Note: This is for informational purposes only. Doctors cannot provide a diagnosis or individual treatment advice via e-mail. Please consult your physician about your specific health care concerns.
If a patient has cancer of the larynx, the doctor will do more tests to find
out if cancer cells have spread to other parts of the body. This process is
called staging, and it helps the doctor to plan the patient’s treatment.
In cancer of the larynx, the definitions of the early stages depend on where
the cancer started.
The following stages are used to describe cancer of the larynx:
Stage 1: The cancer is only in the area where it started and has not
spread to lymph nodes in the area or to other parts of the body. (Lymph nodes
are small bean-shaped structures that are found throughout the body; they produce
and store infection-fighting cells.) The exact definition of Stage I depends
on where the cancer started, as follows:
Supraglottis: The cancer is only in one area of the supraglottis
and the vocal cords can move normally. Treatment may be one of the following:
External beam radiation therapy
Surgery to remove the supraglottis (supraglottic laryngectomy)
Surgery to remove the larynx (total laryngectomy)
Glottis: The cancer is only in the vocal cords and the vocal cords
can move normally. Treatment may be one of the following:
Radiation therapy
Surgery to take out a vocal cord (cordectomy)
Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy
Laser surgery
Subglottis: The cancer has not spread outside of the subglottis.
Treatment will probably be radiation therapy. In some cases, a hemilaryngectomy
may be done.
Stage II: The cancer is only in the larynx and has not spread to lymph
nodes in the area or to other parts of the body. The exact definition of Stage
II depends on where the cancer started, as follows:
Supraglottis: The cancer is in more than one area of the supraglottis,
but the vocal cords can move normally. Treatment may be one of the following:
External beam radiation therapy
Surgery to remove the supraglottis (supraglottic laryngectomy) or the
entire larynx (laryngectomy)
Radiation therapy given after surgery
A clinical trial of several small doses of radiation per day (hyperfractionated
radiation therapy)
A clinical trial of chemoprevention therapy to prevent a second cancer
in the mouth, throat, windpipe, nose or esophagus
Glottis: The cancer has spread to the supraglottis or the subglottis
or both. The vocal cords may or may not be able to move normally. Treatment
may be one of the following:
Radiation therapy
Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy
A clinical trial of several smaller doses of radiation per day (hyperfractionated
radiation therapy)
A clinical trial of chemoprevention therapy to prevent a second cancer
in the mouth, throat, windpipe, nose or esophagus
Subglottis: The cancer has spread to the vocal cords, which may or
may not be able to move normally. Treatment may be one of the following:
Radiation therapy
Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy.
A clinical trial of several smaller doses of radiation per day (hyperfractionated
radiation therapy)
A clinical trial of chemoprevention therapy to prevent a second cancer
in the mouth, throat, windpipe, nose or esophagus
Stage III: At Stage III, laryngeal cancer may have either of the following
characteristics:
The cancer has not spread outside of the larynx, but the vocal cords cannot
move normally, or the cancer has spread to tissues next to the larynx.
The cancer has spread to one lymph node on the same side of the neck as
the cancer, and the lymph node measures no more than three centimeters (just
over one inch).
Treatment may be one of the following:
For the supraglottis or glottis:
Surgery to remove the cancer, with or without radiation therapy
Radiation therapy (surgery to remove the larynx may be needed if the
cancer does not shrink after radiation)
A clinical trial of several smaller doses of radiation per day (hyperfractionated
radiation therapy)
A clinical trial of chemotherapy followed by radiation therapy or chemotherapy
combined with radiation therapy (surgery to remove the larynx may be needed
if the cancer does not shrink after chemotherapy and radiation)
Clinical trials of chemotherapy, the use of drugs to make the cancer
cells more sensitive to radiation (radiosensitizers), or new forms of
radiation
Chemoprevention therapy to prevent a second cancer in the mouth, throat,
windpipe, nose or esophagus
For the subglottis:
Surgery to remove the larynx (total laryngectomy), some of the tissue
around it, the thyroid gland (preserving the parathyroid glands located
near the thyroid), and the lymph nodes in the neck (usually followed by
radiation therapy)
Radiation therapy, if a patient cannot have surgery
A clinical trial of several smaller doses of radiation per day (hyperfractionated
radiation therapy)
Clinical trials of chemotherapy, the use of drugs to make the cancer
cells more sensitive to radiation (radiosensitizers), or new forms of
radiation
Chemoprevention therapy to prevent a second cancer in the mouth, throat,
windpipe, nose or esophagus
Stage IV: At Stage IV, laryngeal cancer may have any of the following
characteristics:
The cancer has spread to tissues around the larynx, such as the pharynx
or the tissues in the neck. The lymph nodes in the area may or may not contain
cancer.
The cancer has spread to more than one lymph node on the same side of the
neck as the cancer, to lymph nodes on one or both sides of the neck, or to
any lymph node that measures more than six centimeters (over two inches).
The cancer has spread to other parts of the body.
Treatment may be one of the following:
For the supraglottis or glottis:
Surgery to remove the larynx (laryngectomy) followed by radiation therapy
A clinical trial of several smaller doses of radiation per day (hyperfractionated
radiation therapy)
A clinical trial of chemotherapy followed by radiation therapy or chemotherapy
combined with radiation therapy (surgery to remove the larynx may be needed
if the cancer does not shrink after chemotherapy and radiation)
Clinical trials of chemotherapy, the use of drugs to make the cancer
cells more sensitive to radiation (radiosensitizers), or new forms of
radiation
Chemoprevention therapy to prevent a second cancer in the mouth, throat,
windpipe, nose or esophagus
For the subglottis:
Total laryngectomy, removal of the thyroid gland, and removal of some
of the tissue around the larynx and the lymph nodes in the neck (surgery
is usually followed by radiation therapy)
Radiation therapy, if a patient cannot have surgery
A clinical trial of several smaller doses of radiation per day (hyperfractionated
radiation therapy)
A clinical trial of chemotherapy and hyperfractionated radiation therapy
given at the same time
Clinical trials of chemotherapy, the use of drugs to make the cancer
cells more sensitive to radiation (radiosensitizers), or new forms of
radiation
Chemoprevention therapy to prevent a second cancer in the mouth, throat,
windpipe, nose or esophagus
Recurrent: Recurrent cancer is cancer that has come back (recurred)
after it has been treated. It may come back in the larynx or in another part
of the body. Treatment depends on the kind of treatment the patient had when
first treated. If the previous treatment was surgery alone, the patient may
have surgery again or radiation therapy. If the previous treatment was radiation
therapy alone, the patient may have radiation therapy again or surgery. If the
patient failed surgery and radiation therapy, clinical trials of chemotherapy
may be given to relieve symptoms.
About the Treatments and Side Effects
The primary treatment options for patients with cancer of the larynx are:
Because the larynx helps people with breathing, eating, and talking, a patient
may need special help adjusting to the side effects of the cancer and its treatment.
A patient may need to learn a new way of talking, or may need a special device
to help with talking. The patient’s doctor will consult with several kinds
of doctors who can help determine the best treatment. Trained medical staff
can also help the patient recover from treatment and adjust to new ways of eating
and talking.
Radiation Therapy
Radiation therapy is the use of high-energy x-rays to kill cancer cells and
shrink tumors. Radiation may come from a machine outside the body (external
radiation therapy) or from putting materials that produce radiation (radioisotopes)
through thin plastic tubes into the area where the cancer cells are found (internal
radiation therapy).
External radiation to the thyroid or the pituitary gland may change the way
the thyroid gland works. The doctor may wish to test the thyroid gland before
and after therapy to make sure it is working properly.
Two newer radiation therapies involve using drugs with the radiation therapy
to make the cancer cells more sensitive to radiation (radiosensitization) and
giving radiation therapy in several small doses per day (hyperfractionated radiation
therapy). Patients who stop smoking before starting radiation therapy has a
better chance of surviving longer.
Side effects of radiation therapy: The most common side effects of radiation
therapy are tiredness, skin reactions in the treated areas (such as a rash or
redness), and loss of appetite. Radiation therapy may also cause a decrease
in the number of white blood cells that help protect the body against infection.
Most of these side effects can be treated or controlled and in most cases they
are not permanent.
Surgery
Surgery is a common treatment for cancer of the larynx. A doctor may remove
the cancer and part of the larynx using one of the following operations:
A cordectomy takes out only the vocal cord
A supraglottic laryngectomy takes out only the supraglottis
A partial or hemilaryngectomy removes only part of the larynx
A total laryngectomy removes the entire larynx. During this operation, a
hole is made in the front of the neck to allow the patient to breathe. This
is called a tracheostomy. If cancer has spread to lymph nodes, the lymph nodes
will be removed (lymph node dissection).
Laser surgery is being tested for very early cancers of the larynx. During
laser surgery, a narrow, intense beam of light is used to cut out the cancer.
Side effects of surgery: The side effects of surgery depend on the location
of the tumor and the type of operation, among other factors. Although patients
are often uncomfortable during the first few days after surgery, this pain can
usually be controlled with medicine. The recovery period after an operation
varies from patient to patient.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs
are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy
is a systemic treatment, meaning that the drugs flow through the bloodstream
to nearly every part of the body to kill cancerous cells. It is generally given
in cycles: A treatment period is followed by a recovery period, then another
treatment period, and so on.
People with laryngeal cancer have a higher risk of getting other cancers in
the head and neck area. Clinical trials of chemoprevention therapy are testing
whether certain drugs can prevent second cancers from developing in the mouth,
throat, windpipe, nose, or esophagus (the tube that connects the throat to the
stomach).
Side effects of chemotherapy: Chemotherapy drugs generally fight rapidly
dividing cells in the body. Cells that divide rapidly include both the targeted
cancer cells and healthy cells in the blood, digestive tract, and hair follicles.
Depending on which anticancer drugs a patient receives, he or she may experience
symptoms when healthy cells are damaged along with the cancer cells. If healthy
blood cells are destroyed by chemotherapy, the patient may be more susceptible
to infections, bruising or bleeding, and fatigue.
When cells in the hair roots or digestive tract are affected by anticancer
drugs, the patient may have hair loss, nausea, vomiting, or mouth sores. Not
all chemotherapy patients develop all of these side effects, and the symptoms
usually go away during the recovery period or after the treatments are done.
Doctors can prescribe medicines and other treatments to control most of the
symptoms.
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