Endoscopic laser surgery

For early stage, or limited amount of tumor grown, endoscopic surgery can be an excellent option to result in high cure rates and voice preservation. Similar to a Direct Laryngoscopy, a metal tube is passed through the mouth to see the throat directly. This is performed under general anesthesia. With the use of microscope or telescope, surgical resection of the tumor area can be safely performed.

Cordectomy

A cordectomy is surgery to remove part or all of the vocal cords and may be recommended for early staged Glottic cancers.

Transoral Laser Microsurgery (TLM)

With the use of a microscope and a precision laser, the laryngeal cancers can be successfully removed endoscopically with clean margins. Generally, laryngeal TLM is performed without the need for feeding tubes or breathing tubes.

Open Partial laryngectomy

For mid-staged laryngeal tumors, a partial removal of the voice box can be performed using an incision on the neck. Most patients who have a partial laryngectomy require a temporary tracheostomy, in which the doctor makes a hole in the neck (stoma) to breathe through during the recovery period. This stoma is usually temporary and after the patient recovers, the doctor will remove the tube and the hole will close on its own. Swallowing rehabilitation can be challenging after this surgery.

Total laryngectomy

A total laryngectomy is surgery to remove the entire larynx. The larynx connects the mouth to the lungs, so after this procedure, the doctor will attach the windpipe (trachea) to a hole in the lower neck (stoma) for the patient to breathe through. For a total laryngectomy, the breathing tube is permanent. After this procedure the patient will be offered one of several voice rehabilitation options to allow for effective communication. Voice rehabilitation options are a critical portion of the pre-surgical discussion prior to total laryngectomy.

Neck dissection

A neck dissection is a procedure to selectively remove the lymph nodes in the neck. In this procedure, the doctor removes the lymph nodes that the cancer is most likely to spread to. Assessing the lymph nodes can be a critical part of the treatment of Supraglottic cancers. While in the majority of surgical cases it is not needed, in advanced cases the doctor may also need to remove non-critical structures in the neck, such as muscles, nerves or veins.

Tracheo-esophageal puncture (TEP)

A TEP is a frequently recommended procedure to rehabilitate voicing after a laryngectomy. A procedure will puncture a small connection at the back wall of the stoma (the breathing hole in your neck) to the esophagus. A small, one-way valve (voice prosthesis) is then inserted into this connection. This prosthesis allows the air from the lungs to come up through the valve into the upper esophagus, creating a sound similar to a voice.

Electrolarynx

An electrolarynx is a battery-powered machine that creates sound which can vibrate within the mouth and throat. Patients either place the machine on your neck or place a small tube in the corner of the mouth. When activated, the machine will create the sound. Patients then move the mouth and tongue to articulate the sound into words, similar to natural speech motion.

Esophageal Speech

Esophageal speech is a technique that teaches patients to expel air from the esophagus. The air passes over the tissue of the throat and makes vibrations, which can mimic a voice. Patients can learn to control the air production. Patients generally need to work with a speech language pathologist to learn and practice this technique.

Photon Radiation therapy

A type of radiation therapy that uses x-rays or gamma rays that come from a special machine called a linear accelerator (linac). The radiation dose is delivered at the surface of the body and goes into the tumor and through the body. Photon beam radiation therapy is different from proton beam therapy.

Radiation therapy may be an excellent treatment choice for many laryngeal tumors. Radiation therapy can be used alone to cure many tumors. Radiation therapy may be combined with chemotherapy for advanced staged tumors. Radiation in particular is a commonly selected treatment option when the only surgical alternative is a total laryngectomy. Radiation therapy is also often given after surgery, to reduce the risk of a recurrence/prevent the cancer from coming back. Radiation therapy may also be used for palliation to shrink tumors and relieve symptoms.

Proton beam radiation therapy

Proton therapy is an advanced type of radiation therapy that uses “protons” rather than X-ray “photons” to deliver radiation to the tumor. In conventional radiotherapy, the photon beams can deposit radiation and damage healthy cells as they pass through the body. Proton therapy deposits most of the radiation directly at the tumor site, resulting in less damage to healthy tissue and fewer side-effects. However the use of proton beam therapy for laryngeal cancer is extremely rare.

• Please see Understanding Proton Therapy to learn more.

Chemotherapy

Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy may be combined with radiation therapy to make both treatments more effective. Chemotherapy may also be given before surgery or radiation therapy in order to shrink the tumor. Chemotherapy is sometimes combined with radiation therapy (chemoradiation). For tumors that can no longer be considered curable, chemotherapy can be used as primary treatment to slow the growth of the cancers locally advanced or for widespread tumors.

Biological Therapy/Immunotherapy

Some cases of laryngeal cancer contain cells that over-express certain proteins that cause the cancer to grow more aggressively. A form of biological therapy or immunotherapy is called monoclonal antibodies specifically targets these cells, preventing them from fueling cell growth.

Clinical Trials

Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.