喉癌-Cancer of the Larynx

What are the treatment options for cancer of the larynx?

Treatment options which may be considered include radiotherapy, surgery, and chemotherapy. The treatment advised for each case depends on various factors such as the exact site of the primary tumour in the larynx, the stage of the cancer (how large the cancer is and whether it has spread), the grade of the cancerous cells, and your general health.

You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the possible treatment options for your type of cancer.

You should also discuss with your specialist the aims of treatment. For example:

• In some cases, treatment aims to cure the cancer. There is a good chance of a cure if it is treated in the early stages. Many cases are diagnosed at an early stage. This is because tests are usually done if you develop a persistent hoarse voice which often develops when the cancer is still at an early stage. (Doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no evidence of cancer following treatment. If you are 'in remission', you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.)
• In some cases, treatment aims to control the cancer. If a cure is not realistic, with treatment it is often possible to limit the growth or spread of the cancer so that it progresses less rapidly. This may keep you free of symptoms for some time.
• In some cases, treatment aims to ease symptoms. For example, if a cancer is advanced then you may require painkillers or other treatments to help keep you free of pain or other symptoms. Some treatments may be used to reduce the size of a cancer which may ease symptoms such as pain or difficulty swallowing.

Radiotherapy
This is the common treatment if the cancer is small and has not spread from the larynx (early stage). Radiotherapy is a treatment which uses high energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. (There is a separate leaflet which gives more details about radiotherapy.)

Radiotherapy alone gives a good chance of a cure if the cancer is at an early stage. Radiotherapy is also sometimes used in addition to surgery or chemotherapy in certain situations. For example, radiotherapy may be used to shrink a large tumour prior to surgery. This may give a better chance of success with surgery. It is sometimes used following surgery to kill any cancer cells which may have been left behind following the operation.

Surgery
Tumours which are larger tend to require surgery. Sometimes surgery is aimed at curing the cancer by removing it all. Sometimes surgery is used to relieve symptoms if the cancer is at an advanced stage (palliative surgery). The operations are all done whilst you are asleep under a general anaesthetic.

The type of operation done depends on the size of the tumour, the exact site of the tumour in the larynx, and whether the cancer has spread to nearby structures or lymph glands. For example:

• Endoscopic resection. This is a technique which can remove a small tumour in the larynx. Instruments are passed down the inside of the larynx which cut out a tumour. Sometimes a laser is used to 'burn' out the tumour. This technique does not involve a cut from the outside. It is only suitable for tumours that are small and still confined to the inner lining of the larynx.
• Partial laryngectomy. This is an operation where the affected part of the larynx is cut out. A cut is made in the front of the neck to get at the larynx. If only part of the larynx is removed you should not need a permanent stoma ('hole in the neck') to breathe, and speech may be preserved. A temporary stoma may be required whilst the wound is healing.
• A total laryngectomy. This is an operation where the entire larynx is removed. To be able to breathe after the operation, the top part of the trachea is attached to the front of the neck. You will then have a permanent hole (stoma) in the front of the neck. The vocal cords will have been removed so you will not be able to speak normally again. However, there are various techniques that you can be taught by a speech therapist which can enable you to make sounds and speak in a different way.

If the cancer has spread, the surgeon may also remove lymph glands and other structures near to the larynx in addition to removing the larynx. The amount of tissue removed depends on the extent of local spread of the cancer.

Chemotherapy
Chemotherapy is a treatment which uses anti-cancer drugs to kill cancer cells, or to stop them from multiplying. Chemotherapy used in conjunction with radiotherapy is sometimes used as an alternative to surgery. It aims to preserve the larynx and normal speech. Your specialist will advise when this may be an option.

Chemotherapy may also be advised if the cancer has spread to other areas of the body.

What is the prognosis (outlook)?

If a cancer of the larynx is diagnosed and treated at an early stage then there is a good chance of a cure. A cure is less likely if the cancer has spread.

The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.

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