Treatment for laryngeal cancer depends on the location, size, and extent of the tumor, but most often consists of surgery and/or radiation therapy. The doctor may recommend any of the following procedures:
For smaller, early-stage tumors, laser surgery, vocal cord stripping, or cordectomy may be recommended. For more advanced cases, a partial laryngectomy is often the surgical treatment of choice. Very advanced tumors may require a total laryngectomy to remove the entire larynx. The doctor may also recommend a neck dissection to remove lymph nodes in the neck, if lymphatic spread is suspected.
Endoscopic laser surgery
In this procedure, an endoscope (a thin tube with a camera and light on the end) is passed down the throat and a laser attached to a microscope is used to remove the tumor from the larynx.
Vocal cord stripping
Vocal cord stripping is a procedure in which the doctor removes tissue from the vocal cords layer by layer. This treatment may be effective in treating some stage 0 tumors of the glottis, with less side effects than a more extensive operation.
A cordectomy is surgery to remove part or all of the vocal cords. This procedure may be recommended for some small tumors on the glottis and can be performed using a laser.
In this procedure, a significant portion of the larynx is removed surgically. When performed with a laser, the tumor and surrounding normal tissues are removed through the mouth with the use of an operating microscope. This can be performed without any incisions in the neck. A partial laryngectomy can also be performed as an open procedure. In an open approach the doctor makes an incision in the neck to remove part of the larynx. Most people who have a partial laryngectomy require a tracheostomy, in which the doctor makes a hole in the neck (stoma) to breathe through during surgery and recovery. This stoma is usually temporary and after the patient recovers, the doctor will remove the tube and the hole will close on its own.
A total laryngectomy is surgery to remove the entire larynx. The larynx connects the mouth to the lungs, so after this procedure, the doctor will attach the windpipe (trachea) to a hole in the lower neck (stoma) for the patient to breathe through. For a total laryngectomy, a stoma is permanent. After this procedure the patient will not be able to speak normally, and should speak with the doctor about options for regaining some voice function.
A neck dissection is a procedure to comprehensively remove the lymph nodes in the neck. In this procedure, the doctor removes the lymph nodes that are closest to the larynx that the cancer is most likely to spread to. If these contain cancer, the doctor will then remove the rest of the lymph nodes in the neck. The doctor may also need to remove nearby structures in the neck, such as muscle, nerves, and veins.
After a total laryngectomy, you will no longer be able to speak normally. After the vocal cords have been removed you will have a hole in your neck to breathe through so air can no longer travel up past the larynx to create speech. Ask the doctor about the following procedures that may help you regain some speech function:
Tracheo-esophageal puncture (TEP)
A TEP is often the recommended procedure to regain speech after a laryngectomy. The doctor will create a small hole called a fistula at the back of the stoma (the breathing hole in your neck), thus creating an opening between the windpipe and esophagus. The doctor will then place a small, one-way valve (voice prosthesis) into the hole. This valve allows the patient to push air from the lungs, up through the valve into the upper esophagus, and up into the mouth in order to create speech. The patient may need to cover the stoma while speaking so the air will travel through the valve and not out of the hole.
An electrolarynx is a battery-powered machine that creates sound/voice for you. You can either place the machine on your neck or place a small tube in the corner of your mouth. When you press a button, the machine will detect vibrations and create sound. You can then move your mouth and tongue to turn the sound into words.
Esophageal speech is a technique that may help patients regain some speech. As air moves down the esophagus, it passes over muscles in the throat and makes vibrations. Patients can learn to control these vibrations in order to create speech. You may need to work with a speech language pathologist to learn and practice this technique.
The doctor may also recommend any of the following treatments:
Radiation therapy uses waves of high energy rays produced by a machine to destroy cancer cells. Radiation therapy may be the primary treatment for small, early-stage laryngeal tumors. Radiation therapy can cure these tumors on its own in many cases. Radiation therapy is also often given after surgery, to reduce the risk of a recurrence/prevent the cancer from coming back. Radiation therapy may be combined with chemotherapy or biological therapy for locally advanced tumors. For most tumors of the larynx, radiation therapy, often with chemotherapy, allow for complete eradication of the tumor while preserving the voice box. Radiation therapy may also be used palliatively to shrink tumors and relieve symptoms.
Proton beam radiation therapy
Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects.
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy may be combined with radiation therapy to make both treatments more effective. Chemotherapy may also be given before surgery or radiation therapy in order to shrink the tumor. Chemotherapy is sometimes combined with radiation therapy (chemoradiation) and used as primary treatment for advanced/widespread tumors. Some patients require chemotherapy after surgery, in combination with radiotherapy, for advanced cancers.
Some cases of laryngeal cancer contain cells that over-express certain proteins (EGFR protein) that cause the cancer to grow more aggressively. A form of biological therapy called monoclonal antibodies specifically targets these cells, preventing them from fueling cell growth.
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.