Laryngeal Cancer

Treatment

The type of laryngeal cancer treatment that a patient receives depends on a number of factors. Among these are the exact location and size of the tumor and whether the laryngeal 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 laryngeal cancer 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 laryngeal cancer treatment options, the patient may want to talk with the doctor about taking part in a research study of new treatment methods.

The patient and the doctor should discuss the treatment choices very carefully because laryngeal cancer 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 laryngeal cancer treatment options and possible changes in voice and appearance.

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 laryngeal cancer 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 during the laryngeal cancer treatment process, 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 cannot 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.

Surgery or surgery combined with radiation is suggested for some newly diagnosed patients with laryngeal cancer. 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 laryngeal cancer treatment plan, and the patient's general health, a hospital stay may be needed.

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