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Laryngeal and Hypopharyngeal Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

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 and hypopharynx

The larynx, commonly called the voice box, is a tube-shaped organ in the neck that is important for breathing, talking, and swallowing. 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 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.

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 begin in any part of the larynx or hypopharynx. Cancer occurs in the larynx or hypopharynx when normal 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 spread to other parts of the body. A benign tumor means the tumor will not spread.

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

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 together since treatments are often similar; however, these are two separate types of cancer.

Looking for More of an Overview?

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

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Laryngeal and Hypopharyngeal Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

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

Laryngeal cancer is one of the most common head and neck cancers. This year, an estimated 12,630 adults (10,000 men and 2,630 women) in the United States will be diagnosed with laryngeal cancer. It is estimated that 3,610 deaths (2,870 men and 740 women) from this disease will occur this year.

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

The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. 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 five-year survival rate of people with hypopharyngeal cancer is 53%. If the cancer has spread to nearby areas and/or lymph nodes, the five-year survival rate is 39%. If the cancer has spread to distant parts of the body, the five-year survival rate is 24%.

The five-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. 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. For cancer in the supraglottis, the rates are 59% for the earliest stage to 35% for the most advanced stage. And regarding people with cancer in the subglottis, the rates range from 65% at the earliest stage to 32% at the most advanced stage.

Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of people with this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with laryngeal or hypopharyngeal cancer. Because statistics are often measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2014, and the American Cancer Society website.

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Laryngeal and Hypopharyngeal Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

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.

 

 


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

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Laryngeal and Hypopharyngeal Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing these types of cancer. 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 or 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 or 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 or 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.

Prevention and early detection

Researchers continue to look into what factors cause laryngeal and hypopharyngeal cancer and what people can do to lower their personal risk. There is no proven way to completely prevent these diseases, but there may be steps you can take to lower your cancer 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. 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.

Talk with your doctor if you have concerns about your personal risk of developing laryngeal or hypopharyngeal cancer.

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Laryngeal and Hypopharyngeal Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

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 (often an early symptom)
  • An enlarged lymph node or a 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.

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 helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select 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, 04/2014

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 cheek. 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. This test 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.
  • Fiberoptic 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 fiberoptic 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. The sample removed during the biopsy is analyzed by a pathologist. 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 (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 pill 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 pill 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 located 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.

Positron emission tomography (PET) scan. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the patient’s body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. A scanner then detects this substance to produce images of the inside of the body.

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 helps explain the different stages and grades for these types of cancer. Use the menu on the side of your screen to select Stages and Grades, or you can select 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, 04/2014

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. 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.

One tool that doctors use to describe the stage is the TNM system. TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:

  • How large is the primary tumor and where is it located? (Tumor, T)
  • Has the tumor spread to the lymph nodes? (Node, N)
  • Has the cancer metastasized to other parts of the body? (Metastasis, M)

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. 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.

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.

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.

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 (for both larynx and hypopharynx). 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.

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.

Distant metastasis (for both larynx and hypopharynx). The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.

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

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

Stage I Laryngeal

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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

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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

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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

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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

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

Stage IVC Laryngeal

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Recurrent: Recurrent cancer is cancer that has come back after treatment.  If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Grade

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 only moderately differentiated.

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

Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer-Verlag New York, www.cancerstaging.net.

Information about the cancer’s stage and grade will help the doctor recommend a treatment plan. The next section helps explain the treatment options for these types of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select 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, 04/2014

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 proven 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 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 treatment might affect a person’s quality of life, including how a person feels, looks, talks, eats, and breathes. Cancers of the larynx and hypopharynx and their treatments can have a significant impact on 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 that 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, psychiatrists, dietitians, nurses, physician assistants, and social workers. Diagnostic radiologists and pathologists also are an integral part of the treatment team because they assist with diagnosis and staging.

There are three main treatment options for laryngeal and hypopharyngeal cancer: surgery, radiation therapy, and chemotherapy. One or a combination of these therapies may be used to treat the cancer. Surgery and radiation therapy are the most common forms of treatment 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.

Surgery

During surgery, a surgical oncologist, a doctor who specializes in treating cancer using surgery, removes the cancerous tumor and some of the healthy tissue around it, called a margin. 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 around the tumor 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 the 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 afterwards.

Tracheostomy. In both partial and total laryngectomies, 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.

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.

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.

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 any surgery.

Learn more about cancer surgery.

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 side effects 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 radiation therapy.

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 is delivered through 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 (treatment before surgery, radiation therapy, or both) or an adjuvant therapy (treatment after surgery, radiation therapy, or both).

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 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 to avoid a laryngectomy and preserve 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.

Using chemotherapy as an initial treatment before surgery or radiation therapy, known as induction chemotherapy, has also been shown to allow for larynx preservation. Cetuximab (Erbitux; see below) with radiation therapy is being investigated.

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. As a result, doctors can 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 targeted treatments.

Cetuximab is a targeted treatment approved for use in combination with radiation therapy (see above) for head and neck cancer that has not spread. It is also approved for use with chemotherapy to treat patients with metastatic cancer. 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 can help a person at any stage of illness. 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, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and 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 supportive 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 is 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. 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 seeking 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 surgery or radiation therapy. Supportive 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 “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious 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 the 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.

When there is a recurrence, a cycle of testing will begin again to learn as much as possible, including whether the cancer’s stage has changed. In particular, treatment planning when there is tumor spread and growth at distant organs (called M1 or distant metastasis; see the Stages 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 therapies 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.

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 treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and this 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 helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select 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, 04/2014

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.

Doctors and scientists are always looking for better ways to treat patients with laryngeal or hypopharyngeal cancer. To make scientific advances, doctors create research studies involving volunteers, called 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.

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, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. 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.

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.

For specific topics being studied for laryngeal and hypopharyngeal cancer, learn more in the Latest Research section.

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. 

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.

The next section helps explain the areas of research going on today about these types of cancer. Use the menu on the side of your screen to select Latest Research, or you can select 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, 04/2014

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 treatment. 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, in which radiation therapy is given in several small doses per day.

Targeted and tumor-specific therapy. Increasing knowledge of the biology of cancer is leading to the development of biologic and targeted therapies. Multiple new drugs are currently under 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 section, cetuximab, a monoclonal antibody directed at the epidermal growth factor receptor, or EGFR, has already been approved for use with current radiation therapy approaches. 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 under study 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 is focused 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).

Chemoprevention. Researchers are evaluating the benefits of using chemotherapy as a way to prevent the development of a second cancer after treatment for laryngeal or hypopharyngeal cancer has finished.

Photodynamic therapy. In 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.

Supportive 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: 

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select 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, 04/2014

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 or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

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.

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 After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 04/2014

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

After treatment for laryngeal or hypopharyngeal cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

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 two months for the first year, every four months for the second year, every six 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. If radiation therapy was given, a person should have his or her thyroid function checked regularly. 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. Enrollment in clinical trials researching new ways to prevent these diseases may also be an option.

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. After a total laryngectomy, some people can learn to use the esophagus to produce sound; this is called esophageal speech. 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. A third method of voice rehabilitation, called tracheoesophageal (TE) voice restoration, is performed in many people who have had 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.

People recovering from laryngeal or hypopharyngeal cancer are also encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, limiting alcohol, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for you needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select 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, 04/2014

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.

  • 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?
  • What are the 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 and follow-up care?
  • 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?
  • 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 relieve these side effects?
  • 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?
  • Will I need cancer rehabilitation services after treatment? What can I expect?
  • What functional deficits in speech, swallowing, or shoulder motion will likely occur, and what rehabilitation services are available?
  • If I have surgery, will there be need for major reconstruction? How will this affect my ability to speak and eat?
  • If surgery is done, will there be a need for a neck dissection (removal of lymph nodes)? If so, what type of dissection will be done? What does this mean?
  • If I receive radiation therapy, will there be any lasting side effects, such as loss of saliva, loss of taste, or permanent difficulty in swallowing?
  • 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?
  • How will my nutrition be maintained if the treatment affects my ability to eat the foods I am used to eating?
  • If I am a smoker, how can you help me quit?
  • If I am a smoker, will quitting help this treatment have a better outcome?
  • What follow-up tests will be needed, and how often will I need them?
  • 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?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select 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, 04/2014

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. Here are a few sections that may get you started in exploring the rest 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.