Overview of Treatment of Laryngeal Cancer

There are different types of treatment for patients with laryngeal cancer.

Treatment is planned by a team of doctors with expertise in treating head and neck cancer.

Four types of standard treatment are used:

• Surgery
• Radiation therapy
• Chemotherapy
• Immunotherapy

New types of treatment being tested in clinical trials:

• Targeted therapy

Treatment for laryngeal cancer may cause side effects.

Patients may want to think about taking part in a clinical trial.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Follow-up tests may be needed.

Treatment of Laryngeal Cancer

Stage I Laryngeal Cancer:

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

If cancer is in the supraglottis, treatment may include:

• Radiation therapy.
• Supraglottic laryngectomy.

If cancer is in the glottis, treatment may include:

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

If cancer is in the subglottis, treatment may include:

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

Stage II Laryngeal Cancer:

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

If cancer is in the supraglottis, treatment may include:

• Radiation therapy to the tumor and nearby lymph nodes.
• Supraglottic laryngectomy which may be followed by radiation therapy.

If cancer is in the glottis, treatment may include:

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

If cancer is in the subglottis, treatment may include:

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

Stage III Laryngeal Cancer:

Treatment of newly diagnosed 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:

• Chemotherapy and radiation therapy given together
• Chemotherapy followed by chemotherapy and radiation therapy given together. Laryngectomy may be done if cancer remains.
• Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
• Surgery, which may be followed by radiation therapy.

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 followed by surgery if cancer comes back in the same area.
• Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
• Chemotherapy followed by chemotherapy and radiation therapy given together. Laryngectomy may be done if cancer remains.

Stage IV Laryngeal Cancer:

Treatment of newly diagnosed stage IVA, IVB, and IVC laryngeal cancer depends on where cancer is found in the larynx.

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

• Chemotherapy and radiation therapy given together.
• Chemotherapy followed by chemotherapy and radiation therapy given together. Laryngectomy may be done if cancer remains.
• Radiation therapy alone for patients who cannot be treated with chemotherapy and surgery.
• Surgery followed by radiation therapy. Chemotherapy may be given with the radiation therapy.

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 with or without chemotherapy.
• Chemotherapy and radiation therapy given together.

Standard treatment Options

Surgery

Surgery may be used to diagnose and treat oropharyngeal cancers.

After 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 lower the risk that the cancer will come back, is called adjuvant therapy.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.

Nivolumab and pembrolizumab are types of immunotherapies inhibitors used to treat metastatic or recurrent laryngeal cancer.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Certain ways of giving external radiation therapy can help keep radiation from damaging nearby healthy tissue. These types of radiation therapy include the following:

Conformal radiation therapy: Conformal radiation therapy uses a computer to make a 3-dimensional (3-D) picture of the tumor and shapes the radiation beams to fit the tumor.

Intensity-modulated radiation therapy (IMRT): IMRT is a type of 3-dimensional (3-D) radiation therapy that uses a computer to make pictures of the size and shape of the tumor. Thin beams of radiation of different intensities (strengths) are aimed at the tumor from many angles.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

Chemotherapy refers to medications that stop or slow the growth of cancer cells by interfering with the ability of rapidly growing cells like cancer cells to divide.

Drugs commonly used to treat oropharyngeal cancers are called cis-platinum or less commonly, carboplatinum.

Both of these are administered as an infusion through the vein over a few hours.

Cis-platinum can be administered every three weeks or every week.

Carboplatinum is administered every three weeks.