After determining a diagnosis and completing a full pre-treatment evaluation, doctors will recommend a course of treatment for their patients. In general, there are three different options for the treatment of glottic laryngeal cancers that can be used alone or in combination.
Patients and their care teams should have extensive discussions to determine the best treatment course.
Surgery
Surgery may be an option for the treatment of laryngeal cancers, depending on the type, grade, and stage of the cancer. Glottic cancer may be treated by a partial or total laryngectomy, and often a neck dissection.
In some cases of small, early stage tumors, minimally invasive transoral surgery can be performed using direct laryngoscopy and a laser or other laryngeal instruments. For more advanced tumors, surgery may involve the removal of a portion of or the entire larynx (voicebox). There are a variety of different open partial laryngeal procedures that have been developed which provide the opportunity for a surgeon to successfully remove the cancer and restore a functioning larynx.
Radiation
For the treatment of laryngeal cancers, there are two types of radiation that may be used based on the timing and the setting of the radiation. Radiation therapy can be used as a form of primary treatment, in which an external beam of radiation is directed at the tumor in order to destroy the rapidly dividing cancer cells. Radiation can also be given following surgical resection, termed adjuvant radiation, with the goal of decreasing the chances that the cancer will come back.
Chemotherapy
Chemotherapy is sometimes used in combination with radiation therapy as a primary treatment. It is also sometimes given prior to beginning either primary surgical or nonsurgical treatment, called induction or neoadjuvant chemotherapy.
General Treatment Options for Glottic Laryngeal Cancer
Treatment recommendations will depend on T, N and M stages. The following are some general treatment guidelines.
Cancer Within the Glottis (Carcinoma in situ)
- For small cancers that have not invaded very deeply, surgical removal is generally preferred. Surgery can usually be done through the mouth using an endoscope (laryngoscopy).
- Primary radiation therapy is also a treatment option although this is not usually recommended for carcinoma in situ.
Tumors That Do Not Require a Total Laryngectomy (T1-2, selected T3)
- Surgery can be performed either through the mouth using a laryngoscope or in larger tumors through an open approach. Unilateral or bilateral neck dissections may also be performed depending on the tumor size and location, as well as the findings on preoperative imaging.
- Depending on the findings during surgery, no additional treatment may be necessary, or adjuvant radiation may be recommended.
- Primary radiation therapy is also a treatment option.
T3 Tumors That Require a Total Laryngectomy (N0-1)
For tumors that require removal of the entire larynx (voice box), there are a few treatment options:
- Chemotherapy and radiation, followed by surgery if there is any remaining or recurrent cancer.
- If a patient cannot tolerate chemotherapy, radiation alone is an option, followed by surgery if there is any remaining or recurrent cancer.
- Surgical removal of the voice box (total laryngectomy) with unilateral or bilateral neck dissection.
- If there are no adverse features found, no additional treatment may be necessary.
- If adverse features are found, surgery may be followed by adjuvant radiation.
- Induction chemotherapy is also an option. Depending on the response to the initial chemotherapy, treatment may be followed by some combination of radiation, chemotherapy, and surgery.
- Patients may also be enrolled in a clinical trial.
T3 Tumors That Require a Total Laryngectomy (N2-3)
For tumors that require removal of the entire larynx (voice box), there are a few treatment options:
- Chemotherapy and radiation, followed by surgery if there is any remaining or recurrent cancer.
- Surgical removal of the voice box (total laryngectomy) with unilateral or bilateral neck dissection.
- If there are no adverse features, no additional treatment is necessary.
- If adverse features are found, additional treatment may include radiation alone, chemotherapy plus radiation, or further surgery.
- Induction chemotherapy is also an option. Depending on the response to the initial chemotherapy, treatment may be followed by some combination of radiation, chemotherapy, and surgery.
- Patients may also be enrolled in a clinical trial.
T4a (Any N)
- The recommended treatment for these tumors is surgical removal of the voice box (total laryngectomy) with unilateral or bilateral neck dissection.
- Surgery will usually be followed by radiation with or without chemotherapy.
- If a patient chooses not to have surgery, treatment options include chemotherapy and radiation, induction chemotherapy followed by additional therapy depending on the response to therapy, or enrollment in a clinical trial.
T4b (any N): Unresectable Neck Disease or Patient is Unfit for Surgery
In cases that are very advanced, or in patients who are extremely sick, patients should have an extensive discussion with their doctor in order to consider the possibility of palliative therapy or end of life hospice care.
