Treatment for cancer of the larynx depends on a number of factors. Among these are the exact location and size of the tumor and whether the cancer has spread. To develop a treatment plan to fit each patient’s needs, the doctor also considers the person’s age, general health, and feelings about the possible treatments.

Many patients want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When discussing treatment options, the patient may want to talk with the doctor about taking part in a research study of new treatment methods. Such studies are called clinical trials.

The patient and the doctor should discuss the treatment choices very carefully because treatments for this disease may change the way a person looks and the way he or she breathes and talks. In many cases, the patient meets with both the doctor and a speech pathologist to talk about treatment options and possible changes in voice and appearance.

People with cancer of the larynx have many important questions. The doctor and other members of the health care team are the best ones to answer them. Most patients want to know the extent of their cancer, how it can be treated, how successful the treatment is expected to be, and how much it is likely to cost. These are some questions patients may want to ask the doctor:

• What are my treatment choices?
• Would a clinical trial be appropriate for me?
• What are the expected benefits of each kind of treatment?
• What are the risks and possible side effects of each treatment?
• How will I speak after treatment?
• How will I look?
• Will I need to change my normal activities? If so, for how long?
• When will I be able to return to work?
• How often will I need to have checkups?

When a person is diagnosed as having cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the doctor. Often, it helps to make a list of questions. To help remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some people also want to have a family member or friend with them when they talk to the doctor - to take part in the discussion, to take notes, or just to listen.

Getting A Second Opinion

Treatment decisions are complex. Before starting treatment, the patient might want a second doctor to review the diagnosis and treatment plan. It may take a week or two to arrange for a second opinion. A short delay will not reduce the chance that treatment will be successful. Some insurance companies require a second opinion; others cover a second opinion if the patient requests it.

There are a number of ways to find a doctor who can give a second opinion:

• The patient’s doctor may be able to suggest a specialist to consult.
  
• The Cancer Information Service, at 1-800-4-CANCER (1-800-422-6237), can tell callers about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
  
• Patients can get the names of doctors from their local medical society, a nearby hospital, or a medical school.

Treatment Methods

Cancer of the larynx is usually treated with radiation therapy (also called radiotherapy) or surgery. These are types of local therapy; this means they affect cancer cells only in the treated area. Some patients may receive chemotherapy, which is called systemic therapy, meaning that drugs travel through the bloodstream. They can reach cancer cells all over the body. The doctor may use just one method or combine them, depending on the patient’s needs.

In some cases, the patient is referred to doctors who specialize in different kinds of cancer treatment. Often several specialists work together as a team. The medical team may include a surgeon; ear, nose, and throat specialist; cancer specialist (oncologist); radiation oncologist; speech pathologist; nurse; and dietitian. A dentist may also be an important member of the team, especially for patients who will have radiation therapy.

Radiation therapy uses high-energy rays to damage cancer cells and stop them from growing. The rays are aimed at the tumor and the area close to it. Whenever possible, doctors suggest this type of treatment because it can destroy the tumor and the patient does not lose his or her voice. Radiation therapy may be combined with surgery; it can be used to shrink a large tumor before surgery or to destroy cancer cells that may remain in the area after surgery. Also, radiation therapy may be used for tumors that can’t be removed with surgery or for patients who cannot have surgery for other reasons. If a tumor grows back after surgery, it is generally treated with radiation.

Radiation therapy is usually given 5 days a week for 5 to 6 weeks. At the end of that time, the tumor site very often gets an extra "boost" of radiation. The National Cancer Institute book Radiation Therapy and You is a useful source of information about this form of treatment.

Surgery or surgery combined with radiation is suggested for some newly diagnosed patients. Also, surgery is the usual treatment if a tumor does not respond to radiation therapy or grows back after radiation therapy. When patients need surgery, the type of operation depends mainly on the size and exact location of the tumor.

If a tumor on the vocal cord is very small, the surgeon may use a laser, a powerful beam of light. The beam can remove the tumor in much the same way that a scalpel does.

Surgery to remove part or all of the larynx is a partial or total laryngectomy. In either operation, the surgeon performs a tracheostomy, creating an opening called a stoma in the front of the neck. (The stoma may be temporary or permanent.) Air enters and leaves the trachea and lungs through this opening. A tracheostomy tube, also called a trach ("trake") tube, keeps the new airway open.

A partial laryngectomy preserves the voice. The surgeon removes only part of the voice box - just one vocal cord, part of a cord, or just the epiglottis - and the stoma is temporary. After a brief recovery period, the trach tube is removed, and the stoma closes up. The patient can then breathe and talk in the usual way. In some cases, however, the voice may be hoarse or weak.

In a total laryngectomy, the whole voice box is removed, and the stoma is permanent. The patient, called a laryngectomee, breathes through the stoma. A laryngectomee must learn to talk in a new way.

If the doctor thinks that the cancer may have started to spread, the lymph nodes in the neck and some of the tissue around them are removed. These nodes are often the first place to which laryngeal cancer spreads.

Chemotherapy is the use of drugs to kill cancer cells. The doctor may suggest one drug or a combination of drugs. In some cases, anticancer drugs are given to shrink a large tumor before the patient has radiation therapy or surgery. Also, chemotherapy may be used for cancers that have spread.

Anticancer drugs for cancer of the larynx are usually given by injection into the bloodstream. Often the drugs are given in cycles - a treatment period followed by a rest period, then another treatment and rest period, and so on. Some patients have their chemotherapy in the outpatient part of the hospital, at the doctor’s office, or at home. However, depending on the drugs, the treatment plan, and the patient’s general health, a hospital stay may be needed. The National Cancer Institute publication Chemotherapy and You has helpful information about this type of treatment.

Treatment Studies

Researchers are looking for treatment methods that are more effective against cancer of the larynx and have fewer side effects. When laboratory research shows that a new method has promise, it is used to treat cancer patients in clinical trials. These trials are designed to find out whether the new approach is both safe and effective and to answer scientific questions. Patients who take part in clinical trials make an important contribution to medical science and may have the first chance to benefit from improved treatment methods.

Many clinical trials of new treatments for cancer of the larynx are under way. Doctors are studying new types and schedules of radiation therapy, new drugs, new drug combinations, and new ways of combining various types of treatment. Scientists are trying to increase the effectiveness of radiation therapy by giving treatments twice a day instead of once. Also, they are studying drugs called "radiosensitizers." These drugs make the cancer cells more sensitive to radiation.

People who have had cancer of the larynx have an increased risk of getting a new cancer in the larynx or in the lungs, mouth, or throat. Doctors are looking for ways to prevent these new cancers. Some research has shown that a drug related to vitamin A may protect people from new cancers.

Patients who are interested in taking part in a trial should talk with their doctor. They may want to read the National Cancer Institute booklet What Are Clinical Trials All About?, which explains the possible benefits and risks of treatment studies.

One way to learn about clinical trials is through Physician Data Query (PDQ), a computerized resource developed by the National Cancer Institute. PDQ contains information about cancer treatment and about clinical trials in progress all over the country. The Cancer Information Service can provide PDQ information to doctors, patients, and the public.

Source: "What You Need To Know About Cancer Of The Larynx," Brochure, NIH Publication No. 95-1568, National Cancer Institute, March 1995 .

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