that was removed during the operation. Sometimes it is not possible to completely remove the cancer. In these cases, other treatments will be recommended.

The most common surgical procedures used to treat laryngeal or hypopharyngeal cancer include:

  • Partial laryngectomy. This is the removal of part of the larynx, which helps preserve the voice. The following are some of the different types of partial laryngectomies:
    • Supraglottic laryngectomy: During this procedure, the surgeon removes the area above the vocal folds. If part of the hypopharynx is removed along with the cancer, this procedure is called a partial pharyngectomy.

    • Cordectomy: The removal of a vocal fold.

    • Vertical hemilaryngectomy: The removal of one side of the larynx.

    • Supracricoid partial laryngectomy: The removal of the vocal folds and the area surrounding them

  • Total laryngectomy. This procedure removes the entire larynx. During the operation, a hole called a stoma is made in the front of the neck through the windpipe to allow the person to breathe. This is called a tracheostomy (see below). Because the vocal folds have been removed, people can no longer speak using their vocal folds after a total laryngectomy. However, a speech pathologist can teach people to speak in a different way after surgery.

  • Laryngopharyngectomy. A laryngopharyngectomy is the removal of the entire larynx, including the vocal folds and part or all of the pharynx. After this surgery, doctors must reconstruct the pharynx using flaps of skin from the forearm, other parts of the body, or a segment of the intestine. Like a total laryngectomy, people can no longer speak using the vocal folds after laryngopharyngectomy, and they may also have difficulty swallowing. However, speech pathologists can help people learn to speak and swallow afterward.

  • Neck dissection. If the cancer has spread to the lymph nodes in the neck some of these lymph nodes may need to be surgically removed. This is called a neck dissection. There are several types of neck dissections, such as a partial neck dissection, modified neck dissection, or selective neck dissection. Depending on the stage and location of the cancer, some or all the lymph nodes in the neck may have to be removed. A patient may have varying degrees of stiffness in the shoulder and the neck and loss of sensation in the neck after this type of surgery.

  • Laser surgery. Laser surgery uses a beam of light to remove a small tumor in the larynx or perform a partial laryngectomy. This tool is a relatively new treatment approach that is not yet widely used. It should only be performed by an experienced doctor.

Other types of surgery that may occur during treatment for laryngeal or hypopharyngeal cancer include:

  • Tracheostomy. As part of both a partial and total laryngectomy, the surgeon makes a hole called a stoma in the front of the neck into the windpipe or trachea. A tube is often inserted to keep the hole open. Air enters and leaves the windpipe (trachea) and lungs through the stoma, allowing the person to breathe.

    For people who have a partial laryngectomy, the stoma is usually temporary. After recovery from the partial laryngectomy, the tube is removed, the hole heals shut, and the person can then breathe and talk in the same way as before the surgery. In some cases, the voice may be hoarse or weak.

    For people who have a total laryngectomy, the stoma is permanent. The person will continue to breathe through the stoma and must learn to speak in a new way.

  • Reconstruction (plastic surgery). This type of operation is aimed at restoring a person’s appearance and function of the affected area. For example, if the surgery requires major tissue removal, reconstructive or plastic surgery may be done to replace the missing tissue.

In general, surgery often causes swelling of the mouth and throat, making it difficult to breathe. After the operation, the lungs and windpipe produce a great deal of mucus. The mucus is removed with a small suction tube until the person learns to cough through the stoma. Similarly, saliva may need to be suctioned from the mouth because swelling in the throat can prevent swallowing. Talk with your doctor about what you can expect after surgery.

In addition, surgery may cause permanent loss of voice or impaired speech, difficulty swallowing or talking, facial disfigurement, numbness in parts of the neck and throat, and less mobility in the shoulder and neck area. Surgery can also decrease thyroid gland function, especially after a total laryngectomy.

Rehabilitation of lost or altered physical functions and emotional support services are important parts of care following surgery. This may take time and require the expertise of different members of the treatment team. Patients are encouraged to talk with their health care team about what to expect before having any type of surgery.

Learn more about the basics of cancer surgery.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

For laryngeal and hypopharyngeal cancer, chemotherapy may be used as a neoadjuvant therapy before surgery, radiation therapy, or both, or it may be given as adjuvant therapy after surgery, radiation therapy, or both. Using chemotherapy as an initial treatment before surgery or radiation therapy, known as induction chemotherapy, has been shown to preserves the larynx and its ability to function.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, nausea and vomiting, hair loss, loss of appetite, diarrhea, dry mouth, hearing loss, and open sores in the mouth that can lead to infections.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Chemoradiotherapy

Depending on the stage of the cancer, a combination of chemotherapy and radiation therapy, often referred to as concomitant chemoradiotherapy, may be used. Chemoradiotherapy helps people avoid having a laryngectomy and preserves the larynx and its ability to function. For many people, this is the preferred standard treatment option. However, combining chemotherapy and radiation therapy can cause more side effects than treatment with radiation therapy alone.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Recent studies show that not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

Cetuximab (Erbitux) is a targeted treatment approved for use in combination with radiation therapy for head and neck cancer that has not spread. It is also approved for use with chemotherapy to treat patients with metastatic cancer (see below).

Targeted therapy is an area of active research for head and neck cancers. Learn more about the Latest Research being conducted.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Metastatic cancer

If cancer has spread to another organ in the body, it is called metastatic cancer and is not curable. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer because there can be different opinions about the best treatment plan. Learn more about getting a second opinion before starting treatment, so you are comfortable with the treatment plan chosen.

Typically, the treatment recommendation includes systemic chemotherapy, either using standard drugs or investigational drugs as part of a clinical trial. Your health care team may also recommend a treatment plan that includes targeted therapy, surgery, or radiation therapy. Palliative care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED. 

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Most recurrences at the original cancer site or in the neck happen during the first 18 to 24 months after the original treatment. People who stop using tobacco, preferably before treatment begins, have a better chance of living longer.  Using tobacco during radiation takes away any benefit from this form of treatment.

When there is a recurrence, a cycle of testing will begin again to learn as much as possible. In particular, treatment planning when there is tumor spread and growth at distant organs (called M1 or distant metastasis; see the Stages and Grades section) requires very careful evaluation and treatment. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery, radiation therapy, chemotherapy, and targeted therapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials, and it offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with laryngeal or hypopharyngeal cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was previously tested in clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating laryngeal and hypopharyngeal cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with laryngeal or hypopharyngeal cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for laryngeal and hypopharyngeal cancer, learn more in the Latest Research section.   

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer. Two websites to search for clinical trials for head and neck cancers are SPOHNC (Supporting People with Head and Neck Cancer) and the U.S. National Institutes of Health clinical trials website clinicaltrials.gov.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research, and it explains areas of scientific research currently going on for these types of cancer. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will read about the scientific research being done now to learn more about these types of cancer and how to treat them. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about laryngeal and hypopharyngeal cancer, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with either of these diseases. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

  • Radiation therapy approaches. Researchers are evaluating more effective ways of using radiation therapy. One promising approach, radiosensitization, involves giving drugs that make the cancer cells more sensitive to radiation therapy so they can be destroyed more easily. Another approach is called hyperfractionated radiation therapy. It gives radiation therapy in several small doses per day.

  • Targeted and tumor-specific therapy. Increasing knowledge of the biology of cancer is leading to the development of targeted therapies, in addition to immunotherapy and biologic therapies (see below). Multiple new drugs are currently in various stages of development. They offer real hope for targeted, tumor-specific approaches with equal or greater effectiveness and fewer side effects for these types of cancer and for head and neck cancer overall.

    As discussed in the Treatment Options targeted therapy section, cetuximab has already been approved for use with current radiation therapy approaches. Cetuximab is a monoclonal antibody directed at the epidermal growth factor receptor, or EGFR. A monoclonal antibody is a type of targeted therapy. It is directed against a specific protein in the cancer cells, in this case EGFR, and it does not affect cells that don’t have that protein. Other EGFR inhibitors being studied are erlotinib (Tarceva), gefitinib (Iressa), lapatinib (Tykerb), and panitumumab (Vectibix), often in combination with other treatments.

    In addition, another avenue researchers are studying includes anti-angiogenesis therapy. Anti-angiogenesis therapy is a type of targeted therapy that focuses on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Drugs under investigation in this area include bevacizumab (Avastin) and sunitinib (Sutent).

  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. A drug called pembrolizumab (Keytruda) is being studied in clinical trials, along with other types of immunotherapy drugs.

  • Chemoprevention. Researchers are evaluating the benefits of using chemoprevention as a way to prevent the development of a second cancer after treatment for laryngeal or hypopharyngeal cancer has finished. Chemoprevention is the use of drugs or supplements to lower the risk of cancer.

  • Photodynamic therapy. During photodynamic therapy, a substance that is sensitive to light (photosensitive) is injected into the blood. Cancer cells hold onto the substance longer than healthy cells. Then, laser lights are directed at the area of the tumor, and the substance in the cells is activated to destroy the cancer cells.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current laryngeal and hypopharyngeal cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding laryngeal and hypopharyngeal cancer, explore these related items that take you outside of this guide:

  • To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases now. Please note this link will take you outside of this guide.

  • Visit ASCO’s CancerProgress.Net website to learn more about the historical pace of research for head and neck cancer. Please note this link takes you to a separate ASCO website.

  • Visit the website of the Conquer Cancer Foundation to find out how to help support research for every cancer type. Please note this link takes you to a separate ASCO website. 

The next section in this guide is Coping with Side Effects, and it offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

There are possible side effects for every cancer treatment, but patients don’t experience the same side effects when given the same treatments for many reasons. That can make it hard to predict exactly how you will feel during treatment. 

Common side effects from each treatment option for laryngeal and hypopharyngeal cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Talking with your health care team about side effects

Before treatment begins, talk with your doctor about possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them.

And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with laryngeal or hypopharyngeal cancer. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your cancer care

During and after treatment, be sure to tell the health care team about the side effects you experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the Follow-Up Care section of this guide or talking with your doctor.

The next section in this guide is Follow-up Care, and it explains the importance of check-ups after cancer treatment is finished. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. People recovering from laryngeal or hypopharyngeal cancer should receive regular follow-up medical and dental examinations to check for signs of recurring cancer or a second primary cancer (a new type of cancer somewhere else in the body), as well as to manage any late or long-term side effects from cancer treatment.

A common follow-up schedule for people after treatment for either of these types of cancer is every 2 months for the first year, every 4 months for the second year, every 6 months for the third year, and once a year after that. Diagnostic tests and examinations may be repeated to look for a recurrence or monitor the progress of current treatment.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors including the type and stage of cancer originally diagnosed and the types of treatment given.

If a person uses tobacco, it is important to be monitored for possible second cancers in the lung, esophagus, and head and neck, even without recurrence of the initial cancer. Joining a clinical trial researching new ways to prevent these diseases may also be an option.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them. For example, people who had radiation therapy should have their thyroid function checked regularly.

Rehabilitation is a major part of follow-up care after head and neck cancer treatment. However, people should meet with all rehabilitation specialists before their head and neck cancer treatment begins. Following treatment, people may receive physical therapy to maintain range of movement and speech therapy to regain skills, such as speech and swallowing. When the cancer treatment impairs swallowing, exercise plans can often be designed to strengthen and maintain the ability to eat and swallow.

It is important that people receive early evaluation by a speech pathologist and other members of the health care team to start specific treatment programs and avoid later problems. Supportive care to manage symptoms and maintain nutrition during treatment may also be recommended. Some people may need to learn new ways to eat or prepare food.

Sometimes rehabilitation requires developing a new voice. Options include:

  • Esophageal speech. After a total laryngectomy, some people can learn to use the esophagus to produce sound. This is called esophageal speech.

  • Electrolarynx. Some people use an electronic battery-powered device called an electrolarynx that produces vibration that is transmitted through the tissues of the neck or delivered into the mouth via a plastic tube for speech production.

  • Tracheoesophageal (TE) voice restoration. TE voice restoration is used by many people after a laryngectomy. TE speech is similar to normal laryngeal speech because it uses air from the lungs to power speech production just as it did prior to laryngectomy. A small, removable prosthesis (artificial device) that sits inside the stoma allows air from the lungs to pass into the esophagus for sound production. The sound then travels into the mouth for speech.

People may look different, feel tired, and be unable to talk or eat the way they used to before treatment. People who have a tracheostomy need to learn how to take care of the stoma and keep it clean. Some people may experience depression. The health care team can help people adjust and connect them with both physical and emotional support services.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship, and it describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu on the side of your screen.

What is survivorship?

The word survivorship means different things to different people. Two common definitions include:

  • Having no signs of cancer after finishing treatment.

  • The process of living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every person.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from laryngeal and hypopharyngeal cancers are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible. See the Follow-Up Care section for more information.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: This 44-page booklet (available as a PDF) helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of head and neck cancer do I have? Where exactly is it located?

  • What is the stage and grade of the cancer? What does this mean?

  • Can you explain my pathology report (laboratory test results) to me?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are open to me? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • Should I talk with another doctor to get a second opinion?

  • Who will be part of my health care team, and what does each member do?

  • Who will be coordinating my overall treatment?

  • Should I see any other specialists before starting treatment? Specifically, should I talk with a radiation oncologist, medical oncologist, or plastic surgeon?

  • Can you recommend an oncologic dentist?

  • What kind of mouth rinses or toothpaste can I use? 

  • How should I treat symptoms related to dry mouth?

  • Can you recommend a speech pathologist?

  • What are the possible side effects of each treatment option, both in the short term and the long term?

  • What can be done to prevent or manage these side effects?

  • If I am a smoker, will quitting help this treatment have a better outcome?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?

  • What support services are available for me? To my family?

  • Whom should I call for questions or problems?

  • Are there any other questions I should be asking?

Questions to ask about having surgery

  • What type of surgery will I have?

  • Will lymph nodes need to be removed? If so, what type of neck dissection will be done? What does this mean?

  • How likely is it that I will lose my voice box (larynx)? If this is necessary, what are the options available for voice/speech rehabilitation?

  • Will there be need for major reconstruction? How will this affect my ability to speak and eat?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

  • What functional deficits in speech, swallowing, or shoulder motion will likely occur?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • Will there be any lasting side effects, such as loss of saliva, loss of taste, or permanent difficulty in swallowing?

  • How will I be able to eat a balanced diet if treatment affects my ability to eat the foods I am used to eating?

  • What can be done to relieve the side effects?

Questions to ask about having chemotherapy or targeted therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the risk of the cancer returning? Are there signs and symptoms I should watch for?

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • Will I need cancer rehabilitation services after treatment? What can I expect?

  • If I am a smoker, how can you help me quit?

  • What follow-up tests will be needed, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be coordinating my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources, and it offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu on the side of your screen to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 10/2015

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Laryngeal and Hypopharyngeal Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Laryngeal and Hypopharyngeal Cancer. Use the menu on the side of your screen to select another section to continue reading this guide.