Treatment for Stage III Laryngeal and Hypopharyngeal Cancers

Stage III laryngeal and hypopharyngeal cancers are usually treated with surgical resection, or 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 III 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 will probably 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 you have a laryngectomy or laryngopharyngectomy, you will have a tracheostomy.

• Tracheostomy - After a partial or total laryngectomy, the surgeon will make a hole (tracheostomy) in front of your neck into the trachea and will insert a tube to keep the hole open. You will breathe through this hole. If you had a partial laryngectomy or laryngopharyngectomy, the tube will be removed after you recover from surgery and you will be able to breathe normally. If you had a total laryngectomy or laryngopharyngectomy, the tube will stay in permanently and you will need to learn how to speak in a different way.
  

If your tumor is too large to remove completely by surgery, it might be difficult for you to eat properly. If so, you will receive a gastrostomy tube.

• Gastrostomy tube - If your cancer prevents you from swallowing, your surgeon will place a feeding (gastrostomy) tube through the skin and muscle of your abdomen into your stomach. If the swallowing problem is temporary, the tube might be inserted through your nose, down your esophagus, and into your stomach. Liquid nutrients are dripped through the tube and this process can be used to feed you indefinitely.
  

In addition to surgery, you might be treated with external beam or internal radiation therapy. You might also receive a combination of radiation therapy and chemotherapy instead of surgery, especially if your tumor is too large to remove completely with 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.
  

You might also be treated with chemotherapy, often in combination with radiation therapy or before surgery. The drugs that are used most often for laryngeal and hypopharyngeal cancers are:

• Adrucil^® or Efudex^® (5-fluorouracil or 5-FU) - 5-FU is an antimetabolite drug. 5-FU prevents cells from making DNA and RNA, which stops cells from growing. 5-FU is given as a shot in the vein. The dose depends on your size.
  
• Blenoxane^® (bleomycin) - Bleomycin is an antibiotic. Bleomycin interferes with cell division, which destroys the cells. Bleomycin is given by a shot into a vein or as a shot into the muscle or under the skin. The dose is based on your size.
• Hydrea^® or Droxia^® (hydroxyurea) - Hydroxyurea is an antimetabolite drug. It prevents cancer cells from making DNA and RNA, which stops the cells from growing. The drug is given in capsule or pill form. The dose depends on how well your kidneys work and your blood counts.
• Paraplatin^® (carboplatin) - Carboplatin is a platinum chemotherapy drug that belongs to a group of drugs known as alkylating agents. It stops cancer cells from growing, which kills them. Carboplatin is given as an injection in the vein. The dose depends upon your size but may be lowered or not given if your blood counts are low.
• Platinol^® (cisplatin) - Cisplatin is a platinum compound chemotherapy drug that acts like an alkylating agent. It stops cancer cells from growing, which kills them. Cisplatin is given by an injection into the vein. Your dose depends on the type of cancer you have and your size.
• Rheumatrex^® or Trexall™ (methotrexate) - Methotrexate is an antimetabolite drug. It prevents cells from making DNA and RNA, which stops the growth of cancer cells. Methotrexate is given as a pill by mouth, an injection in a vein, or an injection into a muscle. The dose depends on your size and the type of cancer you have.
• Taxol^® or Onxol^® (paclitaxel) - Paclitaxel belongs to a class of chemotherapy drugs called taxanes. It is also called a mitotic inhibitor because it affects cells during mitosis (cell division). It stops cells from dividing, which kills them. Paclitaxel is given by an injection into a vein. The dose depends on your weight, the side effects you have, and how often the medicine is given.
• Taxotere^® (docetaxel) - Docetaxel belongs to a class of chemotherapy drugs called taxanes. It is also called a mitotic inhibitor because of its effect on the cell during mitosis (cell division). Docetaxel stops cancer cells from growing, which kills them. Docetaxel is given by a shot in a vein. The dose depends on your size, how well your liver is working, and how often the medicine is given.

Your doctor might recommend targeted therapy, which is designed to treat only the cancer cells and minimize damage to normal, healthy cells. Erbitux (cetuximab) is the targeted therapy most often used to treat laryngeal and hypopharyngeal cancers.

• Erbitux^® (cetuximab) - Cetuximab is a monoclonal antibody, or protein used by the immune system. It can find and attach itself to areas on the surface of cancer cells (epidermal growth factor receptor [EGFR]) that can signal the cells to grow. Cetuximab is given by an injection into the vein.
  

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