Cancer treatment team
Many hospitals use multidisciplinary teams (MDTs) to treat laryngeal cancer. These are teams of specialists that work together to decide the best way to proceed with your treatment. See the box (left) for details of the specialists who make up MDTs.
As well as having a specialist MDT, you may also be assigned a key worker who will usually be a specialist nurse. They will be responsible for co-ordinating your care.
Deciding what treatment is best for you can often be confusing. 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 that you'd like to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.
Your treatment plan
Your recommended treatment plan will depend on the stage that your laryngeal cancer is at (see Laryngeal cancer - diagnosis for more information about staging).
If you have early stage one laryngeal cancer, it may be possible to remove the cancer using radiotherapy alone (see below). Later stage one and stage two cancer will probably require a combination of surgery and radiotherapy.
In stages three and four, more extensive surgery may be needed. Radiotherapy and chemotherapy will probably be used. In particularly severe cases, the entire larynx may have to be removed.
Radiotherapy
Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous cells. It can be used as a primary treatment in early-stage laryngeal cancer. It's also often used as a secondary treatment before or after surgery to stop cancerous cells returning.
The energy beams that are used during radiotherapy have to be precisely targeted to your larynx. In order to ensure that the beams are directed to 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 associated 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, provide treatment for them. For example, protective gels can be used to treat mouth ulcers, and medicines are available if you have a dry mouth.
Radiotherapy can sometimes cause your throat tissue to become inflamed. Severe inflammation can cause breathing difficulties. Contact your MDT 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.
See the Health A-Z topic about Radiotherapy for more information.
Surgery
There are four types of surgery that are used to treat laryngeal cancer. They are:
- laser surgery
- endoscopic resection
- partial laryngectomy
- total laryngectomy
These are discussed below.
Laser surgery
Laser surgery will be used if the tumour in your larynx is still very small. A fibre-optic cable is placed into your larynx and a laser is passed through the cable to destroy the cancerous cells.
The operation is carried out under general anaesthetic. Most people who have laser surgery are able to leave hospital the day after their operation.
Endoscopic resection
Endoscopic resection can be used to treat stage one and stage two laryngeal cancer. The surgeon uses an endoscope, which is a small flexible tube with a light and a camera on one end. Tiny surgical instruments can also be passed down through the endoscope.
During an endoscopic resection, the surgeon will guide the endoscope into your larynx. The camera will be used to relay images to a screen in the operating theatre so that the surgeon is able to see your larynx in detail. They will remove any cancerous cells either using a laser or surgical instruments.
An endoscopic resection is carried out under general anaesthetic and doesn't cause any long-lasting side effects. However, you may feel some soreness in your mouth and throat for a few weeks afterwards.
Partial laryngectomy
A partial laryngectomy is usually used to treat stage three laryngeal cancer. The operation involves surgically removing the affected part of your larynx. Some of your vocal cords will be left in place so that 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 that 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. You may have a small scar.
Total laryngectomy
A total laryngectomy is usually used to treat advanced stage three or stage four laryngeal cancer. The operation involves removing your entire larynx. Nearby lymph nodes 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. There are several ways to help restore your speech. See Laryngeal cancer - recovery for more information about the different ways of restoring your speech.
If you have a total laryngectomy, you'll also need to have a permanent tracheostomy. The tube will usually be removed after a few weeks, leaving the hole. The medical term for a surgically created hole in the skin is a stoma.
You'll be given training about how to keep your stoma clean. Having a permanent tracheostomy can seem daunting and frightening at first, but most people get used to the stoma after a few months. See Laryngeal cancer - recovery for more information about adjusting to life after a laryngectomy.
Chemotherapy
Chemotherapy is often used in combination with radiotherapy before you have surgery to treat advanced laryngeal cancer. Chemotherapy uses powerful cancer-killing medicines to damage the DNA of the cancerous cells and stop them from reproducing.
Chemotherapy can often be used to shrink a tumour, which means it's not necessary to remove your entire larynx during surgery. However, the medicines that are used can sometimes damage healthy tissue as well as the cancerous tissue. Unfortunately, side effects are common and include:
- feeling sick
- being sick
- hair loss
- sore mouth
- mouth ulcers
- tiredness
These side effects should stop after your treatment has finished. 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 who are known to have an infection.
Targeted therapies
Targeted therapies refer to a group of medicines that are designed to target and disrupt one or more of the biological processes that cancerous cells use to grow and reproduce.
A targeted therapy called cetuximab can be used to treat cases of stage three or stage four laryngeal cancer where it's not possible to use chemotherapy. For example, people with kidney disease or people with an ongoing infection can't have chemotherapy because it could make them very ill.
Cetuximab 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 targeting them cetuximab can prevent the cancer from spreading.
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:
- skin rashes
- feeling sick
- diarrhoea
- breathlessness
- eye inflammation (conjunctivitis)
Cetuximab can trigger allergic reactions in some people, such as a swollen tongue or throat.
Occasionally, the allergic reaction can be severe and life-threatening. This is known as an infusion reaction and it occurs in about 1 in 35 people who take cetuximab.
Most infusion reactions occur within 24 hours of treatment starting, so you'll be closely monitored once your treatment begins. If you have symptoms of an infusion reaction, such as a rapid heartbeat or breathing problems, anti-allergy medicines can be used to relieve them – for example, corticosteroids.
These measures mean that deaths resulting from infusion reactions in people taking cetuximab are very rare, occurring in less than 1 out of every 1,000 cases.
