Cancer of the larynx (or voicebox) is a disease in which malignant cells are found in the tissues of the larynx. The larynx is a short passageway shaped like a triangle that is just below the pharynx in the neck. The pharynx is a hollow tube about 5 inches long that starts behind the nose and goes down to the neck to become part of the oesophagus, the tube that goes to the stomach. Air passes through the pharynx and then the larynx on the way to the windpipe (trachea) and into the lungs. Food passes through the pharynx on the way to the oesophagus. The larynx has a small piece of tissue over it, called the epiglottis, to keep food from going into it or the air passages.

The larynx contains the vocal cords, which vibrate and make sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a person’s voice. The muscles in the pharynx, face, tongue, and lips help people form words with sounds to make them understandable.

There are three main parts of the larynx:

1. The glottis (the middle part of the larynx where the vocal cords are)
2. The supraglottis (the tissue above the glottis)
3. The subglottis (the tissue below the glottis). The subglottis connects to the trachea, which takes air to the lungs.

Cancer of the larynx is most commonly found in people who smoke. If a person has cancer of the larynx and smokes, smoking should be stopped.

A doctor should be seen if the following symptoms appear:

• A sore throat that does not go away
• Pain when swallowing
• A change or hoarseness in the voice
• Pain in the ear
• A lump in the neck

If there are symptoms, a doctor will put a tube with a special light on the end of it down the patient’s throat to look at the larynx. This is called laryngoscopy. If tissue that is not normal is found, the doctor will need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This is called a biopsy. The doctor will also feel the throat for lumps.

The chance of recovery (prognosis) depends on where the cancer is in the larynx, whether the cancer is just in the larynx or has spread to other tissues (the stage), and the patient’s general state of health.

Stages of cancer of the larynx

Once cancer of the larynx is found, more tests will be done to find out if cancer cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. In cancer of the larynx, the definitions of the early stages depend on where the cancer started. The following stages are used for cancer of the larynx:

Stage I

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.

Glottis

The cancer is only in the vocal cords and the vocal cords can move normally.

Subglottis

The cancer has not spread outside of the subglottis.

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.

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.

Subglottis

The cancer has spread to the vocal cords, which may or may not be able to move normally.

Stage III

Either of the following may be true:

1. 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.
2. 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 3 centimetres (just over 1 inch).

Stage IV

Any of the following may be true:

1. 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.
2. 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 6 centimetres (over 2 inches).
3. The cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the larynx or in another part of the body.

How cancer of the larynx is treated

There are treatments for all patients with cancer of the larynx. Three kinds of treatment are used:

• Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
• Surgery (taking out the cancer)
• Chemotherapy (using drugs to kill cancer cells)

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumours. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes in 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. Giving drugs with the radiation therapy to make the cancer cells more sensitive to radiation (radiosensitization) is being tested in clinical trials. Radiation given in several small doses per day (hyperfractionated radiation therapy) is also being tested in clinical trials. If smoking is stopped before radiation therapy is started, there is a better chance of surviving longer.

Surgery is a common treatment of cancer of the larynx. A doctor may remove the cancer and part of the larynx using one of the following operations:

1. A cordectomy takes out only the vocal cord.
2. A supraglottic laryngectomy takes out only the supraglottis.
3. A partial or hemilaryngectomy removes only part of the larynx.
4. 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).
5. Laser surgery may be used for very early cancers of the larynx. During laser surgery, a narrow, intense beam of light is used to cut out the cancer.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

People with larynx 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 oesophagus (the tube that connects the throat to the stomach).

Because the larynx helps with breathing 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.

Stage I Laryngeal Cancer

Treatment depends on where the cancer is found in the larynx.

If cancer is in the supraglottis, treatment may be one of the following:

1. External beam radiation therapy
2. Surgery to remove the supraglottis (supraglottic laryngectomy)
3. Surgery to remove the larynx (total laryngectomy)

If the cancer is in the glottis, treatment may be one of the following:

1. Radiation therapy
2. Surgery to take out a vocal cord (cordectomy)
3. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy
4. Laser surgery

If the cancer is in the subglottis, treatment will probably be radiation therapy. In some cases, a hemilaryngectomy may be done.

Stage II Laryngeal Cancer

Treatment depends on where the cancer is found in the larynx.

If the cancer is in the supraglottis, treatment may be one of the following:

1. External-beam radiation therapy
2. Surgery to remove the supraglottis (supraglottic laryngectomy) or the entire larynx (laryngectomy).
3. Radiation therapy may be given after surgery.
4. A clinical trial of several small doses of radiation per day (hyperfractionated radiation therapy).
5. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the glottis, treatment may be one of the following:

1. Radiation therapy.
2. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy.
3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
4. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the subglottis, treatment may be one of the following:

1. Radiation therapy.
2. Surgery to remove part of the larynx (hemilaryngectomy) or total laryngectomy.
3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
4. A clinical trial of chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

Clinical trials are evaluating the use of several smaller doses of radiation per day (hyperfractionated radiation therapy).

Stage III Laryngeal Cancer

Treatment depends on where the cancer is found in the larynx.

If the cancer is in the supraglottis, treatment may be one of the following:

1. Surgery to remove the cancer with or without radiation therapy.
2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the glottis, treatment may be one of the following:

1. Surgery with or without radiation therapy.
2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the subglottis, treatment may be one of the following:

1. Surgery to remove the larynx (total laryngectomy), some of the tissue around it, the thyroid gland while preserving the parathyroid glands located near the thyroid, and the lymph nodes in the neck. Surgery is usually followed by radiation therapy.
2. Radiation therapy if a patient cannot have surgery.
3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
4. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
5. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus

Stage IV Laryngeal Cancer

Treatment depends on where the cancer is found in the larynx.

If the cancer is in the supraglottis, treatment may be one of the following:

1. Surgery to remove the larynx (total laryngectomy) followed by radiation therapy.
2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the glottis, treatment may be one of the following:

1. Total laryngectomy followed by radiation therapy.
2. Radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after radiation.
3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
4. A clinical trial of chemotherapy followed by radiation therapy or chemotherapy combined with radiation therapy. Surgery to remove the larynx (laryngectomy) may be needed if the cancer does not shrink after chemotherapy and radiation.
5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

If the cancer is in the subglottis, treatment may be one of the following:

1. 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.
2. Radiation therapy if a patient cannot have surgery. Clinical trials are testing new ways of giving radiation therapy and the use of radiosensitizers.
3. A clinical trial of several smaller doses of radiation per day (hyperfractionated radiation therapy).
4. A clinical trial of chemotherapy and hyperfractionated radiation therapy given at the same time.
5. Clinical trials of chemotherapy, the use of drugs to make the cancer cells more sensitive to radiation (radiosensitizers), or new forms of radiation.
6. Chemoprevention therapy to prevent a second cancer in the mouth, throat, windpipe, nose, or oesophagus.

Recurrent Laryngeal Cancer

Treatment depends on the kind of treatment the patient had when first treated. If the patient had surgery alone, the patient may have surgery again or radiation therapy. If the patient had radiation therapy alone, additional radiation therapy or surgery may be considered. If the patient failed surgery and radiation therapy, clinical trials of chemotherapy may be given to relieve symptoms.

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