To help doctors give their patients the best possible care, ASCO asks its medical experts to develop recommendations for specific areas of cancer care. ASCO recently issued a clinical practice guideline about larynx preservation. This patient guide is based on ASCO's recommendations.

As you read this guide, please keep in mind that every person treated for cancer is different. These recommendations are not meant to replace your or your doctors' judgment. The final decisions you and your doctors make will be based on your individual circumstances.

Information in ASCO's patient education materials is not intended as medical advice or as a substitute for the treating doctor's own professional judgment; nor does it imply ASCO endorsement of any product or company.

Cancer of the larynx (laryngeal cancer) is one of the most common cancers of the head and neck. The larynx is a tube-shaped organ in the neck located at the top of the windpipe that is important for breathing, talking, and swallowing. The larynx opens during breathing to allow air to pass into the lungs. It also contains vocal cords that vibrate to make sound for speech production.

The larynx consists of three parts, and cancer may occur in any of the following areas:

• Supraglottis, which is the area above the vocal cords
  
  
• Glottis, which is the middle section that holds the vocal cords
  
  
• Subglottis, which is the area below the vocal cords that connects the larynx to the windpipe

Larger image

Because of the function and location of the larynx, cancer of the voice box and its treatment can affect breathing, talking, and eating. Larynx preservation therapy refers to treatment that maintains the function of the larynx. Examples of larynx preservation therapies include:

• Radiation therapy
  
  
• Chemoradiation therapy (giving radiation therapy along with chemotherapy)
  
  
• Partial laryngectomy (surgery that removes part of the larynx)

A total laryngectomy is surgery that removes the entire larynx. After a laryngectomy, patients can no longer speak using their vocal cords. For some patients, a total laryngectomy may be the best option to treat the cancer or a recurrence (return) of cancer.

The recommendations for larynx preservation include the following:

• The first approach to the treatment of nearly all patients with T1 or T2 (early stage) laryngeal cancer should be to preserve the larynx.



• The most widely applicable approach for preserving the larynx while treating patients with T3 or T4 (late stage) laryngeal cancer that does not extend outside the voice into the surrounding soft tissue is chemoradiation therapy.



• Laryngeal cancer is best treated with a specialized team of doctors and other health-care professionals who can provide support and rehabilitative services, such as a head and neck surgeon; radiation and medical oncologists; nurses; experts in speech, swallowing, and hearing rehabilitation; social workers; and dietitians.



• Patients are encouraged to talk with their doctors about the risks and benefits of various treatment options when comparing treatments that preserve the larynx with total laryngectomy.

There are several treatment options to preserve the larynx and the ability to speak. Patients are encouraged to discuss with their doctors the risks, benefits, and effectiveness of each treatment option when deciding on treatment strategy. In addition, research has shown that not smoking and/or drinking alcohol during and after cancer treatment improves the results of treatment.

• What is my diagnosis, including type and stage of cancer?



• What are the options for treatment that would preserve my larynx and my ability to speak?



• How effective are they compared with laryngectomy (removal of the larynx)?



• What are the risks and benefits of these treatment options?



• Is there a chance I may lose my larynx in the future?



• How long will I need to recover from treatment?



• Are there rehabilitative services to help me manage the side effects of treatment?



• Am I eligible for a clinical trial?



• Where can I find more information?

Read the entire clinical practice guideline published in the August 1, 2006 issue of the Journal of Clinical Oncology (JCO).

Download a slide presentation from the guideline created for oncologists and other health-care professionals.

Cancer.Net Guide to Laryngeal and Hypopharyngeal Cancer

Cancer.Net (www.cancer.net) is the comprehensive, oncologist-approved cancer information website from ASCO. Visit Cancer.Net to find guides on more than 90 types of cancer, clinical trials information, coping resources, information on managing side effects, a live online chat series, medical illustrations, cancer information in Spanish, the latest cancer news, and much more. For more information about ASCO's patient information resources, call toll free 888-651-3038.

American Cancer Society
1599 Clifton Rd., NE
Atlanta, GA 30329-4251
Toll Free: 800-ACS-2345 (800-227-2345)
TTY: 866-288-4327
Tel: 404-320-3333
www.cancer.org

CancerCare
275 Seventh Ave.
New York, NY  10001
Toll Free: 800-813-HOPE (4673)
Tel: 212-712-8400
Fax: 212-712-8495
www.cancercare.org

Support for People with Oral, Head, and Neck Cancer
P.O. Box 53
Locust Valley, NY  11560-0053
Toll Free: 800-377-0928
Tel: 516-759-5333
Fax: 516-671-8794
www.spohnc.org

Copyright 2006 American Society of Clinical Oncology