Head & Neck Oncology Program

Laryngeal Cancer

Stages and Treatment Options

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:

radiation therapy
surgery
chemotherapy

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.

This page was last updated on: March 3, 2008.