July 3, 2006
To help doctors give their patients the best possible care, the American Society of Clinical Oncology (ASCO) asks its medical experts to develop evidence-based recommendations for preserving the larynx during cancer treatment. This guide for patients is based on ASCO's recommendations.
- Cancer of the larynx and its treatment can affect how a person speaks, eats, and breathes.
- It is often possible to preserve the larynx during treatment of laryngeal cancer; talk with your doctor about treatment options that will preserve the larynx.
- Laryngeal cancer is best treated with a team of doctors and other specialists that can provide support and rehabilitation services.
The larynx, sometimes 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. Cancer of the larynx (laryngeal cancer) is one of the most common cancers of the head and neck.
The larynx consists of three parts, and cancer may occur in any of the following areas:
- Supraglottis, which is the area above the vocal cords
- Glottis, which is the middle section that holds the vocal cords
- Subglottis, which is the area below the vocal cords that connects the larynx to the windpipe
Because of the function and location of the larynx, cancer of the voice box and its treatment can affect breathing, talking, and eating. Larynx preservation therapy refers to treatment that maintains the function of the larynx. Examples of larynx preservation therapies include:
- Radiation therapy
- Chemoradiation therapy (giving radiation therapy along with chemotherapy)
- Partial laryngectomy (surgery that removes part of the larynx)
A total laryngectomy is surgery that removes the entire larynx. After a laryngectomy, patients can no longer speak using their vocal cords. For some patients, a total laryngectomy may be the best option to treat the cancer or a recurrence (return) of cancer.
The recommendations for larynx preservation include the following:
- The first approach to the treatment of nearly all patients with T1 or T2 (early-stage) laryngeal cancer should be to preserve the larynx.
- The most widely applicable approach for preserving the larynx while treating patients with T3 or T4 (late-stage) laryngeal cancer that does not extend outside the voice box into the surrounding soft tissue is chemoradiation therapy.
- Laryngeal cancer is best treated with a specialized team of doctors and other health care professionals who can provide support and rehabilitative services, such as 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.
- Patients are encouraged to talk with their doctors about the risks and benefits of various treatment options when comparing treatments that preserve the larynx with total laryngectomy.
- What type of laryngeal cancer do I have?
- Would you explain my treatment options? Will this treatment affect my ability to eat, swallow, or speak?
- What are the options for treatment that would preserve my larynx and my ability to speak?
- How effective are these treatment options compared with laryngectomy (removal of the larynx)?
- What are the risks and benefits of these treatment options?
- Is there a chance I may lose my larynx in the future?
- How long will I need to recover from treatment?
- Are there rehabilitative services to help me manage the side effects of treatment?
- Am I eligible for a clinical trial?
- Is there anything else I should be asking?
- Where can I find more information?
Read the entire clinical practice guideline at www.asco.org/guidelines/larynx
About ASCO's Guidelines
To help doctors give their patients the best possible care, ASCO asks its medical experts to develop evidence-based recommendations for specific areas of cancer care, called clinical practice guidelines. Due to the rapid flow of scientific information in oncology, new evidence may have emerged since the time a guideline or assessment was submitted for publication. As a result, guidelines and guideline summaries, like this one, may not reflect the most recent evidence. Because the treatment options for every patient are different, guidelines are voluntary and are not meant to replace your physician's independent judgment. The decisions you and your doctor make will be based on your individual circumstances. These recommendations may not apply in the context of clinical trials.
The information in this guide is not intended as medical or legal advice, or as a substitute for consultation with a physician or other licensed health care provider. Patients with health care-related questions should call or see their physician or other health care provider promptly, and should not disregard professional medical advice, or delay seeking it, because of information encountered in this guide. The mention of any product, service, or treatment in this guide should not be construed as an ASCO endorsement. ASCO is not responsible for any injury or damage to persons or property arising out of or related to any use of this patient guide, or to any errors or omissions.
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