Laryngeal Cancer

Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx.

Types

Most laryngeal cancers form in squamous cells, the thin, flat cells lining the inside of the larynx.

There are three main parts of the larynx:

• Supraglottis: The upper part of the larynx above the vocal cords, including the epiglottis.
• Glottis: The middle part of the larynx where the vocal cords are located.
• Subglottis: The lower part of the larynx between the vocal cords and the trachea (windpipe).

Signs and Symptoms

Possible signs of laryngeal cancer include a sore throat and ear pain.

These and other symptoms may be caused by laryngeal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

• A sore throat or cough that does not go away.
• Trouble or pain when swallowing.
• Ear pain.
• A lump in the neck or throat.
• A change or hoarseness in the voice.

Diagnosis

Exams and tests

The following tests and procedures may be used:

• Physical exam of the throat and neck: An examination in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.
• Laryngoscopy: A procedure in which the doctor examines the larynx (voice box) with a mirror or with a laryngoscope (a thin, lighted tube).
• Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope (a thin, lighted tube) is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. Tissue samples and lymph nodes may be taken for biopsy.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
• Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

The process used to find out if cancer has spread within the larynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnose laryngeal cancer are often also used to stage the disease.

Laryngeal Cancer Stages

The following stages are used for laryngeal cancer:

• Stage 0

In stage 0, abnormal cells are found in the lining of the larynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

• Stage I

In stage I, cancer has formed. Stage I laryngeal cancer depends on where cancer is found in the larynx:

• Supraglottis: Cancer is in one area of the supraglottis only and the vocal cords can move normally.
• Glottis: Cancer is in one or both vocal cords and the vocal cords can move normally.
• Subglottis: Cancer is in the subglottis only.

• Stage II

In stage II, cancer is in the larynx only. Stage II laryngeal cancer depends on where cancer is found in the larynx:

• Supraglottis: Cancer is in more than one area of the supraglottis or surrounding tissues.
• Glottis: Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords do not move normally.
• Subglottis: Cancer has spread to one or both vocal cords, which may not move normally.

• Stage III

Stage III laryngeal cancer depends on whether cancer has spread from the supraglottis, glottis, or subglottis.

In stage III cancer of the supraglottis:

1. Cancer is in the larynx only and the vocal cords do not move normally, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
2. Cancer is in one area of the supraglottis only and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and the vocal cords can move normally; or
3. Cancer is in more than one area of the supraglottis or surrounding tissues and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and/or the vocal cords do not move normally.

In stage III cancer of the glottis:

1. Cancer is in the larynx only and the vocal cords do not move normally, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
2. Cancer is in one or both vocal cords and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and the vocal cords can move normally; or
3. Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords do not move normally. The cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters.

In stage III cancer of the subglottis:

1. Cancer is in the larynx only and the vocal cords do not move normally; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
2. Cancer is in the subglottis only and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or
3. Cancer has spread to one or both vocal cords, which may not move normally, and to one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters.

• Stage IV

Stage IV is divided into stage IVA, stage IVB, and stage IVC. Each substage is the same for cancer in the supraglottis, glottis, or subglottis.

• In stage IVA:
  • Cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus, and may have spread to one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or
  • Cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Vocal cords may not move normally.

• In stage IVB:
  • Cancer has spread to the space in front of the spinal column and surrounds the carotid artery, or has spread to parts of the chest and may have spread to one or more lymph nodes anywhere in the neck (the lymph nodes may be any size); or
  • Cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery or to parts of the chest. Vocal cords may not move normally.

• In stage IVC, cancer has spread beyond the larynx to other parts of the body.

• Recurrent laryngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer is most likely to come back in the first 2 to 3 years. It may come back in the larynx or in other parts of the body.

Treatment

Treatment options depend on the following:

• The stage of the disease.
• The location and size of the tumor.
• Keeping the patient's ability to talk, eat, and breathe as normal as possible.
• Whether the cancer has come back (recurred).

Smoking tobacco and drinking alcohol decrease the effectiveness of treatment for laryngeal cancer. Patients with laryngeal cancer who continue to smoke and drink are less likely to be cured and more likely to develop a second tumor. After treatment for laryngeal cancer, frequent and careful follow-up is important.

There are different types of treatment for patients with laryngeal cancer. Three types of standard treatment are used:

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may test the thyroid gland before and after therapy to make sure it is working properly.

Surgery

Surgery (removing the cancer in an operation) is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:

1. Cordectomy: Surgery to remove the vocal cords only.
2. Supraglottic laryngectomy: Surgery to remove the supraglottis only.
3. Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.
4. Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient's ability to talk.
5. Total laryngectomy: Surgery to remove the whole 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.
6. Thyroidectomy: The removal of all or part of the thyroid gland.
7. Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Psychotherapy

Some studies have shown effects of psychotherapy on cancer, some have not. As yet, no specific studies have been done in Laryngeal cancer. So far, we have no reasons to suggest that psychotherapy would be less useful in specific types of cancer. Spiegel and his collegues (1989) at Stanford university have seen double length of survival in women with breast cancer after group psychotherapy.These groups, initiated by Yalom, were directed at mutual support, emotional expression and sharing and existential issues. Two studies by Goodwin (2001) and Kissane (2007)with oncologically less experienced therapists, did not see effects on survival, nor dit Edelman (1999) using cognitive psychotherapy (CBT). In gastro-intestinal cancer, effects of individual, peri-operative bed-side psychotherapy were seen by Kuchler (2007), while Fawzy (1993) noticed longer disease free periods in melanoma patients after a course in problem focused coping. So far experiential, existential and problem focused counseling by oncologically experienced psychotherapsts may be a useful adjunct to treatment. More information is avaliable under Psycho-Oncology.

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk cancer will recur (come back). The drug isotretinoin is being studied to prevent the development of a second cancer in patients who have had cancer of the head or neck.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.

Treatment Options by Stage

Stage I Laryngeal Cancer=

Treatment of stage I laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis, treatment may include the following:

• Radiation therapy.
• Supraglottic laryngectomy.

If cancer is in the glottis, treatment may include the following:

• Radiation therapy.
• Cordectomy.
• Partial laryngectomy, hemilaryngectomy, or total laryngectomy.
• Laser surgery.

If cancer is in the subglottis, treatment may include the following:

• Radiation therapy with or without surgery.
• Surgery alone.

Stage II Laryngeal Cancer

Treatment of stage II laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis, treatment may include the following:

• Radiation therapy.
• Supraglottic laryngectomy or total laryngectomy with or without radiation therapy.
• A clinical trial of radiation therapy.
• A clinical trial of chemoprevention.

If cancer is in the glottis, treatment may include the following:

• Radiation therapy.
• Partial laryngectomy, hemilaryngectomy, or total laryngectomy.
• Laser surgery.
• A clinical trial of radiation therapy.
• A clinical trial of chemoprevention.

If cancer is in the subglottis, treatment may include the following:

• Radiation therapy with or without surgery.
• Surgery alone.
• A clinical trial of radiation therapy.
• A clinical trial of chemoprevention.

Stage III Laryngeal Cancer

Treatment of stage III laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis or glottis, treatment may include the following:

• Surgery with or without radiation therapy.
• Radiation therapy with or without surgery.
• A clinical trial of radiation therapy.
• A clinical trial of chemotherapy combined with radiation therapy, with or without laryngectomy.
• A clinical trial of radiosensitizers.
• A clinical trial of chemoprevention.

If cancer is in the subglottis, treatment may include the following:

• Laryngectomy plus total thyroidectomy and removal of lymph nodes in the throat, usually followed by radiation therapy.
• Radiation therapy with or without surgery.
• A clinical trial of radiation therapy.
• A clinical trial of chemotherapy.
• A clinical trial of radiosensitizers.
• A clinical trial of chemoprevention.

Stage IV Laryngeal Cancer

Treatment of stage IV laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis or glottis, treatment may include the following:

• Total laryngectomy with radiation therapy.
• Radiation therapy with or without surgery.
• A clinical trial of radiation therapy.
• A clinical trial of chemotherapy combined with radiation therapy, with or without laryngectomy.
• A clinical trial of chemotherapy.
• A clinical trial of radiosensitizers.
• A clinical trial of chemoprevention.

If cancer is in the subglottis, treatment may include the following:

• Laryngectomy plus total thyroidectomy and removal of lymph nodes in the throat, usually with radiation therapy.
• Radiation therapy.
• A clinical trial of radiation therapy.
• A clinical trial of chemotherapy combined with radiation therapy.
• A clinical trial of chemotherapy.
• A clinical trial of radiosensitizers.
• A clinical trial of chemoprevention.

Recurrent Laryngeal Cancer

Treatment of recurrent laryngeal cancer may include the following:

• Surgery with or without radiation therapy.
• Radiation therapy.
• Chemotherapy.
• A clinical trial of chemotherapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life.

Chances of Developing Laryngeal Cancer

Use of tobacco products and drinking too much alcohol can affect the risk of developing laryngeal cancer.

Expected Outcome

Recovery time

Prognosis (chance of recovery) depends on the following:

• The stage of the disease.
• The location and size of the tumor.
• The grade of the tumor.
• The patient's age, gender, and general health, including whether the patient is anemic.

Clinical Trials

• Click here for Laryngeal Cancer Trials

The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families.

Epidemiology

Other Resources

• NCI's LiveHelp

References