ON THIS PAGE: You will learn about the different types of treatments doctors use for people with laryngeal and hypopharyngeal cancer. Use the menu to see other pages.
This section explains the types of treatments that are the standard of care for laryngeal and hypopharyngeal cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.
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 treatment 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.
This team may include medical oncologists, 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 help with diagnosis and staging. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.
There are 3 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. Chemotherapy may be used before or during radiation therapy and/or surgery to increase the chance of destroying cancer cells.
Descriptions of the common types of treatments are listed below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.
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. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for laryngeal and hypopharyngeal cancer because there are different treatment options. Learn more about making treatment decisions.
Preserving the larynx
The first goal of treatment for nearly all patients, especially those with early stage (T1 or T2) laryngeal cancer, is to preserve the function of the larynx. In these cases, surgery or radiation therapy may be used to cure the cancer and preserve the function of the larynx.
For most people with a T3 laryngeal tumor and some people with a T4 laryngeal tumor, combined chemotherapy and radiation therapy can preserve the larynx with good function. For very large laryngeal tumors, total laryngectomy may be the better treatment option.
For more information on the stages of laryngeal cancer, see Stages and Grades.
Talk to your doctor about testing how well your voice works and how well you can swallow before deciding on a treatment plan.
This information is based on ASCO recommendations for larynx preservation in the treatment of laryngeal cancer. Please note that this link takes you to another ASCO website.
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-beam radiation therapy, known as intensity modulated radiation therapy (IMRT), allows 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.
New clinical trials are researching the use of proton beam therapy to see if this can further reduce the damage to healthy tissues during therapy. Proton beam therapy is a type of external-beam radiation therapy that uses protons rather than x-rays (photons) to destroy cancer cells.
A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
Radiation therapy alone can be the main treatment for head and neck cancer or used after surgery to destroy small areas of cancer that could not be removed during the operation. It is often used in combination with chemotherapy to treat many cancers of the head and neck.
Before treatment begins
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 help prevent long-term speech and swallowing problems.
Depending on the stage of the cancer, a combination of chemotherapy and radiation therapy, sometimes called concomitant chemoradiotherapy, may be used. Chemotherapy enhances the effectiveness of radiation therapy. Chemoradiotherapy can help people avoid having surgery and can 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.
Side effects of radiation therapy
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, difficulty opening the mouth, and dental problems (usually preventable, see above). Other side effects may include lymph fluid buildup called lymphedema; 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 that you may experience will be managed.
Radiation therapy may also cause a condition called hypothyroidism, in which the thyroid gland, which is 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. Patients with hypothyroidism will require lifelong supplements of thyroid hormone.
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.
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.
Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have.
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 patient’s natural 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 1 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, so the person can 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. They may also have difficulty swallowing. However, a speech pathologist 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. Patients with laryngeal cancer who receive radiation therapy or chemoradiotherapy usually do not need a 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 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 should only be performed by an experienced doctor.
Other types of surgery that may be used 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. This surgical procedure may also be called a tracheotomy. A tube is often inserted to keep the hole open. Air enters and leaves the windpipe, called the trachea, and lungs through the stoma, so the person can 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, but it usually gets better as the person recovers from surgery.
For people who have a total laryngectomy, the stoma is permanent. The tube is removed but the person will continue to breathe through the stoma and must learn to speak in a new way.
Reconstruction. Reconstruction, or plastic surgery, 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.
Learn more about the basics of cancer surgery.
Side effects of surgery
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, lymphedema, 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 after 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.
Therapies using medication
Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.
Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).
The types of systemic therapies used for laryngeal and hypopharyngeal cancer include:
Each of these types of therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.
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. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.
Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.
For laryngeal and hypopharyngeal cancer, chemotherapy may be used before surgery, radiation therapy, or both. This is called neoadjuvant therapy.
The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, lowered blood counts, 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.
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.
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, research studies continue 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).
Talk with your doctor about possible side effects for a specific medication and how they can be managed.
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. There are 2 immunotherapy drugs, nivolumab (Opdivo) and pembrolizumab (Keytruda), that are approved for the treatment of patients with recurrent or metastatic squamous cell carcinoma after chemotherapy with a platinum-based drug has stopped working. Immunotherapy in combination with chemotherapy and radiation therapy may also be used in clinical trials.
Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy.
Physical, emotional, and social effects of cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer 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 and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.
During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.
If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan.
Typically, the treatment recommendation includes systemic chemotherapy, either using standard drugs or drugs being studied as part of a clinical trial. Your treatment plan may also include a combination of targeted therapy, immunotherapy, surgery, or radiation therapy. Some clinical trials focus on treating tumors with specific genetic changes, called mutations. To participate in these kinds of clinical trials, patients will need to have their tumor undergo molecular testing. These kinds of laboratory tests look for specific genes, proteins, or other factors unique to the tumor. Palliative care will also be important to help relieve symptoms and side effects.
For most people, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. You and your family are encouraged to talk about how you feel 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 is 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 returns 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 in the same place or in the neck happen in the first 18 to 24 months after the original treatment. People who stop using tobacco and alcohol, preferably before treatment begins, have a better chance of living longer. Using tobacco during radiation therapy takes away any benefit that the radiation therapy may offer.
When there is a recurrence, a new cycle of testing will begin again to learn as much as possible. In particular, treatment planning when there is tumor spread and growth to distant organs (called M1 or distant metastasis; see Stages and Grades) requires very careful evaluation and treatment. After this testing is done, you and your doctor will talk about the 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 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. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence.
If treatment does not work
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 for many people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider 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 talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option 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. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.