Treatment

The treatment of laryngeal or hypopharyngeal cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health. In many cases, a team of doctors and other specialists will work with the patient to determine the best treatment plan.

This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials as a treatment option when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.

Laryngeal and hypopharyngeal cancer can often be cured, especially if it is found early. Although curing 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.

Head and neck cancer specialists often form a multidisciplinary team to care for each person, and 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, nurses, dietitians, and social workers. Diagnostic radiologists and pathologists 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 laryngeal and hypopharyngeal cancer. Chemotherapy may be used in combination with radiation therapy to increase the chance of destroying cancer cells.

Surgery

During surgery, the doctor performs an operation to remove 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 (no trace of cancer in the healthy tissue). Sometimes it is not possible to completely remove the cancer; in these cases, additional therapies will be recommended.

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

Partial laryngectomy. The removal of part of the larynx, preserving the voice. The following are some of the different types of partial laryngectomies:

Total laryngectomy. The removal of the entire larynx. During this 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 and they may also have difficulty swallowing after laryngopharyngectomy. 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.

In a partial laryngectomy, the stoma is usually temporary. After recovery from the partial laryngectomy, the tube is removed, the hole heals closed, 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.

In a total laryngectomy, the stoma is permanent, and the person breathes through the stoma and must learn to speak in a new way.

Neck dissection. If cancer has spread to the lymph nodes in the neck, a neck dissection may be necessary. There are several types of neck dissections, depending on the stage and location of the cancer. Some or all the lymph nodes in the neck may have to be removed (partial neck dissection, modified neck dissection, selective neck dissection). A patient may have varying degrees of stiffness in the shoulder and the neck and loss of sensation in the neck after this surgery.

Laser surgery. Laser surgery uses a beam of light to remove the tumor. Such a tool can remove a small tumor of the larynx and perform a partial laryngectomy. This tool is a relatively new treatment approach not yet widely used, and it should be performed by an experienced doctor.

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.

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. It is very important that people are assisted with their rehabilitation of lost or altered functions. This may take time and require the expertise of different members of the treatment team.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A new 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, thus causing fewer side effects. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

Radiation therapy can be the main treatment for head and neck cancer or used postoperatively (used after surgery) to destroy small pockets of cancer that cannot be removed surgically.

Before beginning radiation therapy for any head and neck cancer, people should receive a thorough examination from an oncologic dentist (a dentist with experience in treating people with head and neck cancer). Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning radiation therapy. People should also receive an evaluation from a speech pathologist who has experience treating people with head and neck cancer. Since radiation therapy can cause swelling and scarring, voice and swallowing are often affected.

Radiation therapy to the head and neck may cause the following side effects: redness or skin irritation to the treated area, swelling, dry mouth or thickened saliva from damage to salivary glands (this can be temporary or permanent), bone pain, nausea, fatigue, mouth sores and/or sore throat, dental problems (usually preventable, see above), painful 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).

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. Evaluation by all members of the multidisciplinary treatment team before radiation therapy begins is important to prevent long-term problems.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body.

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 can include fatigue, nausea and vomiting, loss of appetite, diarrhea, dry mouth, hearing loss, and open sores in the mouth that can lead to infections.

Concomitant chemoradiotherapy

Depending on the stage of the cancer, concomitant chemoradiotherapy (a combination of chemotherapy and radiation therapy) may be used to avoid a laryngectomy, preserving the larynx and its ability to function. For many people, this is the preferred standard treatment option; however, concurrent chemotherapy and radiation therapy can cause more side effects.

There are new data supporting the use of induction chemotherapy (initial treatment before surgery or radiation therapy) and cetuximab (Erbitux) with radiation therapy. This may be an option for some patients who cannot receive chemoradiotherapy.

Targeted therapy

Targeted therapy is a treatment that targets faulty genes or proteins that contribute to cancer growth and development.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you’ve been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net’s Drug Information Resources, which provides links to searchable drug databases.

Recurrent cancer

Recurrent cancer is cancer that comes back after treatment. Most recurrences at the original cancer site and in the neck happen in the first 18 to 24 months after the original treatment. If there is a recurrence or persistence of cancer, new testing is necessary before further treatment. Tumor spread and growth at distant organs (M1, or distant metastasis) calls for individual evaluation and treatment. People who stop smoking, preferably before treatment begins, have a better chance of surviving longer.

To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment.