Laryngeal cancer originates in the larynx, an area of the throat used for breathing, swallowing and speaking (it contains the vocal cords). Most of these cancers start in the flat cells lining the larynx.
Hypopharyngeal cancer is found in the lower section of the throat (pharynx) that begins behind the nose and extends about 5 inches down through the neck and ends at the top of the trachea (wind pipe) and esophagus (tube to the stomach).
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Exams and tests performed to detect and diagnose laryngeal and hypopharyngeal cancer may include:
- Laryngoscopy, in which a physician uses a laryngoscope to examine the back of the throat and vocal cords. The most common type is known as a direct fiber-optic laryngoscopy.
- Panendoscopy (also known as an upper GI endoscopy), in which a doctor examines the lining of the esophagus, using an endoscope.
- Barium swallow, which involves a series of X-rays taken after a patient drinks barium, which is a chalky liquid that coats the walls of the throat and esophagus.
- Computed tomography (CT) scan, which can help physicians to determine a tumor’s size and extent. CT scans combine multiple digital images of soft tissues and organs inside the body to provide a more detailed picture than a standard X-ray.
- Magnetic resonance imaging (MRI) scan, which uses radio waves and magnets instead of X-rays to provide detailed pictures of the body’s soft tissues and organs.
- Positron emission tomography (PET) scan, which includes an injection of a radioactive solution into the blood, followed by a digital imaging exam to determine if cancer cells are present. A PET scan is typically performed in conjunction with a CT scan.
- Chest X-ray, which is used to determine if cancer has potentially spread to the lungs.
- Endoscopic biopsy, in which an endoscope is inserted through the nose or mouth to check the throat and remove a small tissue sample for testing. This biopsy is usually performed under anesthesia.
- Fine needle aspiration (FNA) biopsy, in which a thin, hollow needle is used to remove tissue for testing to determine the cause of an enlarged lymph node in the neck, and whether an endoscopic biopsy will be required as part of the diagnosis.
Treatment options may include:
Surgical treatment of laryngeal or hypopharyngeal cancer may include:
- Vocal cord stripping, in which a surgeon removes superficial layers of tissue on the vocal cords. This type of surgery is usually reserved for very early stage cancers.
- Laser surgery, in which a surgeon uses an endoscope to locate a tumor and then vaporizes or removes it with a high-energy laser. This type of surgery is typically reserved for very early stage cancers.
- Cordectomy, in which a surgeon removes all or part of the vocal cords.
- Partial or total pharyngectomy, in which all or part of the throat (pharynx) is removed. The larynx may also be removed at the same time. This surgery may require a reconstructive procedure so patients may swallow easier.
- Lymph node removal surgery (also known as neck dissection) is performed if cancer has spread from the larynx and hypopharynx to lymph nodes of the neck.
- Tracheostomy (also known as a tracheotomy), which involves an incision (hole) in the trachea (windpipe) through the front of the neck to help a patient breathe. A temporary or permanent tracheostomy may be required, depending on the extent of cancer.
- Gastrostomy tube, which is a feeding tube inserted through the abdomen and into the stomach for patients who are unable to swallow and ingest enough food to maintain a sufficient daily diet. It may be used temporarily during chemotherapy or radiation therapy.
Depending on the stage and extent of laryngeal cancer, other surgical options may include:
- Supraglottic laryngectomy, which involves removing only the supraglottis. The supraglottis is the upper part of the larynx (voice box), including the epiglottis, which is the area above the vocal cords.
- Hemilaryngectomy, in which half of the larynx (voice box) is removed and can save a patient’s voice.
- Partial or total laryngectomy, in which a part or all of the larynx (voice box) is removed. This surgery includes a tracheostomy.
- Thyroidectomy, which is the removal of all or part of the thyroid gland.
Radiation therapy may be used as a primary treatment for early stage throat cancers. Small tumors may be cured without the need for surgery.
Radiation therapy may also be prescribed after a surgery to treat any remaining cancer cells. The radiation therapy team includes highly trained specialists who care for their patients each step of the way.
Radiation therapy may also be used to ease symptoms of advanced stage throat cancers that are causing bleeding and difficulty swallowing.
Types of radiation therapy for laryngeal and hypopharyngeal cancers include:
- 3-D conformal radiation
- Intensity-modulated radiation therapy (IMRT)
Chemotherapy may be used to shrink a tumor before surgery. It can also be provided in conjunction with radiation therapy as a primary treatment with the goal of avoiding a laryngectomy.
Chemotherapy may also be part of post-surgery treatment to treat any remaining cancer cells and prevent a recurrence. It can also be part of treatment to reduce symptoms caused by late-stage or metastatic throat cancers.
To enhance the care of people dealing with throat cancer, Scripps Health also offers patient support services.