Treatment options for laryngeal cancer

Your doctor and healthcare team will talk to you about your treatment and the options you have. They will explain the benefits and the possible side effects.

The most common treatments for laryngeal cancer are surgery, radiotherapy, and chemotherapy.

Your treatment depends on:

• your type of laryngeal cancer
• where the cancer is in your larynx
• how far it has grown or spread (the stage)
• how abnormal the cells look under a microscope (the grade)
• your general health and level of fitness

Deciding what treatment you need

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Most people are referred to a head and neck cancer MDT. Or you might be referred to the ear, nose and throat (ENT) multidisciplinary team. You might go to a different hospital if your local hospital doesn't have a specialist MDT.

The MDT usually includes:

Head and neck surgeons

There are different types of head and neck surgeons.

ENT surgeons are specialists who treat ear, nose, throat and neck conditions. 

Oral and maxillofacial surgeons train as both doctors and dentists. They specialise in conditions of the mouth, jaw, face and neck. These surgeons remove the cancer and also rebuild the tissue lost due to the cancer or surgery. 

Plastic surgeons do reconstructive surgery. Some people might have plastic surgery after head and neck cancer surgery. 

Oncologist

An oncologist is a cancer doctor specialising in treating cancer with cancer drugs (medical oncologist) and radiotherapy (clinical oncologist).

Speech and language therapist 

Speech and language therapists play an important role in helping you with:

• communication
• speech
• swallowing difficulties (dysphagia)

They will start supporting you before you start your treatment. This continues during and after treatment.

Head and neck clinical nurse specialist

A clinical nurse specialist is a qualified nurse who has knowledge of head and neck cancers. They help to organise your care between doctors and other health professionals.

Your specialist nurse also supports you during and after your treatment. They make sure you have the information you need so you can cope with treatment as well as possible.

A dietician 

Your dietitian will explain how your treatment might affect your eating and drinking and work out a plan for you. They will also offer advice to help with any changes in your diet when you go home. 

Other healthcare professionals

Other healthcare professionals involved in your care include:

• a head and neck radiologist (doctors who specialise in taking and reading x-rays and scans)
• a head and neck histopathologist (doctors who study organs, tissues, cells and genetics to help provide a diagnosis)
• a prosthodontist (a specialist dentist). They treat complex dental and facial issues
• social workers or benefits advisers

The MDT may also include health professionals who look after people with advanced laryngeal cancer. They can help with symptom control. They include:

• the palliative care team
• a clinical nurse specialist for palliative care

Making decisions

You might have a combination of treatments. And you might need to see various people from the multidisciplinary team. 

Your doctor will discuss your treatment, its benefits, and the possible side effects with you. 

Ask your speech and language therapist or nurse if they can introduce you to someone who had treatment if you think this would be helpful to you.

Treatment overview

Types of treatment

You might have one or more of the following treatments:

• surgery

• radiotherapy

• chemotherapy with radiotherapy (chemoradiotherapy)

• chemotherapy

• targeted cancer drugs

• immunotherapy

Surgery

Surgery is a common treatment for early stage laryngeal cancer. You might have transoral surgery. This means you have surgery through the mouth to reach the cancer. Your surgeon will let you know the stage of your cancer and if transoral surgery is suitable for you.

You might have open surgery to remove part or all of the larynx. Open surgery means you have a cut (incision) in your neck or jaw. You might have this  if:

• transoral surgery isn’t possible
• your cancer is more advanced

If you have surgery for advanced laryngeal cancer, you usually have other treatment afterwards. You might have radiotherapy on its own or together with chemotherapy (chemoradiotherapy).

Depending on the stage and the type of laryngeal cancer you might have surgery to remove the lymph nodes. This might be on one side of your neck or both.  

Radiotherapy

Radiotherapy uses high energy rays to destroy cancer cells. You might have radiotherapy on its own for early stage laryngeal cancer. Or after surgery in some situations. Or you might have radiotherapy with chemotherapy (chemoradiotherapy) for more advanced laryngeal cancer. 

Radiotherapy is also given to control symptoms of advanced cancer.

Chemoradiotherapy

Chemotherapy with radiotherapy is called chemoradiotherapy. You might have chemoradiotherapy on its own as your main treatment or after surgery. 

Chemotherapy

You might have chemotherapy before or after surgery or radiotherapy. It is sometimes given on its own. But you most often have it together with radiotherapy.  

Chemotherapy can be given for advanced laryngeal cancer. The aim is to slow the growth of the cancer and control symptoms (palliative chemotherapy).

Immunotherapy and targeted cancer drugs

You might have targeted cancer drugs or immunotherapy in some situations for locally advanced or advanced laryngeal cancer. But it also depends on:

• the type of laryngeal cancer you have
• other treatments you can have

Treatment by number stage

Below are guidelines for treatment by stage. The treatment you have depends on the type of laryngeal cancer you have and where the cancer is. But remember everyone’s situation is different.

Your healthcare team will work out a treatment plan for you. 

Stage 0 (Tis)

Tis means tumour in situ. This is a very early stage. It may also be called a pre cancer .

The surgeon usually removes the abnormal area with surgery through the mouth (transoral surgery).

Stage 1 and 2

Your surgeon aims to preserve your larynx as much as possible so you are still able to speak.

Treatment might include:

• surgery through your mouth (transoral surgery) to remove the cancer. This might be transoral laser microsurgery (TLM)

• radiotherapy

• surgery to remove part of your voice box (a partial laryngectomy)

You might have lymph nodes in your neck removed. Or radiotherapy to the lymph nodes.  

Your surgeon will recommend further treatment after surgery if:

• the cancer hasn’t been completely removed together with a margin of healthy tissue around it 
• the cancer has spread outside the lymph node

You might need to have radiotherapy after surgery if there is any risk of the cancer coming back. 

Stage 3

You might have radiotherapy on its own or with chemotherapy. This might be your main treatment. Or you might have it after surgery to remove all or part of the larynx. This is to lower the risk of the cancer coming back. Surgery to remove the larynx is called laryngectomy. 

Your surgeon is likely to remove the lymph nodes in your neck. This might be on the side of the cancer or both. You usually have radiotherapy to the neck or chemoradiotherapy afterwards.

Stage 4

You might have a combination of treatments, these include:

• radiotherapy
• chemotherapy 
• chemoradiotherapy
• surgery to remove the larynx (laryngectomy) 

Treatment of the lymph nodes in the neck may include surgery on one or both sides (a neck dissection). You usually have radiotherapy to the neck or chemoradiotherapy afterwards. Or you might have radiotherapy and chemotherapy without surgery. 

Other treatments include targeted cancer drugs and immunotherapy .

For advanced cancer , your doctor will refer you to a palliative care team. Palliative care specialists care for people in the final stages of their illness. But they also work with people with any stage of cancer. They can give expert help including:

• controlling symptoms such as pain, sickness and breathing problems
• supporting you with diet and physical care
• helping you have the best possible quality of life, whether you are at home or in a hospital or hospice

Laryngeal cancer that comes back

The treatment you might have for laryngeal cancer that has come back depends on where in your body the cancer is. It also depends on what treatment you had previously.

Before you start, your doctor will usually take another tissue sample (a biopsy). And you often have other tests, for example, a CT or MRI scan.

You might have surgery if your surgeon can remove the cancer and you are fit enough.

You might have radiotherapy on its own or after surgery.

Other treatment options include:

• chemotherapy
• immunotherapy
• targeted cancer drugs

Advanced laryngeal cancer

Deciding about treatment can be difficult when you have advanced cancer .

It helps to understand:

• how treatment can help you

• how it might affect your quality of life

• what are the side effects

Your doctor or specialist nurse can talk to you about the benefits and possible side effects. You can ask them questions.

It also helps to talk things over with a close relative, a friend or a trained counsellor at the hospital.

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. It may help to think about the other factors involved in each treatment, such as:

• whether you need extra appointments

• if you need more tests

• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments, such as chemotherapy. But you can still have medicines to help control symptoms, such as sickness or pain.

Your doctor or nurse will explain what could help you. You can also ask them to refer you to a local symptom control team to give you support at home.

Having treatment as part of a clinical trial

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

A second opinion

A second opinion means seeing another GP or specialist doctor. They will give their view on your diagnosis or treatment. This might mean going to a different NHS hospital or GP surgery. Or you can pay to see a doctor privately.