The larynx, commonly called the voice box, is a tube-shaped organ in the neck that is important for breathing, talking, and swallowing. It is located at the top of the windpipe or trachea. The front walls protrude from the neck to form what most people call the Adam's apple. During breathing, the larynx opens like a valve to allow air to pass into the lungs. During swallowing, the vocal cords or folds come together and with the epiglottis protect the airway and prevent food from entering to the lungs. The larynx contains the vocal cords or folds that vibrate to make sound for speech production. Cancer can develop in any of these three parts of the larynx:
Glottis. Middle section that holds the vocal cord
Supraglottis. Area above the vocal cords
Subglottis. Area below the vocal cords, which connects the larynx to the windpipe
The hypopharynx (also called the gullet) is the lower part of the throat and surrounds the larynx. The pharynx (throat) is a hollow tube about 5 inches long that starts behind the nose (nasopharynx) and ends at the level of the larynx (laryngopharynx). It is continuous with the esophagus (the tube that goes to the stomach).
Cancer occurs in the larynx and/or hypopharynx when normal cells begin to change, grow without control, and no longer die, forming a mass of cells called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous). Malignant tumors can invade nearby tissues and/or spread (metastasize) to other parts of the body. Cancers of the larynx and hypopharynx and their treatments can have a significant impact on talking and eating.
About 95% of all cancers of the larynx and hypopharynx are of the squamous cell carcinoma type, meaning they begin in the flat, squamous cells in the lining of the organs.
Laryngeal and hypopharyngeal cancer is among the five main types of cancer in the head and neck region, a grouping called head and neck cancer.
Statistics
Laryngeal cancer is one of the most common head and neck cancers. In 2008, an estimated 12,250 adults (9,680 men and 2,570 women) in the United States will be diagnosed with laryngeal cancer. It is estimated that 3,670 deaths (2,910 men and 760 women) from this disease will occur this year. In 2008, an estimated 2,400 adults (1,900 men and 500 women) in the United States will be diagnosed with hypopharyngeal cancer.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with laryngeal or hypopharyngeal cancer. Because statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Statistics adapted from the American Cancer Society’s publication, Cancer Facts & Figures 2008.
A risk factor is anything that increases a person's chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can 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 communicating them to your doctor may help you make more informed lifestyle and health-care choices.
Two factors greatly increase the risk of laryngeal and hypopharyngeal cancer:
Tobacco use. Use of tobacco, including cigarettes, cigars, pipes, chewing tobacco, and snuff, is the single largest risk factor for head and neck cancer.
Alcohol. Frequent and heavy consumption of alcohol increases the risk of laryngeal and hypopharyngeal cancer.
Eighty-five percent (85%) of head and neck cancer is linked to tobacco use. Using alcohol and tobacco together increases this risk even more. Second-hand smoke may also increase a person's risk of head and neck cancer. Recent research suggests that people who have used marijuana may be at higher risk for head and neck cancer.
Other factors that can raise a person's risk of developing laryngeal and hypopharyngeal cancer include:
Gender. Men are four to five 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 the disease.
Race. Black people are more likely than white people to develop laryngeal and hypopharyngeal cancer.
Occupational inhalants. Exposure to asbestos, wood dust, paint fumes, and certain chemicals may increase a person's risk of laryngeal and hypopharyngeal cancer.
Poornutrition. 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 laryngeal and hypopharyngeal cancer.
Gastroesophageal reflux disease (GERD). Chronic reflux of stomach acid into the larynx and pharynx may lead to laryngeal and hypopharyngeal cancer. This may or may not be associated with the symptoms of heartburn.
Human papillomavirus (HPV). Exposure to this virus may be a risk factor for laryngeal and hypopharyngeal cancer. HPV is passed from one person to another during sexual intercourse.
Plummer-Vinson syndrome. This rare condition involves iron deficiency and causes difficulty swallowing. The presence of this disease increases the risk of hypopharyngeal cancer.
Prevention and Early Detection
Although some of the risk factors for laryngeal and hypopharyngeal cancer cannot be changed, many risks can be avoided by making certain lifestyle changes. 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.
People who use alcohol and tobacco should receive a general screening examination at least once a year. 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.
People with laryngeal or hypopharyngeal cancer may experience the following symptoms. Sometimes, people with laryngeal or hypopharyngeal cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
Hoarseness or change in voice (often an early symptom)
An enlarged lymph node
Lump in the neck
Airway obstruction, difficulty breathing, and noisy breathing
Persistent sore throat, or a feeling that something is caught in the throat
Persistent difficulty in swallowing
Ear pain
Chronic bad breath
Choking
Unexplained weight loss
Fatigue
People who notice any of these symptoms should consult a doctor and/or dentist, especially if the symptoms are persistent or get worse. When detected early, laryngeal and hypopharyngeal cancer can often be treated successfully while preserving the function of the larynx and/or hypopharynx.
Because many of these symptoms can also be caused by other noncancerous health conditions, it is always important to receive regular health and dental screenings, especially for those who routinely drink alcohol or currently use tobacco products or have used them in the past.
Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
The following tests may be used to diagnose laryngeal and hypopharyngeal cancer:
Physical examination. The doctor will feel for any lumps in the neck, lip, gums, and cheek. The doctor will inspect the nose, mouth, throat, and tongue for abnormalities and often use a mirror for a clearer view of these structures. Though there is no specific blood test that detects laryngeal or hypopharyngeal cancer, several tests, including blood and urine tests, may be done to determine the diagnosis and establish the extent of the disease.
Laryngoscopy. This test can be performed in three ways. In an indirect laryngoscopy, the doctor sprays the throat with a local anesthetic to prevent gagging and then uses a small, long handled mirror to see the vocal cords. In a fiberoptic laryngoscopy, the doctor inserts a lighted tube through the person's nose or mouth and down the throat to view the larynx and hypopharynx. In a direct laryngoscopy, done in an operating room, the person receives a sedative or general anesthetic. The doctor then views the larynx and hypopharynx using an instrument called a laryngoscope. A sample of tissue for a biopsy 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 and, the trachea and the bronchus located next to the lung and the esophagus.
Videostroboscopy. This fiberoptic video technique is used so the doctor can see the larynx. It is performed in the same way as the indirect laryngoscopy. It is used to view the vocal cords and can detect motion abnormalities and other changes, including changes in vibration. Videostroboscopy helps to determine the location and size of a tumor, as well as how the tumor has affected the function of the larynx and hypopharynx.
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. In a fine needle aspiration biopsy, cells are withdrawn using a thin needle inserted directly into the tumor. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
The following imaging tests may be used to determine if the cancer has metastasized:
X-ray. An x-ray is a picture of the inside of the body. Sometimes, the patient will be asked to swallow barium, which coats the mouth and throat, to enhance the image on the x-ray (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. A dentist may extensive take x-rays of the teeth, mandible (jawbone), and maxilla (upper jaw), including a panorex (panoramic view). Any signs of cancer may be followed with a computed tomography scan.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, an iodine-based contrast medium (a special dye) is injected into a patient's vein to provide better detail.
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.
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 lymph nodes in the neck (cervical lymph nodes).
Radionuclide bone scan. In a radionuclide bone scan, a small amount of radioactive material is injected into a patient's vein and a special camera is used to determine whether the cancer has spread to the bones. In head and neck cancer, bone scans are recommended if there are signs of bone metastasis.
Positron emission tomography (PET) scan. In a PET scan, radioactive sugar molecules are injected into the body. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from a CT scan, an MRI, and a physical examination. PET scanning is used to detect cancer in other organs or a hidden primary tumor. PET scanning is recommended when the cancer is relatively advanced, and it is often used following initial treatment to determine if all of the cancer was eliminated.
Staging is a way of describing cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine 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 (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. 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. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.
TX: Indicates the primary tumor cannot be evaluated.
T0: No evidence of a tumor is found.
Tis: Describes a stage called carcinoma (cancer) in situ. This is a very early cancer where cancer cells are found only in one layer of tissue.
When describing a later stage tumor, doctors divide the larynx into three regions: the glottis, the supraglottis, and the subglottis.
Glottis tumor
T1: Describes a tumor that is limited to the vocal cords, but it does not affect movement of the cords.
T1a: Describes a tumor in just the right or left vocal cord.
T1b: Describes a tumor in both vocal cords.
T2: Describes a tumor that has spread to the supraglottis and/or the subglottis. T2 also describes a tumor that affects the movement of the vocal cords, without paralyzing the cord.
T3: Describes a tumor that is limited to the larynx and paralyzes at least one of the vocal cords.
T4a: The tumor has spread to the thyroid cartilage and/or the tissue beyond the larynx.
T4b: The tumor has spread to the chest area and encases the arteries.
Supraglottis tumor
T1: Describes a tumor located in a single area above the vocal cords that doesn't affect movement of the vocal cords.
T2: Describes a tumor that started in the supraglottis, but has spread to the mucus membranes that line other areas, such as the base of the tongue.
T3: Describes a tumor that is limited to the larynx with vocal cord involvement and/or has spread to surrounding tissue.
T4a: The tumor has spread through the thyroid cartilage and/or the tissue beyond the larynx.
T4b: The tumor has spread to the chest area and encases the arteries.
Subglottis tumor
T1: Describes a tumor that is limited to the subglottis.
T2: Describes a tumor that has spread to the vocal cords and may or may not affect movement of the cords.
T3: Describes a tumor that is limited to the larynx and affects the vocal cords.
T4a: The tumor has spread to the cricoid or thyroid cartilage and/or the tissue beyond the larynx.
T4b: The tumor has spread to the chest area and encases the arteries.
Hypopharynx
T1: Describes a small tumor, not larger than 2 centimeters (cm), that is limited to a single site in the lower throat.
T2: Describes a tumor that involves more than one site in the lower throat, but does not touch the voice box; or, a tumor that measures larger than 2 cm, but not larger than 4 cm.
T3: Describes a tumor that is larger than 4 cm or a tumor that has spread to the larynx.
T4a: Describes a tumor that has spread into nearby structures, such as the thyroid, the arteries that carry blood to the brain, or the esophagus.
T4b: The tumor has spread to the prevertebral fascia, encases the arteries, or involves mediastinal structures.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that 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 nodes in the head and neck area, careful assessment of lymph nodes is an important part of staging.
NX: Indicates that the regional lymph nodes cannot be evaluated.
N0: There is no evidence of cancer in the regional nodes.
N1: Indicates that cancer has spread to a single node on the same side as the primary tumor and the cancer found in the node is 3 cm or smaller.
N2: Describes any of the following conditions:
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.
N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measure larger than 6 cm.
N2c: Cancer has spread to more than one lymph node on either side of the body, and none measure larger than 6 cm.
N3: Indicates that the cancer found in the lymph nodes is larger than 6 cm.
Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body.
MX: Indicates that distant metastasis cannot be evaluated.
M0: Indicates that the cancer has not spread to other parts of the body.
M1: Describes cancer that has spread to other parts of the body.
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications.
Stage 0: Describes a carcinoma in situ (Tis), with no spread to lymph nodes (N0) or distant metastasis (M0).
Stage III: Describes any larger tumor (T3), with no spread to regional lymph nodes (N0) or metastasis (M0), or a smaller tumor (T1, T2) that has spread to regional lymph nodes (N1) but has no sign of distant metastasis (M0).
Stage IVA: Describes any invasive tumor (T4a), with either no lymph node involvement (N0) or spread to only a single same-sided lymph node (N1), but no metastasis (M0). It is also used for any cancer (T) with more significant spread to the lymph nodes (N2), but no metastasis (M0).
Tumor grade. Doctors also describe a primary tumor by its grade, which is determined by using a microscope to examine tissue from a tumor. The doctor compares the tumor tissue with normal tissue. Normal tissue contains many different types of cells grouped together, which is called differentiated. Tissue from tumors usually has cells that look more alike, called poorly differentiated. Generally, the more differentiated the tissue, the better the prognosis.
GX: Indicates the grade cannot be evaluated.
G1: Indicates the cells look more like normal tissue (well differentiated).
G2: The cells are only moderately differentiated.
G3: The cells don't resemble normal tissue (poorly differentiated).
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
The treatment of laryngeal and hypopharyngeal cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient's overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.
Laryngeal and hypopharyngeal cancer can often be cured, especially if it is found early. Although curing 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 treatment might affect a person's quality of life, including how a person feels, looks, talks, eats, and breathes.
Head and neck cancer specialists often form a multidisciplinary team to care for each person, and an evaluation should be done by each specialist before any treatment begins. The team may include medical and radiation oncologists, surgeons, otolaryngologists (ear, nose, and throat doctors), maxillofacial prosthodontists, dentists, physical therapists, speech pathologists, audiologists, psychiatrists, nurses, dietitians, and social workers. Diagnostic radiologists and pathologists are an integral part of the treatment team because they assist with diagnosis and staging.
There are three main treatment options for laryngeal and hypopharyngeal cancer: surgery, radiation therapy, and chemotherapy. One or a combination of these therapies may be used to treat the cancer. Currently, surgery and radiation therapy are the most common forms of treatment for laryngeal and hypopharyngeal cancer. Chemotherapy may be used in combination with radiation therapy to increase the chance of destroying any cancer cells that may remain after surgery.
Surgery
During surgery, the doctor performs an operation to remove the cancerous tumor and some of the healthy tissue around it (called a margin). The goal of surgery is to remove the entire tumor and leave negative margins (no trace of cancer in the healthy tissue). Sometimes it is not possible to completely remove the cancer.
The most common surgical procedures used to treat laryngeal and hypopharyngeal cancer include:
Partiallaryngectomy. The removal of part of the larynx, preserving the voice. The following are some of the different types of partial laryngectomies:
Supraglottic laryngectomy. The removal of the area above the vocal cords. If part of the hypopharynx is to be removed with the cancer, this is called a partial pharyngectomy.
Cordectomy. The removal of a vocal cord.
Vertical hemilaryngectomy. The removal of one side of the larynx.
Supracricoid partial laryngectomy. The removal of the vocal cords and the area surrounding them.
Total laryngectomy. The removal of the entire larynx. During this operation, a hole called a stoma is made in the front of the neck through the windpipe to allow the person to breathe. This is called a tracheostomy (see below). People no longer can speak using their vocal cords after a total laryngectomy. However, a speech pathologist can teach people to speak in a different way after the surgery.
Laryngopharyngectomy. A laryngopharyngectomy is the removal of the entire larynx, including the vocal cords, 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 cords and they may also have difficulty swallowing after laryngopharyngectomy. However, speech pathologists can help people learn to speak and swallow afterward.
Tracheostomy. In both partial and total laryngectomies, the surgeon makes a hole called a stoma in the front of the neck into the windpipe or trachea and inserts a tube to keep the hole open. Air enters and leaves the windpipe (trachea) and lungs through the stoma, allowing the person to breathe.
In a partial laryngectomy, the stoma is usually temporary. After recovery from the partial laryngectomy, the tube is removed, the hole heals closed, 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.
In a total laryngectomy, the stoma is permanent, and the person breathes through the stoma and must learn to speak in a new way.
Neck dissection. If cancer has spread to the lymph nodes in the neck, a neck dissection may be necessary. There are several types of neck dissections, depending on the stage and location of the cancer. Some or all the lymph nodes in the neck may have to be removed (partial neck dissection, modified neck dissection, selective 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 surgery.
Laser surgery. Laser surgery uses a beam of light to remove the tumor, similar to the way a scalpel would remove a tumor. Such a tool can remove a small tumor of the larynx and perform a partial laryngectomy. This tool is a relatively new treatment approach not yet widely used, and it should be performed by an experienced doctor.
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.
Surgery may cause permanent loss of voice or impaired speech, difficulty swallowing or talking, 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. It is very important that people are assisted with their rehabilitation of lost or altered functions. This may take time and require the expertise of different members of the treatment team.
Radiation therapy
Radiation therapy is the use of high energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A new method of external radiation therapy, known as intensity modulated radiation therapy (IMRT), allows for more effective doses of radiation therapy to be delivered while reducing the damage to healthy cells, thus causing fewer side effects. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
Radiation therapy can be the main treatment for head and neck cancer or used postoperatively (used after surgery) to destroy small pockets of cancer that cannot be removed surgically.
Before beginning radiation therapy for any head and neck cancer, people should receive a thorough examination from an oncologic dentist (a dentist with experience in treating people with head and neck cancer). Since radiation therapy can cause tooth decay, damaged teeth may need to be removed. Often, tooth decay can be prevented with proper treatment from a dentist before beginning radiation therapy. People should also receive an evaluation from a speech pathologist who has experience treating people with head and neck cancer. Since radiation therapy can cause swelling and scarring, voice and swallowing are often affected.
Radiation therapy to the head and neck may cause the following side effects:
Redness or skin irritation to the treated area
Swelling
Dry mouth or thickened saliva, from damage to salivary glands (this can be temporary or permanent)
Bone pain
Nausea
Fatigue
Mouth sores and/or sore throat
Dental problems (usually preventable, see above)
Painful 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
Buildup of earwax which dries out because of the radiation therapy's effect on the ear canal
Scarring (fibrosis)
Radiation therapy may also cause a condition called hypothyroidism, in which the thyroid gland (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.
Most long-term side effects of radiation therapy can be prevented or reduced. Evaluation by all members of the multidisciplinary treatment team before radiation therapy begins is important to prevent long-term problems.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body.
For laryngeal and hypopharyngeal cancer, chemotherapy may be used as a neoadjuvant therapy (treatment before surgery, radiation therapy, or both) or an adjuvant therapy (treatment after surgery, radiation therapy, or both).
The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, nausea and vomiting, loss of appetite, diarrhea, dry mouth, hearing loss, and open sores in the mouth that can lead to infections.
Concomitant chemoradiotherapy
Depending on the stage of the cancer, concomitant chemoradiotherapy (a combination of chemotherapy and radiation therapy) may be used to avoid a laryngectomy, preserving the larynx and its ability to function. For many people, this is the preferred standard treatment option; however, concurrent chemotherapy and radiation therapy can cause more side effects.
There are new data supporting the use of induction chemotherapy (initial treatment before surgery or radiation therapy) and cetuximab (Erbitux) with radiation therapy. This may be an option for some patients who cannot receive chemoradiotherapy.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
Recurrent cancer
Recurrent cancer is cancer that comes back after treatment. Most recurrences at the original cancer site and in the neck happen in the first 18 to 24 months. If the diagnostic examination identifies a recurrence or persistence of cancer, new testing is necessary before attempting further treatment. Tumor spread and growth at distant organs (M1, or distant metastasis) calls for individual evaluation and treatment. People who stop smoking, preferably before treatment begins, have a better chance of surviving longer.
Smoking during cancer treatment
Even after being diagnosed with cancer, quitting smoking is still helpful. Continuing to smoke during cancer treatment may decrease the effectiveness of treatment, cause a second cancer to develop, and worsen treatment side effects, such as diminished voice control. Even people who have recently quit are more likely to recover better than individuals who continue to smoke. For more information on ways to quit smoking and why it's important to quit, read Cancer.Net's Feature: Resources to Help You Quit Smoking.
The National Comprehensive Cancer Network (NCCN) has a series of treatment guidelines that have been translated into patient-friendly language. In accordance with Cancer.Net's Linking Policy, please note that this link does not imply ASCO's endorsement of the content, but rather it is an effort to provide additional information that may be helpful to people living with cancer and their families. The NCCN treatment guide for laryngeal and hypopharyngeal cancer can be found at www.nccn.org.
Doctors and scientists are always looking for better ways to treat patients with laryngeal and hypopharyngeal cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make 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 and hypopharyngeal cancer.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about Clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.
Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person's overall health.
Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with your doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net's section on Managing Side Effects, based on ASCO's curriculum.
In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net's section on Caring for the Whole Patient.
For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor.
After treatment for laryngeal or hypopharyngeal cancer, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years.
People should receive regular follow-up medical and dental examinations to check for signs of recurring cancer, second primary cancer (cancer somewhere else in the body), and to manage any late or long-term side effects from cancer treatment.
A common follow-up schedule for people following treatment for this type of cancer is every two months for the first year, every four months for the second year, every six months for the third year, and once a year after that. Diagnostic examinations may be repeated to detect recurrences or document the progress of current treatment. If a person still smokes, it is important to be monitored for possible second cancers in the lung, esophagus, and head and neck, even without recurrence of the initial cancer. Enrollment in prevention clinical trials may also be an option.
Rehabilitation is a major part of follow-up care after head and neck cancer treatment. People may receive physical therapy to maintain movement and the range of movements and speech therapy to regain skills, such as speech and swallowing. Supportive care to manage symptoms and maintain nutrition during treatment may be recommended. Some people may need to learn new ways to eat or prepare food.
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.
Sometimes rehabilitation requires developing a new voice. After a total laryngectomy, some people can learn to use the esophagus to produce sound; this is called esophageal speech. Some people use an electronic battery-powered device called an electrolarynx that produces vibration that is transmitted through the tissues of the neck or delivered into the mouth via a plastic tube for speech production. A third method of voice rehabilitation, called tracheoesophageal (TE) voice restoration, is performed in many people who have had 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 prior to laryngectomy. A small, removable prosthesis (artificial replacement) that sits inside the stoma allows air from the lungs to pass into the esophagus for sound production. The sound then travels into the mouth for speech.
When the cancer treatment impairs swallowing, exercise plans can often be designed to strengthen and maintain the ability to eat and swallow. It is important that people receive early evaluation by the members of the health-care team to start specific treatment programs to avoid later problems. People should meet with all rehabilitation specialists before their head and neck cancer treatment begins.
People recovering from laryngeal or hypopharyngeal cancer are encouraged to follow established guidelines for good health, such as maintaining a health weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for you needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about the Late Effects of Childhood Cancer.
Research for laryngeal and hypopharyngeal cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.
Radiofrequency thermal ablation (RFA). RFA uses heat to kill cancer cells. It is a minimally invasive treatment option that may be useful for localized tumors that cannot be removed by surgery.
Gene therapy. Gene therapy is a targeted form of treatment that uses biologic gene manipulation to change bits of genetic code in a person's cells. Although gene therapy is relatively new, it appears to show promising potential for treating head and neck cancer.
Photodynamic therapy. In photodynamic therapy, a substance that is photosensitive (sensitive to light) is injected into the blood. Cancer cells hold the substance for longer than normal cells. Then, laser lights are directed at the area of the tumor, and the substance in the cells is activated to kill the cancer cells.
New therapy approaches. Increasing knowledge of the biology of cancer is leading to the development of biologic and targeted therapies. Some of the available drugs are used in conjunction with conventional chemotherapy or radiation therapy. People should inquire about such treatment options, offered mainly in clinical trials. Researchers are evaluating more effective ways of using radiation treatment. One promising approach, radiosensitization, involves administering 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, in which radiation therapy is given in several small doses per day.
Targeted and tumor-specific therapy. Multiple new drugs are currently under various stages of development. They offer real hope for targeted tumor-specific approaches for this type of cancer (and head and neck cancer, in general). Cetuximab (a monoclonal antibody directed at the epidermal growth factor receptor) is already approved for use with contemporary radiation therapy approaches. The hope is that these and other more targeted therapies will offer new treatment options with equal or greater effectiveness and fewer side effects.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
What type of laryngeal or hypopharyngeal cancer do I have? Where exactly is it located?
What is the stage of the cancer? What does this mean?
What are the treatment options?
What clinical trials are available to me?
What treatment do you recommend? Why?
Should I get an additional consultation or second opinion?
What are the possible side effects of each treatment option?
What can be done to relieve the possible side effects?
What functional deficits (in speech, swallowing, or shoulder motion) will likely occur, and what rehabilitation services are available?
If I have surgery, will there be need for major reconstruction, and how is this going to affect my ability to speak and eat?
If surgery is done, will there be a need for a neck dissection (removing lymph nodes)? If so, what type of dissection will be done? What does this mean?
If I receive radiation therapy, what are the lasting side effects of such treatment including loss of saliva, loss of taste, and permanent difficulty in swallowing?
How likely is it that I will lose my voice box (larynx), and if this is necessary, what are the options available for voice/speech rehabilitation?
How will my nutrition be maintained if the treatment affects my ability to eat the foods I am used to consuming?
Can you recommend an oncologic dentist?
Should I see other specialists prior to treatment? Should I specifically talk with a radiation oncologist, medical oncologist, plastic surgeon, or a speech pathologist?
What will rehabilitation after treatment consist of?
If I am a smoker, can you help me to quit?
If I am a smoker, will quitting this habit help this treatment have a better outcome?
After treatment, what follow-up tests will be needed, and how often will I need them?
Will there be any lasting or late side effects that will need special care?
Are there any other questions I should be asking?
What support services are available for me? For my family?
Support for People with Oral, Head, and Neck Cancer, Inc. (SPOHNC)
P.O. Box 53
Locust Valley, NY 11560-0053
Toll Free: 800-377-0928
Phone: 516-759-5333 www.spohnc.org
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