What do we mean by 'Laryngeal Cancer'? It is a type of Throat Cancer that is also known as voice box cancer. If it's not the cancer type you're looking for, please explore the information about other types of Throat Cancers or other types of Head and Neck Cancers.
Following a diagnosis of Laryngeal Cancer, your cancer care team will discuss the treatment options including the possibility of participating in a clinical trial that is suitable for you. This is also a good time to consider if you would like a second opinion. The most suitable treatment of Laryngeal Cancer depends on many things including:
size and location of the cancer
whether the cancer has spread
personal factors (e.g. age, general health and treatment history)
types of treatment available (and whether any clinical trials are available)
your preferences for treatment
There are two broad categories of treatment for Laryngeal Cancers; surgery and radiation therapy. Chemotherapy is sometimes used at same time with radiation therapy (called concurrent chemotherapy).
Surgery is generally used for advanced stage Laryngeal Cancer. Your doctor may consider removing the cancer using a robot (Transoral Robotic Surgery, or TORS). TORS may be performed by a head and neck cancer surgeon, which is carried out through the mouth without any external cuts.
Your doctor will explain details of the surgery, general risks and side effects of surgery. Ask your doctor if you have questions. They may recommend:
stopping blood thinners (e.g. aspirin) before surgery to reduce the risk of bleeding
special stockings to reduce the risk of blood clots
early mobilisation (i.e. not staying in bed) to reduce the risk of blood clots and chest infection
antibiotics to lower the risk of wound infection.
If you smoke, it is important that you consider stopping smoking before starting treatment to help reduce the risk of infection and help you recover after your treatment. The surgery options for early and advanced Laryngeal Cancers are:
Some advanced laryngeal cancers can be removed without any external cuts using a robotic system or by using laser surgery.
A laryngectomy is the removal of all (total laryngectomy) or part of the larynx (partial laryngectomy).
Partial laryngectomy is removal of part of your larynx. The larynx is the medical name for the voice box.
This is removal of part of the hypopharynx via an open neck approach.
This is the removal of all the larynx and pharynx. It is different to laryngectomy, where only the larynx (or part of it) is removed.
The most common radiation therapy treatment for Laryngeal Cancer is called external beam radiation. This type of radiation therapy applies radiation from outside the body. Radiation therapy can be used in both the early and advanced stages of Laryngeal Cancer in the following ways:
This is frequently used in the definitive treatment (curative) of early (stage I or II) laryngeal cancer in an outpatient setting. This is when radiation therapy is targeted at the larynx alone. Treatments are usually given daily, for a period of 7 weeks.
This is a curative treatment option for patients with advanced stage Laryngeal Cancer. The aim of the therapy is to preserve the larynx and its function. It is another option to removing the voice box (total laryngectomy). Radiation therapy comprehensively treats the cancer of the voice box, its surrounding region, and the lymph nodes at both sides of the neck. Radiation therapy is typically delivered daily (but not on weekends) for 7 weeks and can be given as:
definitive radiation therapy alone; or
definitive radiation therapy with concurrent chemotherapy (adding chemotherapy to radiation therapy (chemoradiation) to make it more effective).
This is given after the surgical removal of the voice box and the lymph nodes (on both or either sides of the neck). It is used as an additional treatment to kill cancer cells that may not have been removed during surgery. It usually starts about 4 weeks after surgery to allow recovery from surgery. Radiation therapy treatment usually lasts for about 6 weeks. Sometimes chemotherapy is added to the adjuvant radiation therapy (chemoradiation) to make it more effective.
In cases where a cure is not possible, radiation therapy is used to relieve symptoms of advanced laryngeal cancer. Symptoms that may require palliative radiation therapy include pain, bleeding, breathing and swallowing difficulties.
You will meet with many members of the cancer care team, who will help you learn how to look after yourself through radiation therapy, recovery and long term follow-up. They will also talk to you about side effects and how to manage them. It may be helpful to write down questions as they come up, so you can ask anyone in your cancer care team when you see them.
If you are having radiation therapy for advanced stage laryngeal cancer, dental extraction may be needed to remove any broken or infected teeth before radiation therapy. It is important to take out any broken or infected teeth before radiation therapy. Taking out unhealthy teeth after radiation therapy can cause problems with the jaw bone.
Your cancer and its treatment can make it hard to eat and drink. Your doctor will recommend you see a dietitian to maximise your nutrition during treatment as well as while you are recovering. Sometime feeding tubes may be recommended depending on the area being treated and the dose of radiation therapy. There are two common types of feeding tubes:
Gastrostomy tube (sometimes called a PEG tube): this type of tube is inserted through your abdominal wall into your stomach, with part of the tube staying outside the stomach. A syringe can be attached to the tube to give you food this way if needed. The tube is inserted using a camera through the mouth into the stomach (gastroscopy) or using a CT scanner to guide insertion directly through the skin. If a PEG tube is needed, your doctor will organise this before starting your radiation therapy
Nasogastric tube: this type of tube goes through the nose down into the stomach and is usually used for short periods (days or weeks). A nasogastric tube can be inserted at any time (before, during or after treatment).
There are many other aspects of supportive care that are available, ask your doctor if you have any specific needs.
The side-effects of radiation therapy start around two weeks into treatment and progress through treatment to peak in the last week or just after treatment ends. The side effects start to improve 2-3 weeks after the end of treatment.
the dose of radiation therapy
the area being treated
whether or not chemotherapy is added to the radiation.
tiredness
hoarse voice
skin irritation in the treated area e.g. redness, dryness and itching, weeping skin, scaling or sometimes skin breakdown (sores)
pain on swallowing or difficulty with swallowing
irritation in the throat progressing to sore throat requiring pain killers
dry mouth and throat (with advanced stage laryngeal cancer treatment).
Most side effects are short lived and may go away within 4–6 weeks of finishing radiation therapy. Some side effects may last for months after you finish radiation therapy and some may be permanent.
Once your radiation therapy ends, you will continue to have follow-up appointments so that your doctor can check your recovery and monitor any side effects that you may have. If you've had advanced stage laryngeal cancer, your doctor may arrange for a PET scan about 12 weeks after finishing radiation therapy to make sure the cancer has completely gone. If the cancer doesn't go away after radiation therapy, or comes back again in the future, you may still be able to have salvage surgery (Total laryngectomy) to try to cure the cancer.
Your doctor may recommend that you receive specific supportive care to help during your treatment and recovery.
Chemotherapy works by destroying or damaging cancer cells. For laryngeal cancer, it is usually given into a vein through a needle with a cannula (tube) attached. There are a number of ways that chemotherapy may be used to treat laryngeal cancer including:
Sometimes chemotherapy is added to definitive radiation therapy (chemoradiation). It is usually used for advanced stage laryngeal cancers. This may be given once every 3 weeks or once a week throughout the duration of radiation therapy. The addition of chemotherapy makes the radiation more effective at killing cancer cells but also leads to increased side effects in most patients.
This is when chemotherapy is given after surgery in combination with radiation therapy (chemoradiation). This may be given once every 3 weeks or once a week throughout the duration of radiation therapy. The addition of chemotherapy makes the radiation more effective at killing cancer cells but also leads to increased side effects in most patients.
This is when chemotherapy is given before surgery or radiation therapy to help shrink large cancers and make them easier to remove or target with radiation therapy. This is not commonly used for laryngeal cancer.
This is used when the cancer is incurable. The cancer may be too large or has spread too much to be removed by surgery. Palliative chemotherapy helps to slow the growth of cancer and reduce symptoms. It is important to remember that palliative chemotherapy is not as intense as other types and is much less likely to have significant side effects.
Before you start treatment, your medical oncologist will choose one or more chemotherapy medications that will be best to treat the type of cancer you have. The chemotherapy medications your doctor chooses may depend on:
whether the treatment is curative or palliative
when it is used
your medical history
a feeling of wanting to vomit (nausea) or vomiting
more side effects of radiation, if you have chemotherapy at the same time as radiation
loss of feeling in the fingers and toes
kidney damage (caused by some medications)
hearing loss/thinning
ringing in the ears
rash
higher risk of infection (if the chemotherapy reduces the number of white cells in the blood)
Most of these side effects are short lived and may go away once you finish chemotherapy. Some side effects can take months or years to improve or may be permanent.
Once your treatments end, you will have regular follow-up appointments so that your doctor can check your recovery, make sure the cancer has not returned and monitor and treat any side effects that you may have. Your doctor may recommend that you receive some specific supportive care to help during your recovery.
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