What are treatment options for larynx cancer?
People with early laryngeal cancer may be treated with surgery or radiation therapy. People with advanced laryngeal cancer may have a combination of treatments. For example, radiation therapy and chemotherapy are often given at the same time. Targeted therapy is another option for some people with advanced laryngeal cancer.
The choice of treatment depends mainly on your general health, where in your larynx the cancer began, and whether the cancer has spread.
You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat laryngeal cancer include:
- Ear, nose, and throat doctors (otolaryngologists)
- General head and neck surgeons
- Medical oncologists
- Radiation oncologists
Other health care professionals who work with the specialists as a team may include a dentist, plastic surgeon, reconstructive surgeon, speech-language pathologist, oncology nurse, registered dietitian, and mental health counselor.
Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. You'll want to consider how treatment may affect eating, swallowing, and talking, and whether treatment will change the way you look during and after treatment. You and your health care team can work together to develop a treatment plan that meets your needs.
Before, during, and after cancer treatment, you can have supportive care to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Information about supportive care is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping.
Also, NCI's Cancer Information Service can answer your questions about supportive care. Call 1–800–4–CANCER (1–800–422–6237). Or chat using LiveHelp, NCI's instant messaging service, at http://www.cancer.gov/livehelp.
You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of laryngeal cancer.
You may want to ask your doctor these questions before you begin treatment:
- How large is the tumor? What is the stage of the disease? Has the tumor grown outside the larynx or spread to other organs?
- What are my treatment choices? Do you suggest surgery, radiation therapy, or a combination of treatments? Why?
- What are the expected benefits of each kind of treatment?
- What is my chance of keeping my voice with surgery, radiation therapy, or a combination of treatments?
- What can I do to prepare for treatment?
- Will I need to stay in the hospital? If so, for how long?
- What are the risks and possible side effects of each treatment? How can side effects be managed?
- What is the treatment likely to cost? Will my insurance cover it?
- How will treatment affect my normal activities?
- Is a research study (clinical trial) a good choice for me?
- Can you recommend a doctor who could give me a second opinion about my treatment options?
- How often should I have checkups?
Surgery is a common treatment for people with cancer of the larynx. The surgeon may use a scalpel or laser. Laser surgery may be performed with a laryngoscope. You and your surgeon can talk about the types of surgery and which may be right for you:
- Removing part of the larynx: The surgeon removes only the part of the larynx that contains the tumor.
- Removing all of the larynx: The surgeon removes the entire larynx and some nearby tissue. Some lymph nodes in the area may also be removed.
It takes time to heal after surgery, and the time needed to recover is different for each person. It's common to feel weak or tired for a while, and your neck may be swollen.
Also, you may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.
Surgery may change your ability to swallow, eat, or talk. You may need to have reconstructive or plastic surgery to rebuild the tissue. The surgeon may use tissue from another part of your body to repair the throat. You can have reconstructive or plastic surgery at the same time as you have the cancer removed, or you can have it later on. Talk with your doctor about which approach is right for you.
If you lose the ability to talk for a short time after surgery, you may find it helpful to use a notepad, writing toy (such as a magic slate), cell phone, or computer to write messages. Before surgery, you may want to make a recording for your answering machine or voicemail that tells callers that you have lost your voice.
Some people may need a temporary feeding tube.
The surgeon may need to make a stoma. The stoma is a new airway through an opening in the front of your neck.
Air enters and leaves the trachea and lungs through this opening. A metal or plastic tube (a "trach," or tracheostomy tube) keeps the new airway open.
Before you leave the hospital, your health care team will teach you how to care for the stoma. You will learn to remove and clean the trach tube, clean out your airway, and care for the skin around the stoma.
You may want to follow these tips:
- Keep the skin around the stoma clean.
- If the air is dry, use a humidifier.
- If the air is dusty or smoky, cover your stoma with a scarf, tie, or specially made cover.
- Protect your stoma from water.You should cover your stoma before you take a shower.
- Cover your stoma when you cough or sneeze.
For many people, the stoma is needed only until recovery from surgery. Several days after surgery, the tube will be removed, and the stoma will close up. If your entire larynx is removed, the stoma will be permanent. You will then need to learn to use a special device to enable you to speak as you no longer have vocal cords.
People with stomas work in almost every type of business and can do nearly all of the things they did before surgery. However, they can't hold their breath, so heavy lifting may be hard. Also, swimming and water skiing are not possible without a special device and training to keep water out of the lungs.
Some people may feel self-conscious about the way they look and speak with a stoma. They may be concerned about how other people feel about them. They may also be concerned about how their sex life may be affected. Many people find that talking about these concerns is helpful.
You may want to ask your doctor these questions before having surgery:
- Do you recommend surgery to remove the tumor? Why? Do I need any lymph nodes removed? Will other tissues in my neck need to be removed?
- After surgery to remove the cancer, will my throat area need to be repaired with tissue from another part of my body?
- What is the goal of surgery?
- How will I feel after surgery? How long will I be in the hospital?
- What are the risks of surgery?
- Will I have trouble swallowing, eating, or speaking? Will I need to see a speech-language pathologist for help?
- What will my neck look like after surgery? Will I have a scar?
- If I need a stoma, do you recommend that I get a medical bracelet that says "neck breather"?
- Will I need reconstructive or plastic surgery? When can that be done?
Radiation therapy uses high-energy rays to kill cancer cells. It's an option for people with any stage of laryngeal cancer. People with small tumors may choose radiation therapy instead of surgery. It may also be used after surgery to destroy cancer cells that may remain in the area.
The radiation comes from a large machine outside the body. You may go to the hospital or clinic once or twice a day, generally 5 days a week for several weeks. Each treatment takes only a few minutes.
Radiation therapy aimed at the neck may cause side effects:
- Sore throat and difficulty swallowing: Your throat may become sore, or you may feel like there's a lump in your throat. It may be hard for you to swallow.
- Changes in your voice: Your voice may become hoarse or weak during radiation therapy. Your larynx may swell, causing voice changes. Your doctor may suggest medicine to reduce the swelling.
- Skin changes in the neck area: The skin on your neck may become red or dry. Good skin care is important. It's helpful to expose your neck to air while also protecting it from the sun. Also, avoid wearing clothes that rub your neck, and don't shave the area. You should not use lotions or creams on your neck without your doctor's advice. These skin changes usually go away when treatment ends.
- Changes in the thyroid: Radiation therapy can harm your thyroid (an organ in your neck beneath the voice box). If your thyroid doesn't make enough thyroid hormone, you may feel tired, gain weight, feel cold, and have dry skin and hair. Your doctor can check the level of thyroid hormone with a blood test. If the level is low, you may need to take thyroid hormone pills.
- Fatigue: You may become very tired, especially in the later weeks of radiation therapy. Resting is important, but doctors usually advise people to stay as active as they can.
- Weight loss: You may lose weight if you have eating problems from a sore throat and trouble swallowing. Some people may need a temporary feeding tube.
Some side effects go away after radiation therapy ends, but others last a long time. Although the side effects of radiation therapy can be upsetting, your doctor can usually treat or control them. It helps to report any problems that you are having so that your doctor can work with you to relieve them.
You may want to ask your doctor these questions before having radiation therapy:
- What is the goal of this treatment?
- When will the treatments begin? When will they end?
- What are the risks and side effects of this treatment? What can I do about them?
- How will I feel during therapy? What can I do to take care of myself?
- Are there any long-term effects?
- If the tumor grows back after radiation therapy, will surgery be an option?
Chemotherapy uses drugs to kill cancer cells. The drugs that treat laryngeal cancer are usually given through a vein (intravenous). The drugs enter the bloodstream and travel throughout your body.
Chemotherapy and radiation therapy are often given at the same time. You may receive chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some people need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:
- Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug.
- Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may change in color and texture.
- Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.
Also, chemotherapy can cause painful mouth and gums, dry mouth, infection, and changes in taste. Some drugs used for laryngeal cancer can cause tingling or numbness in the hands or feet. You may have these problems only during treatment or for a short time after treatment ends.
Some people with laryngeal cancer receive a type of treatment known as targeted therapy. It may be given along with radiation therapy.
Cetuximab (Erbitux) was the first targeted therapy approved for laryngeal cancer. Cetuximab binds to cancer cells and interferes with cancer cell growth and the spread of cancer. You may receive cetuximab through a vein once a week for several weeks at the doctor's office, hospital, or clinic.
During treatment, your health care team will watch for signs of problems. Some people get medicine to prevent a possible allergic reaction. Side effects may include rash, fever, headache, vomiting, and diarrhea. These effects usually become milder after the first treatment.
You may want to ask your doctor these questions about chemotherapy or targeted therapy:
- Why do I need this treatment?
- Which drug or drugs will I have
- How does the drug work?
- When will treatment start? When will it end?
- How will I feel during treatment? What are the side effects? Are there any lasting side effects? What can I do about them?
How does a person get a second opinion after a throat cancer diagnosis
Before starting treatment, you may want a second opinion about your diagnosis, stage of cancer, and treatment plan. Some people worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor's diagnosis and treatment plan. However, if the second opinion doctor has a different opinon, he or she may suggest another approach, and may help you decide between them. Either way, you'll have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.
It may take some time and effort to gather your medical records and see another doctor. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.
There are many ways to find a doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.