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Laryngeal and Hypopharyngeal Cancer - Introduction

Approved by the Cancer.Net Editorial Board, 01/2019

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. Use the menu to see other pages. Think of that menu as a roadmap for this complete guide.

About the larynx

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

The larynx is important for breathing, talking, and swallowing. It contains the vocal folds, also called vocal cords, which 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 the lungs.

There are 3 parts of the larynx:

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

  • Supraglottis. The area above the vocal folds.

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

About the hypopharynx

The hypopharynx, also called the gullet, is the lower part of the throat. It surrounds the larynx. The pharynx, more commonly known as the throat, is a hollow tube about 5 inches long. It starts behind the nose, which is a region called the nasopharynx, and ends at the level of the larynx, a region called the laryngopharynx. The pharynx leads into the esophagus, which is the tube that goes to the stomach.

About cancer in the larynx or hypopharynx

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

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

Laryngeal and hypopharyngeal cancers are 2 of the main types of cancer in the head and neck region, a grouping called head and neck cancer. This section covers both laryngeal cancer and hypopharyngeal cancer because their treatments are often similar. However, these are 2 separate types of cancer. Go to the Medical Illustrations page to see a drawing of these structures.

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If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain the number of people who are diagnosed with laryngeal and hypopharyngeal cancer and general survival rates. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Statistics

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will find information about the number of people who are diagnosed with laryngeal and hypopharyngeal cancer each year. You will also read general information on surviving these diseases. Remember, survival rates depend on several factors. Use the menu to see other pages.

Laryngeal cancer

Laryngeal cancer is a common type of head and neck cancer. This year, an estimated 12,410 adults (9,860 men and 2,550 women) in the United States will be diagnosed with laryngeal cancer.

It is estimated that 3,760 deaths (3,010 men and 750 women) from this disease will occur this year. Both the death rate and incidence rate have dropped 2 percent each year in recent years, mainly due to a decrease in smoking.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for laryngeal cancer is 61%. More than half of patients (53%) are diagnosed and treated before the cancer has spread outside the larynx, and in these cases, the 5-year survival rate is 78%. If the cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 46%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 34%.

However, the 5-year survival rate also depends on the location of the cancer (glottis, supraglottis, or subglottis, as explained in the Introduction) and the stage.

  • Glottis. Approximately 60% of laryngeal cancer is found in the glottis. Almost 80% of cases are found in its earliest stage, which has a survival rate of 90%. When the cancer is in the most advanced stage and has spread to other parts of the body, the survival rate is 44%.

  • Supraglottis. Approximately 35% of laryngeal cancer is found in the supraglottis. For cancer in the supraglottis, the survival rates are 59% for the earliest stage to 34% for the most advanced stage.

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

Hypopharyngeal cancer

Each year, an estimated 3,000 people in the United States will be diagnosed with hypopharyngeal cancer.

Survival rates for hypopharyngeal cancer vary based on a variety of factors, particularly the stage. The 5-year survival rate for hypopharyngeal cancer is 33%. If the cancer is found at an early, localized stage, the 5-year survival rate of people with hypopharyngeal cancer is 53%. About 17% of cases are diagnosed at this stage. If the cancer has spread to nearby areas and/or lymph nodes (stages II and III), the 5-year survival rate is 36% to 39%. If the cancer has spread to distant parts of the body, the 5-year survival rate is 24%. Approximately 54% of cases are diagnosed at this stage. Hypopharyngeal cancer is often found at a more advanced stage because of its location. Laryngeal cancer often will cause hoarseness or coughing up blood, which can lead to an earlier diagnosis. Hypopharyngeal cancers can go longer without causing symptoms.

It is important to remember that statistics on the survival rates for people with laryngeal and hypopharyngeal cancer are an estimate. The estimate comes from annual data based on the number of people with these types of cancer in the United States. Also, experts measure the survival statistics every 5 years. So the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Talk with your doctor if you have any questions about this information. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's (ACS) publications, Cancer Facts and Figures 2019 and Cancer Facts and Figures 2017: Special Section – Rare Cancers in Adults, and the ACS website (January 2019).

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by laryngeal and hypopharyngeal cancer. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Medical Illustrations

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will find a drawing of the main body parts affected by laryngeal and hypopharyngeal cancer. Use the menu to see other pages.

 

The lower part of the throat is called the hypopharynx or gullet. It surrounds the larynx. The larynx is a tube-shaped organ located in the front of the neck and at the top of the windpipe or trachea. It contains the vocal folds (vocal cords) and is made up of three parts. The middle section, or glottis, contains the vocal folds. The supraglottis is the area above the vocal folds. The subglottis is the area below the vocal folds that connects the larynx to the windpipe, or trachea, a hollow tube that carries air to the lungs. A flap of tissue called the epiglottis helps protect the airway and prevent food from entering the trachea during swallowing. Copyright 2003 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors and PreventionIt explains the factors that may increase the chance of developing laryngeal or hypopharyngeal cancer and what people can do to lower their risk. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Risk Factors and Prevention

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will find out more about the factors that increase the chance of developing laryngeal or hypopharyngeal cancer and what people can do to lower their risk. Use the menu to see other pages.

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

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

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

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

  • Gender. Men are 4 to 5 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/Ethnicity. Black people and white people are more likely to develop laryngeal and hypopharyngeal cancer than Asian people and Hispanic people.

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

  • Poor nutrition. A diet low in vitamins A and E can raise a person’s risk of laryngeal and hypopharyngeal cancer. Foods that are rich in these vitamins may help prevent the disease, including eating fresh fruits and vegetables, although more research is needed.

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

  • Poor oral hygiene. Not brushing teeth regularly and not using dental floss can increase the risk of head and neck cancer. Dental checkups twice a year are encouraged for all people at risk for these types of cancer.

  • 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.

  • Human papillomavirus (HPV). Although HPV is the primary cause of cancers in the base of the tongue and tonsils, there are rare cases of laryngeal cancer caused by HPV. Sexual activity with someone who has HPV is the most common way someone gets HPV. There are different types of HPV, called strains. Research links some HPV strains more strongly with certain types of cancers. There are vaccines available to protect you from some HPV strains.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause these types of cancer, including ways to prevent it. Although there is no proven way to completely prevent this disease, you may be able to lower your risk. Stopping the use of tobacco products is the most important thing a person can do, even for people who have been smoking for many years. Avoiding exposure to secondhand smoke is also important. Additionally, drinking alcohol increases the risk. Even people who drink light amounts (1 drink per day) are at higher risk for developing cancer. Talk with your health care team for more information about your personal risk of cancer.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Screening

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will find out more about screening for laryngeal and hypopharyngeal cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

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

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

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for laryngeal and hypopharyngeal cancer

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

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems laryngeal and hypopharyngeal cancers can cause. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Symptoms and Signs

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. Use the menu to see other pages.

People with laryngeal or hypopharyngeal cancer may experience the following symptoms or signs. Sometimes, people with laryngeal or hypopharyngeal cancer do not have any of these changes. Or, the cause of a symptom may be a different medical condition that is not cancer.

  • Hoarseness or other voice changes that do not go away within 2 weeks. This is often an early symptom.

  • An enlarged lymph node or lump in the neck

  • Airway obstruction, difficulty breathing, and noisy breathing

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

  • Difficulty swallowing that does not go away

  • Ear pain

  • Chronic bad breath

  • Choking

  • Unexplained weight loss

  • Fatigue

If you are concerned about any changes you experience, please talk with a doctor and/or dentist, especially if these changes 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 figure out the cause of the problem, called a diagnosis.

Because many of these symptoms can also be caused by health conditions that are not cancer, it is always important to have regular health and dental screenings, especially for those who routinely drink alcohol or use tobacco products or have used them in the past. See the Screening section for more information.

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

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Diagnosis

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

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

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and general health

  • The results of earlier medical tests

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

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

  • Laryngoscopy. A laryngoscopy can be performed in 3 ways:

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

    • Fiber optic laryngoscopy. During this procedure, the doctor inserts a flexible, lighted tube through the person’s nose or mouth and down the throat to view the larynx and hypopharynx. The nose is often sprayed with a local anesthetic to make the procedure more comfortable.

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

  • Videostroboscopy. This fiber optic video technique is used so the doctor can better 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 finding a tumor. 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. Videostroboscopy is useful because the results frequently allow the doctor to find potential changes in the larynx before they are visible to the eye alone.

  • 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 taken using a thin needle inserted directly into the tumor. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

  • Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests can help determine your treatment options.

The following imaging tests may be used to determine if and how much the cancer has spread:

  • Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can 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 or liquid to swallow.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of soft tissue, such as the tonsils and the base of the tongue. MRI can 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 or liquid to swallow.

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

  • 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.

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

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

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

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

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease and how the cancer cells look under a microscope. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Stages and Grades

Approved by the Cancer.Net Editorial Board, 01/2019

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

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

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

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

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

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

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

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

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm). A centimeter is roughly equal to the width of a standard pen or pencil.

Stages may also be 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.

Tis: This is a stage called carcinoma (cancer) in situ. It is a very early cancer where cancer cells are found in only 1 layer of tissue.

When describing T1 to T4 tumors, doctors divide the larynx into 3 regions: the glottis, the supraglottis, and the subglottis (see the Introduction).

Glottis tumor of the larynx

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

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

  • T1b: The tumor is in both vocal folds.

T2: The tumor has spread to the supraglottis and/or the subglottis. The tumor may also affect the movement of the vocal cord.

T3: The tumor is limited to the larynx and paralyzes at least 1 of the vocal cords. The tumor may also invade the space inside the larynx and/or the cartilage around the thyroid gland.

T4: The tumor has spread beyond the larynx.

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

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

Supraglottis tumor of the larynx

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

T2: The tumor started in the supraglottis, but it has spread to the mucous membranes that line other nearby areas, such as the base of the tongue. The vocal cords are not affected.

T3: The tumor is limited to the larynx and affects the vocal cords. The tumor may have spread to surrounding tissue.

T4: The tumor has spread beyond the larynx.

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

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

Subglottis tumor of the larynx

T1: The tumor is only in the subglottis.

T2: The tumor has spread to the vocal cords. Movement of the vocal cords may be affected.

T3: The tumor is limited to the larynx and affects the vocal folds. It may also invade the space inside the larynx and/or the cartilage of the thyroid.

T4: The tumor has spread beyond the larynx.

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

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

Tumors of the hypopharynx

TX: The primary tumor cannot be evaluated.

Tis: This is a stage called carcinoma (cancer) in situ. It is a very early cancer where cancer cells are found in only 1 layer of tissue.

T1: The tumor is 2 cm or smaller and is limited to a single place in the lower throat.

T2: The tumor involves more than 1 site in the lower throat, or the tumor measures between 2 cm and 4 cm but does not touch the voice box.

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

T4a: The tumor has spread into nearby structures, such as the thyroid gland, 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 the chest area.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs 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 lymph nodes in the head and neck area, the doctor’s careful assessment of lymph nodes is an important part of staging.

When cancer has spread through a lymph node and into the tissues directly surrounding it, this is called extranodal extension (ENE). Knowing whether ENE is present plays an important role in the evaluation of lymph nodes in hypopharyngeal cancer.

Evaluation of nodes can be clinical or pathological. Clinical evaluation is based on the results of tests done before surgery, which may include physical examinations and imaging scans. Pathological evaluation is based on what is found during surgery plus the results of physical examinations, imaging scans, and biopsies. In general, pathological evaluation provides the most information to determine a patient's prognosis.

Clinical N

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller. There is no ENE.

N2a: 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. There is no ENE.

N2b: Cancer has spread to more than 1 lymph node on the same side as the primary tumor, and none measures larger than 6 cm. There is no ENE.

N2c: Cancer has spread to more than 1 lymph node on either side of the body, and none measures larger than 6 cm. There is no ENE.

N3a: The cancer is found in a lymph node and is larger than 6 cm. There is no ENE.

N3b: There is ENE in any lymph node.

Pathological N

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller. There is no ENE.

N2a: Cancer has spread to 1 lymph node and is 3 cm or smaller, but there is ENE. Or, 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, and there is no ENE.

N2b: Cancer has spread to more than 1 lymph node on the same side as the primary tumor, and none measures larger than 6 cm. There is no ENE.

N2c: Cancer has spread to more than 1 lymph node on either side of the body, and none measures larger than 6 cm. There is no ENE.

N3a: The cancer is found in a lymph node and is larger than 6 cm. There is no ENE.

N3b: There is ENE in a single lymph node on the same side as the primary tumor, and it is larger than 3 cm. Or, cancer has spread to many lymph nodes, and at least 1 has ENE. Or, there is ENE in a single lymph node on the opposite side of the primary tumor that is 3 cm or smaller.

Metastasis (M)

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

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.

Larynx

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

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

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

Stage III: Either of the following applies:

  • A larger tumor with no spread to regional lymph nodes or metastasis (T3, N0, M0).

  • A tumor that has spread to regional lymph nodes but has no sign of distant metastasis (T1–T3, N1, M0).

Stage IVA: Either of the following applies:

  • There is an invasive tumor. If it has spread to the lymph nodes, it is only to a single lymph node on the same side of the primary tumor. There is no distant metastasis (T4a, N0 or N1, M0).

  • There is significant spread to the lymph nodes but no distant metastasis (T1–T4a, N2, M0).

Stage IVB: Either of the following applies:

  • There is extensive spread to the lymph nodes but no distant metastasis (any T, N3, M0).

  • The tumor is locally advanced and may involve the lymph nodes, but there is no distant metastasis (T4b, any N, M0).

Stage IVC: There is evidence of distant spread (any T, any N, M1).

Hypopharynx

Stage 0: There is carcinoma in situ, with no spread to lymph nodes or other parts of the body (Tis, N0, M0).

Stage I: The tumor is 2 cm or less in size, but cancer has not spread to lymph nodes or other parts of the body (T1, N0, M0).

Stage II: The tumor is between 2 cm and 4 cm, but cancer has not spread to lymph nodes or other parts of the body (T2, N0, M0).

Stage III: Either of the following applies:

  • The tumor is larger than 4 cm or has spread to the epiglottis, but the cancer has not spread to lymph nodes or other parts of the body (T3, N0, M0).

  • The tumor has not invaded nearby tissues, except the epiglottis. Cancer is in 1 lymph node on the same side as the primary tumor, and it is 3 cm or smaller, with no ENE. Cancer has not spread to other parts of the body (T1–T3, N1, M0).

Stage IVA: Either of the following applies:

  • The tumor has invaded the larynx, muscle of the tongue, muscles in the jaw, roof of the mouth, or jawbone. Cancer may have spread to 1 lymph node, but it has not spread to other parts of the body (T4a, N0 or N1, M0).

  • The tumor may be small or it may have invaded nearby structures, like the larynx, muscles of the tongue or jaw, roof of the mouth, or jawbone. Cancer has spread to 1 or more lymph nodes, but none is larger than 6 cm. There is no ENE. Cancer has not spread to other parts of the body (T1–T4a, N2, M0).

Stage IVB: Either of the following applies:

  • The tumor is any size. The cancer is found in a lymph node and is larger than 6 cm, but there is no ENE, or there is ENE in any lymph node. Cancer has not spread to other parts of the body (any T, N3, M0).

  • The tumor has invaded muscles and bones in the region of the mouth; the nasopharynx, which is the air passageway at the upper part of the throat behind the nose; or the base of the skull, or the tumor encases the carotid artery. Lymph nodes may or may not be involved. Cancer has not spread to other parts of the body (T4b, any N, M0).

Stage IVC: Cancer has spread to other parts of the body (any T, any N, M1).

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

Grade (G)

Doctors also describe these types of cancer by their grade (G). The grade 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 has different cell groupings, it is called "differentiated" or a "low-grade tumor." If the cancerous tissue looks very different from healthy tissue, it is called "poorly differentiated" or a "high-grade tumor." The cancer’s grade can help the doctor predict how quickly the cancer will spread. In general, the lower the tumor’s grade, the better the prognosis.

GX: The grade cannot be evaluated.

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

G2: The cells are moderately differentiated.

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

G4 (hypopharynx only): The cells don’t look like healthy tissue at all (undifferentiated).

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Information about the cancer’s stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Types of Treatment

Approved by the Cancer.Net Editorial Board, 01/2019

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.

Treatment overview

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

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.

Chemoradiotherapy

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.

Surgery

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

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:

  • Chemotherapy

  • Targeted therapy

  • Immunotherapy

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

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

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

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.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

Metastatic cancer

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.

Laryngeal and Hypopharyngeal Cancer - About Clinical Trials

Approved by the Cancer.Net Editorial Board, 01/2019

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. Use the menu to see other pages.

What are clinical trials?

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

Clinical trials are used for all types and stages of laryngeal and hypopharyngeal cancer. Many focus on new treatments to learn if a new treatment is safe, effective, and possibly better than the existing treatments. These types of studies evaluate new drugs, different combinations of treatments, new approaches to radiation therapy or surgery, and new methods of treatment.

People who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there are some risks with a clinical trial, including possible side effects and the chance that the new treatment may not work. People are encouraged to talk with their health care team about the pros and cons of joining a specific study.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some people, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are a way to contribute to the 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.

Insurance coverage and the costs of clinical trials differ by location and by study. In some programs, some of the expenses from participating in the clinical trial are reimbursed. In others, they are not. It is important to talk with the research team and your insurance company first to learn if and how your treatment in a clinical trial will be covered. Learn more about health insurance coverage of clinical trials.

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

Patient safety and informed consent

To join a clinical trial, people must participate in a process known as informed consent. During informed consent, the doctor should:

  • Describe all of the treatment options so that the person understands how the new treatment differs from the standard treatment.

  • List all of the risks of the new treatment, which may or may not be different than the risks of standard treatment.

  • Explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, the schedule of treatment, and any possible financial costs that a patient may have to pay.

Clinical trials also have certain rules called “eligibility criteria” that help structure the research and keep patients safe. You and the research team will carefully review these criteria together.

People who participate in a clinical trial may stop participating at any time for personal or medical reasons. 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 people 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 they choose to leave the clinical trial before it ends.

Finding a clinical trial

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

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer. For instance, clinical trials for head and neck cancers can be found at a patient advocacy group called SPOHNC (Supporting People with Head and Neck Cancer) and the U.S. government's ClinicalTrials.gov. (Please note that these 2 links take you to other, separate websites.)

PRE-ACT, Preparatory Education About Clinical Trials

In addition, you can find a free video-based educational program about cancer clinical trials in another section of this website.

The next section in this guide is Latest Research. It explains areas of scientific research for laryngeal and hypopharyngeal cancer. Use the menu to choose another section to continue reading this guide.

Laryngeal and Hypopharyngeal Cancer - Latest Research

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will read about the scientific research being done to learn more about laryngeal and hypopharyngeal cancers and how to treat them. Use the menu to see other pages.

Doctors are working to learn more about laryngeal and hypopharyngeal cancers, 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 best diagnostic and treatment options for you.

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

  • Targeted and tumor-specific therapy. More and more knowledge of the biology of cancer is leading to the development of targeted therapies, in addition to immunotherapy (see below). Many new drugs are in various stages of development.

  • Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Nivolumab and pembrolizumab have been approved to treat this disease (see Types of Treatment), and other types of immunotherapy drugs are being studied in clinical trials.

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

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

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

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 in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Coping with Treatment

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ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. Use the menu to see other pages.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment. People who are being treated for head and neck cancer may find it helpful to reach out to support groups that specialize in helping people being treated for laryngeal and hypopharyngeal cancer.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care" or "supportive care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for laryngeal and hypopharyngeal cancer are listed in the Types of Treatment section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Talk with your health care team regularly about how you are feeling. It is important to let them know about any new side effects or changes in existing side effects. If they know how you are feeling, they can find ways to relieve or manage your side effects to help you feel more comfortable and potentially keep any side effects from worsening.

You may find it helpful to keep track of your side effects so it is easier to explain any changes with your health care team. Learn more about why tracking side effects is helpful.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing your stress level. Sometimes, people find it difficult to express how they feel to their loved ones. Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer.

You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost of medical care stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Patients and their families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with laryngeal or hypopharyngeal cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis, including:

  • Providing support and encouragement

  • Talking with the health care team

  • Speaking with medical providers

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to and from appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you do not think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print out.

Looking for More on How to Track Side Effects?

Cancer.Net offers several resources to help you keep track of your symptoms and side effects. Please note that these links will take you to other sections of Cancer.Net:

  • Cancer.Net Mobile: The free Cancer.Net mobile app allows you to securely record the time and severity of symptoms and side effects.

  • ASCO Answers Managing Pain: Get this 36-page booklet about the importance of pain relief that includes a pain tracking sheet to help patients record how pain affects them. The free booklet is available as a PDF, so it is easy to print out.

  • ASCO Answers Fact Sheets: Read 1-page fact sheets on diarrhea and rash that provide a tracking sheet to record the timing and severity of the side effect. These free fact sheets are available as a PDF, so they are easy to print out.

The next section in this guide is Follow-up Care. It explains the importance of checkups after cancer treatment is finished. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Follow-Up Care

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Health care providers want to keep track of your recovery in the months and years ahead. 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, which is a new type of cancer that develops somewhere else in the body. These regular examinations can also help with the management of any late or long-term side effects from cancer treatment.

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

Learn more about the importance of follow-up care.

Watching for recurrence

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

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

The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. This is sometimes called “scan-xiety.” Learn more about how to cope with this type of stress.

Managing long-term and late side effects

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

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

Cancer rehabilitation

Rehabilitation is a major part of follow-up care after treatment for head and neck cancer. However, people should meet with all rehabilitation specialists before their 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. Many people who have been treated for head and neck cancer have difficulty eating. Listen to a podcast about managing eating challenges after treatment.

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

Sometimes rehabilitation requires developing a new voice. Options include:

  • Esophageal speech. Some people can learn to use the throat muscles of the esophagus to produce sound. This is called esophageal speech.

  • Electrolarynx. Some people use a mechanical battery-powered device called an electrolarynx to speak. This device produces vibration that is transmitted through the tissues of the neck or is delivered into the mouth through a plastic tube to produce speech.

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

Not every person is interested in or can learn all of these voice methods. It is important to meet with an experienced speech pathologist before surgery to understand what rehabilitation will be needed and to select the best method or methods for the individual, if necessary.

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

Keeping personal health records

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

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

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

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Survivorship

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will read about how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to see other pages.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

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

Survivorship is one of the most complicated parts of having cancer. This is because it is different for every person.

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

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

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

  • Understanding the challenge you are facing

  • Thinking through solutions

  • Asking for and allowing the support of others

  • Feeling comfortable with the course of action you choose

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

Changing role of caregivers

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

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

A new perspective on your health

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

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

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

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

Looking for More Survivorship Resources?

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

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The free booklet is available as a PDF, so it is easy to print out.

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

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

The next section offers Questions to Ask the Health Care Team to help start conversations with your cancer care team. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Questions to Ask the Health Care Team

Approved by the Cancer.Net Editorial Board, 01/2019

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

Talking often with the health care team 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 a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

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

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

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

  • Does my cancer need to be genetically tested?

  • Is my cancer curable? If not, why?

Questions to ask about choosing a treatment and managing side effects

  • What are my treatment options?

  • What clinical trials are available for 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?

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

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

  • 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 leading my overall treatment?

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

  • Can you recommend an oncologic dentist?

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

  • How should I treat symptoms related to dry mouth?

  • Can you recommend a speech pathologist?

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

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

  • Will treatment affect my ability to speak, eat, and swallow?

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

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

  • If I’m worried about managing the costs of cancer care, who can help me?

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

  • If I have questions or problems, who should I call?

Questions to ask about having surgery

  • What type of surgery will I have?

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

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

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

  • How long will the operation take?

  • How long will I be in the hospital?

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

  • Who should I contact about any side effects I experience? And how soon?

  • What are the possible long-term effects of having this surgery? Will this affect my ability to move my shoulder?

Questions to ask about having radiation therapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

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

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

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

  • What can be done to relieve the side effects?

Questions to ask about having systemic therapy using medication

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • Who should I contact about any side effects I experience? And how soon?

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

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

  • What kind of dental care do I need? How often should I see the dentist?

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

  • Do I need to make changes in my diet? Are there certain foods that I should avoid? Can I drink alcohol?

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

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

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

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

  • Who will be leading my follow-up care?

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

The next section in this guide is Additional Resources. It offers some more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.

Laryngeal and Hypopharyngeal Cancer - Additional Resources

Approved by the Cancer.Net Editorial Board, 01/2019

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. Use the menu to go back and see other pages.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer 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 links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Laryngeal and Hypopharyngeal Cancer. Use the menu to choose a different section to read in this guide.