Treating laryngeal cancer

The treatment for laryngeal cancer largely depends on the size of the cancer. The main treatments are radiotherapy, surgery and chemotherapy.

Most hospitals use multidisciplinary teams (MDTs) of specialists that work together to decidethe best way to proceed with your treatment.

Members of your MDT will probably include a surgeon, a clinical oncologist (a specialist in non-surgical treatment of cancer), and a specialist cancer nurse who will be responsible for co-ordinating your care.

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 you'd like to askyour care team. 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 of thecancer (see diagnosing laryngeal cancer for more information on staging).

If you have early-stage laryngeal cancer, it may be possible to remove the cancer using surgery (endoscopic resection) or Radiotherapy alone. This may also be the case with slightly larger cancers, although a combination of surgery and radiotherapy is sometimes required.

In later-stage laryngeal cancer, more extensive surgery may be needed. Radiotherapy and chemotherapy will probably be used in combination. In some cases, the entire larynx may have to be removed.

A medication called cetuximab may be used in cases where chemotherapy is not suitable.

These treatments are described below.

Radiotherapy

Radiotherapy uses controlled doses of high-energy radiation to destroy cancerous cells. It can be used as a treatment on its own for early-stage laryngeal cancer, or it can be usedafter surgery to stop cancerous cells returning. It's sometimes combined with chemotherapy.

The energy beams used during radiotherapy have to be precisely targeted to your larynx.To ensurethe beams are directed at the exact area, a special plastic mask will be made to hold your head in the right position. A mould of your face will be taken, so that the mask can be made before treatment starts.

Radiotherapy is usually given in short daily sessions from Monday to Friday, with a break from treatment at the weekend. The course of treatment usually lasts for three to seven weeks.

As well as killing cancerous cells, radiotherapy can affect healthy tissue and has a number of side effects, including:

• sore, red skin (similar to sunburn )
• mouth ulcers
• dry mouth
• loss of taste
• loss of appetite
• tiredness
• feeling sick

Your MDT will monitor any side effects and treat them when possible. For example, protective gels can be used to treat mouth ulcers, and medicines are available for a dry mouth.

Radiotherapy can sometimes cause your throat tissue to become inflamed. Severe inflammation can cause breathing difficulties. Contact your key worker or visit your local accident and emergency (A&E) department as soon as possible if you have difficulty breathing.

Most side effects should pass within a few weeks of treatment finishing.

They are:

• endoscopic resection
• partial laryngectomy
• total laryngectomy

These are described below.

Endoscopic resection

Endoscopic resection can be usedinearly-stage laryngeal cancer.

During the procedure, a surgeon uses a special microscope to get a magnified view of the larynx. This allows them to remove the cancer either with a laser or small surgical instruments.

An endoscopic resection is carried out under general anaesthetic , so you willbe unconscious during the procedure and won't feel any pain.

Yourmouth and throatmay feel sore for a few weeks after the operation and there's a risk of your voice changing as a result of the procedure, which can be permanent.

Partial laryngectomy

A partial laryngectomy can be used to treat some laryngeal cancers. The operation involves surgically removing the affected part of your larynx. Some of your vocal cords will be left in place, so 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. Your surgeonmay need tocreate a temporary hole in your neck, which will be attached to a tube 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, leaving a small scar.

This operation isuncommon nowadays,as endoscopic resection is preferred whenever possible.

Total laryngectomy

A total laryngectomy is usually used to treat advanced laryngeal cancer. The operation involves removing your entire larynx. Nearby lymph nodes (small glands that form part of the immune system) 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 after the operation. However, there are several ways to help restore your speech.

If you have a total laryngectomy, your surgeon will also need to create a permanent hole in your neck (called a stoma) to help you breath after the operation.

You will be given training on how to keep your stoma clean. Having a stoma can seem daunting and frightening at first, but most people get used to it after a few months.

See recovering from laryngeal cancer for more information about speaking after surgery and looking after a stoma.

Chemotherapy

Chemotherapy uses powerful cancer-killing medicines to damage the DNA of the cancerous cells and stop them reproducing. It may be used toshrink a tumour before surgery or radiotherapy, or in combination with radiotherapy to make the radiotherapy more effective.

It can also be used totreat laryngeal cancer that's advanced or has come back after treatment. In this situation, it can relieve symptoms and may slow the cancer's growth.

Chemotherapy medication is usually given as an injection into a vein (intravenously) once every three or four weeks, for up to six months. You may need to stay in hospital for a few daysduring each treatment or you may just come in for a short visit each time.

Chemotherapy can sometimes damage healthy tissue as well as the cancerous tissue. This, unfortunately, means side effects are common, such as:

• feeling and being sick
• hair loss
• loss of appetite
• diarrhoea
• sore mouth and mouth ulcers
• tiredness

Chemotherapy can also weaken your immune system, making you more vulnerable to infection and illness.

It's therefore important to report any symptoms of a potential infection to yourMDT, such as a high temperature, chills or a persistent cough. You should also avoid close contact with peopleknown to have an infection.

Theside effects of chemotherapy should improve after your treatment has finished.

These medications target and disrupt the processes that cancerous cells use to grow and reproduce.

Cetuximab can be used in combination with radiotherapy to treat more advanced laryngeal cancer, when it's not possible to use chemotherapy. For example, people with kidney or heart disease, or people with an ongoing infection, may not be able to have chemotherapy, because it could make them very ill.

Cetuximab is given slowlythrough a drip into your vein (intravenously) for up to an hour or more. It's usually given weekly forup to sevenweeks.

Side effects of cetuximab are usually mild and include:

• rashes
• feeling sick
• diarrhoea
• breathlessness

Cetuximab can also trigger allergic reactions in some people, which can cause problems such as a swollen tongue or throat. In a few cases,the reaction can be severe and potentially life-threatening.

Most serious reactions occur within a day of treatment starting, so you'll be closely monitored once your treatment begins. If you have symptoms of a severereaction, such as a rapid heartbeat or breathing problems, medication can be used to relieve them (such as corticosteroids ).