Laryngeal (larynx) cancer - Treating laryngeal cancer

The treatment for laryngeal cancer largely depends on how far the cancer has spread.

Most hospitals use multidisciplinary teams (MDTs) of specialists that work together to decide the best way to proceed with your treatment.

Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.

Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions you'd like to ask your care team. For example, you may want to find out advantages and disadvantages of particular treatments.

Your treatment plan

Your recommended treatment plan will depend on the stage of the cancer (see diagnosing laryngeal cancer for more information about staging).

If you have early stage laryngeal cancer, it may be possible to remove the cancer using laser surgery (endoscopic resection) or radiotherapy alone. This may also be the case with slightly larger cancers, although a combination of surgery and radiotherapy is sometimes required.

In later stage laryngeal cancer, more extensive surgery may be needed. Radiotherapy and chemotherapy will probably be used in combination. In particularly severe cases, the entire larynx may have to be removed.

A medication called cetuximab may be used in cases where chemotherapy is not suitable.

These treatments are described below.

Radiotherapy

Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous cells. It can be used as a treatment on its own for early-stage laryngeal cancer, or it can be used before or after surgery to stop cancerous cells returning.

The energy beams used during radiotherapy have to be precisely targeted to your larynx. To ensure the beams are directed at the exact area, a special plastic mask will be made to hold your head in the right position. During your first visit to the radiotherapist, a mould of your face will be taken to make the mask.

Radiotherapy is usually given in short daily sessions from Monday to Friday, with a break from treatment at the weekend. As well as killing cancerous cells, radiotherapy can affect healthy tissue and has a number of side effects, including:

sore, red skin (similar in appearance to sunburn)
mouth ulcers
sore mouth and throat
dry mouth
loss of taste
loss of appetite
tiredness
feeling sick

Your MDT will monitor any side effects and, where possible, treat them. For example, protective gels can be used to treat mouth ulcers, and medicines are available for a dry mouth.

Radiotherapy can sometimes cause your throat tissue to become inflamed. Severe inflammation can cause breathing difficulties. Contact your key worker or visit your local accident and emergency (A&E) department as soon as possible if you have difficulty breathing.

Most side effects should pass after your course of radiotherapy has been completed, although symptoms such as tiredness and dry mouth can last for several months following treatment.

Surgery

There are three types of surgery that can be used to treat laryngeal cancer. They are:

endoscopic resection
partial laryngectomy
total laryngectomy

These are discussed below.

Endoscopic resection

Endoscopic resection can be used in early stage laryngeal cancer.

During the procedure, a surgeon uses a microscope to get a magnified view of the larynx. This allows them to remove the cancer either with a laser or small surgical instruments.

An endoscopic resection is carried out under general anaesthetic, so you will be unconcious during the procedure and won’t feel any pain.

Your mouth and throat may feel sore for a few weeks after the operation and there is a risk of your voice changing as a result of the procedure, which can be permanent.

Partial laryngectomy

A partial laryngectomy can be used to treat some laryngeal cancers. The operation involves surgically removing the affected part of your larynx. Some of your vocal cords will be left in place so you will still be able to talk, but your voice may be quite hoarse or weak.

While your larynx is healing, you may find breathing difficult. If this is the case, the surgeon will create a temporary hole in your neck, which will be attached to a tube you can breathe through. This is known as a temporary tracheostomy.

Once your larynx has healed, the tube can be removed and the hole will heal, leaving a small scar.

This operation is uncommon in the UK nowadays, as endoscopic resection is preferred when suitable.

Total laryngectomy

A total laryngectomy is usually used to treat advanced laryngeal cancer. The operation involves removing your entire larynx. Nearby lymph nodes (small glands that form part of the immune system) may also need to be removed if the cancer has spread to them.

As your vocal cords will be removed, you won't be able to speak in the usual way after the operation. However, there are several ways to help restore your speech. See recovering from laryngeal cancer for more information about this.

If you have a total laryngectomy, your surgeon will also need to create a permanent hole in your neck (called a stoma) to help you breath after the operation.

You'll be given training about how to keep your stoma clean. Having a stoma can seem daunting and frightening at first, but most people get used to it after a few months. See recovering from laryngeal cancer - recovery for more information about adjusting to life after a laryngectomy.

Chemotherapy

Chemotherapy uses powerful cancer-killing medicines to damage the DNA of the cancerous cells and stop them reproducing.

Chemotherapy is often used in combination with radiotherapy before or after surgery to treat advanced laryngeal cancer.

Chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. This, unfortunately, means side effects are common, such as:

feeling sick
being sick
hair loss
sore mouth
mouth ulcers
tiredness

Chemotherapy can also weaken your immune system, making you more vulnerable to infection and illness.

It's therefore important that you report any symptoms of a potential infection to your MDT, such as a high temperature, persistent cough or reddening of the skin. Also avoid close contact with people known to have an infection.

The side effects of chemotherapy should improve after your treatment has finished.

Cetuximab

Cetuximab is a type of medication called a biological therapy. These medications target and disrupt the processes that cancerous cells use to grow and reproduce.

Cetuximab specifically targets special proteins called epidermal growth factor receptors (EGFRs), which are found on the surface of cancerous cells. EGFRs help the cancer to grow, so by disrupting them cetuximab can prevent the cancer from spreading.

Cetuximab can be used in combination with radiotherapy to treat more advanced laryngeal cancer where it's not possible to use chemotherapy. For example, people with kidney or heart disease, or people with an ongoing infection will not be able to have chemotherapy because it could make them very ill.

Cetuximab is given intravenously (through a drip into your vein) which slowly delivers the first dose over the course of a few hours. Further doses should take about an hour and are given weekly.

The side effects of cetuximab are usually mild and include:

rashes
feeling sick
diarrhoea
breathlessness

Cetuximab can also trigger allergic reactions in some people, which can cause problems such as a swollen tongue or throat. In about 1 in 35 people who take cetuximab, the allergic reaction can be severe and life-threatening.

Most serious reactions occur within 24 hours of treatment starting, so you'll be closely monitored once your treatment begins. If you have symptoms of a severe reaction, such as a rapid heartbeat or breathing problems, anti-allergy medicines can be used to relieve them (such as corticosteroids).

These measures mean that deaths resulting from severe reactions in people taking cetuximab are rare, occurring in less than 1 in every 1,000 cases.