Treatment for Stage I Laryngeal and Hypopharyngeal Cancers

Stage I laryngeal and hypopharyngeal cancers are often treated with surgery , usually resection, or surgical removal of the entire tumor as well as some of the healthy tissue around it. The normal-looking tissue is taken just in case it contains any cancer cells. The following types of resection are often used to remove stage I laryngeal and hypopharyngeal cancers:

• Laryngectomy - The surgeon removes some or all of the larynx:
  • Partial laryngectomy (hemilaryngectomy) - The surgeon removes the part of the larynx above the vocal cords if you have a small cancer in the supraglottis. After this procedure (supraglottic laryngectomy), you will be able to speak normally. If you have a small tumor in the vocal cords (glottis), the surgeon might be able to remove just one vocal cord (cordectomy) and leave the other one so that you can still speak.
• Total laryngectomy - The surgeon removes the entire larynx and then attaches your windpipe (trachea) to the skin of your neck (see tracheostomy below). You will no longer be able to speak normally using your vocal cords after this operation.
• Pharyngectomy - The surgeon removes part (partial pharyngectomy) or all (total pharyngectomy) of the pharynx.
• Laryngopharyngectomy - Pharyngectomy is usually done in combination with laryngectomy. The surgery to remove both the larynx and pharynx is known as a laryngopharyngectomy. Like laryngectomy and pharyngectomy, laryngopharyngectomy can be partial (if the surgeon removes only part of the larynx and part of the pharynx) or total (if the surgeon removes all of the larynx and all of the pharynx).
• Thyroidectomy -  The surgeon removes most or all of the thyroid gland.
  • Near-total - The surgeon removes nearly all of the thyroid gland but leaves small amounts of tissue around the parathyroid glands (which produce a hormone that helps control the levels of calcium and phosphorus in the body) to reduce the risk of damage to these glands.
  • Total - The surgeon removes the entire thyroid through an incision in the neck.
    

During your resection, the surgeon doctor might remove some of the lymph nodes (small organs that help fight infection) in your neck because laryngeal and hypopharyngeal cancers often spread to these lymph nodes:

• Neck dissection - The goal of neck dissection is to remove lymph nodes that do or are likely to contain cancer that has spread (metastasized) from the original tumor in the larynx or hypopharynx. There are different types of neck dissection:
  • Modified radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. However, the surgeon does not take out sections of muscle, nerve, and the large veins in the neck.
  • Radical - The surgeon removes all of the lymph nodes on one side of the neck from the lower edge of the jaw to the upper edge of the collarbone. The surgeon also takes out sections of muscle, nerve, and the large veins in the neck.

    If your tumor is located only on your glottis (vocal cords), it might be possible to remove your cancer through laser surgery:

• Laser surgery - The surgeon uses a thin, flexible tube attached to a light (endoscope) to find the tumor. He or she then uses a high-intensity laser to burn or cut the tumor out.
  

Depending on where your tumor is located, it might be possible to treat it with radiation therapy instead of surgery, most likely external beam radiation therapy (EBRT). But in some cases, internal radiation therapy is used with or instead of EBRT. Radiation therapy might also be given after surgery. 

• External beam radiation therapy (EBRT) - Radiation from a high-energy x-ray machine (linear accelerator) outside the body is focused on the cancer cells. EBRT can harm both the cancer cells and nearby healthy tissue. Most people are treated with EBRT for a few minutes 5 days a week for 5 to 7 weeks as an outpatient. This technique is used more often for laryngeal and hypopharyngeal cancers than internal radiation therapy.
• Intensity modulated radiation therapy (IMRT) - IMRT, an external radiation technique, is an advanced form of high-precision radiotherapy.  It allows for the precise delivery of radiation doses to a malignant tumor or to specific areas within the tumor with minimal damage to surrounding tissue.  
• Internal radiation therapy (brachytherapy or interstitial radiation therapy) - Tiny pellets (or “seeds”) that contain radioactive materials are injected into your bloodstream and guided to the tumor. Brachytherapy lets the doctor use a higher dose of radiation than EBRT. This type of treatment involves a one-time procedure.

This content has been reviewed and approved by Myo Thant, MD.