Surgery and Other Treatments for Laryngeal Cancer

The larynx (voice box) is located at the top of the trachea (the windpipe).

The larynx contains the vocal cords. Vocal cords vibrate and allow us talk and sing.

With cancer of the larynx (laryngeal cancer), malignant cells grow in the tissue of the larynx. Most laryngeal cancers form in squamous cells, the flat cells that line the inside of the larynx.

Cancer Staging

Staging the cancer helps doctors decide the prognosis and the best treatments to prescribe. Cancer stages are determined by the size and the exact location of the tumor.

Radiation Therapy (Radiotherapy)

Radiation therapy stops cancer cells from dividing. The growth of the tumor is slowed. Radiation also destroys cancer cells and can shrink or eliminate tumors.

People who are diagnosed with an early stage laryngeal cancer can often be cured with radiotherapy only. This treatment preserves the voice.

Radiation alone (without surgery) is successful in treating 80% to 90% of people with stage I laryngeal cancer, and 70% to 80% with stage II cancer.

Stage III and IV usually require a combination of radiation and chemotherapy.

Radiotherapy may also be given as an additional therapy (adjuvant therapy).
Adjuvant therapy is used after surgery:

If some cancer cells might still remain in the body
If the tumor was difficult to remove completely
When the tumor has penetrated the wall of the larynx
If the pathologist finds cancer cells in the lymph nodes

If the tumor is pressing against the windpipe it can cause pain and difficultly breathing or swallowing. Radiotherapy can relieve the symptoms by shrinking the size of the tumor. Only a short course of treatments is needed to control symptoms (palliation).

If the radiotherapy is not able to destroy all the cancer, surgery might be needed to remove the cancer that remains (called salvage surgery).

Chemotherapy

Medical oncologists administer chemotherapy if the cancer has spread to lymph nodes or other organs. The medicine circulates in the blood and disrupts the growth of the cancer cells. Chemotherapy medications are taken by mouth or given through a vein for several months.

Chemotherapy alone cannot cure this type of cancer.

Chemotherapy is prescribed for different reasons:

Together with radiotherapy as an alternative to surgery (called chemoradiation)
After surgery to decrease the risk of the cancer returning
To slow the growth of a tumor and control symptoms when the cancer cannot be cured (palliative treatment).

Surgery

Endoscopic laser surgery on the larynx is very effective. In stages I and II, surgery has better or equal cure rates when compared to radiation therapy.

Endoscopic Resection

Endoscopic resection can remove very early cancers of the larynx. General anesthesia is used. The surgeon inserts an endoscope (a tube with a camera and a light on the inside of the tube) into the throat to locate the cancer. Then the surgeon uses a scalpel or a laser to remove the cancerous tissue. A laser is a thin hot beam of light. It cuts tissue and controls bleeding at the same time.

Surgery is often the best and only option for large cancers, or cancer that does not respond to radiation treatments.

Partial Laryngectomy

Partial laryngectomy is used to treat small laryngeal cancer, or for cancer that has returned after radiation (recurrent cancer). During partial laryngectomy, only part of the larynx is removed. At least one part of one vocal cord is not removed. After a partial laryngectomy patients can still speak, but the voice might be hoarse or weak. There are different types of partial laryngectomies. Your doctor might use these names:

A cordectomy is the removal of one vocal cord.
A frontolateral laryngectomy is the removal of the front of both vocal cords and most of the cancerous cord.
An anterior frontal laryngectomy is the removal of the front of both vocal cords.
A hemilaryngectomy is the removal of one side of the voice box.

During the procedure, the surgeon will make an opening in the neck to the windpipe. This will create a temporary tracheostomy (a hole in the neck for breathing). The tracheostomy allows the larynx to heal after surgery. After healing, the patients usually speak and eat differently.

Supraglottic Laryngectomy

A supraglottic laryngectomy is used when the tumor is only in the area above the vocal cords. The surgeon will use either the laser or the open technique to remove the voice box structures above the vocal cords (the false vocal cords and the epiglottis).

Total Laryngectomy

The surgeon may need to remove the entire voice box to cure the cancer. This is called a total laryngectomy.

The larynx connects the mouth to the lungs. After the larynx is removed, there is no connection for air to enter the lungs. During the procedure, the surgeon will make an opening in the neck for breathing. The opening is called a tracheotomy or a stoma. The stoma is permanent after a total laryngectomy.

Without vocal cords, patients cannot speak in the normal way. One method to help patients speak is the creations of a fistula (a small opening in the tissues for passage of air). The fistula is made during the laryngectomy. A speech therapist can teach different ways to make sounds and help patients learn to speak again

Two weeks after surgery, the patient can eat without difficulty.

Neck Dissection

If cancer has affected the lymph nodes in the neck, a neck dissection (removal of the lymph nodes) might be needed during any type of head and neck cancer surgery.