Laryngeal Cancer

Head and neck cancer specialists will ask about your symptoms, discuss your medical history, and examine your throat and neck. You may also undergo one or more the following tests.

Swallow Function Tests / Swallow Evaluations
A speech-language pathologist and/or radiologist assesses your ability to swallow and speak, possibly using an endoscope, fluoroscopy (using X-rays to record video of your internal swallowing function), or a modified barium swallow (which requires you to chew and swallow food that has been mixed with a metallic substance that shows up on X-ray imaging).

Flexible Laryngoscopy
A lighted tube is inserted in the throat to help your doctor examine your voice box and identify lesions or tumors and what other structures might be involved.

Biopsy
A small sample of tissue is removed with a needle or another instrument (in your doctor’s office or in an operating room) and examined under a microscope to look for cancerous cells. 

Advanced Imaging
CT, MRI, and PET scans can help doctors locate cancer, identify its type, and determine whether it has spread. We use the latest imaging technology to produce high-quality images while limiting your exposure to radiation.

When detected early, voice box cancer can usually be cured with radiation therapy and/or surgery. More advanced cancers may require a combination of therapies. Your treatment plan will be based on your condition and preferences.

Radiation Therapy
MRI and CT imaging technology pinpoint the tumor’s location, and beams of high-energy X-rays destroy the cancer cells. This targeted radiation treatment minimizes damage to surrounding healthy tissue.

Surgery
Head and neck surgeons carefully remove the tumor while preserving vital neighboring structures. Nearby lymph nodes may also be removed. In some cases, surgeons may use a minimally invasive approach to access the larynx through the mouth instead of through an incision in the neck. This method shortens recovery time.

After surgery, you may need to breathe through a new airway in your throat called a stoma, temporarily, until the swelling goes down. Some people may require a stoma permanently. Your doctor will meet with you periodically to evaluate your healing and determine when it is safe to close the stoma and when you can safely eat and drink.

• Partial Laryngectomy: This surgical procedure removes the cancerous parts of your larynx and leaves the healthy portion behind to preserve your natural voice.
   
• Total Laryngectomy: In some cases, the entire voice box, including the vocal cords, may be removed. This is called a total laryngectomy. Before surgery, your doctor will discuss the nature of your surgery, including the length of your hospital stay, and whether you need additional treatments. A speech-language pathologist will educate you about changes to expect with breathing and swallowing. They will also review communication options in detail, which may include speaking with a handheld artificial (electronic) larynx or learning to speak with esophageal speech.
   
  • Tracheo-esophageal Puncture (TEP) Procedure: This allows you to communicate with your voice after a total laryngectomy. The TEP surgery creates a small opening or "puncture" in the wall between your trachea and esophagus. Then a small voice prosthesis device is placed (either at the same time as your laryngectomy, or it can be done later) that allows air to flow from your lungs into your esophagus. The air vibrates the esophagus to make sound. Although you’ll only need to undergo the initial placement surgery once, the voice prosthesis must be changed every few months.

These treatments may be recommended in combination with another type of therapy or for palliative care.

Chemotherapy 
These medicines kill cancer cells or stop them from growing. Chemotherapy may be recommended to improve radiation therapy and/or surgical results. Our medical oncologists carefully consider your specific type of tumor and potential risks and benefits before recommending chemotherapy as part of your personalized treatment plan. We routinely combine the newest chemotherapy drugs with standard drug regimens to achieve a better response, fewer side effects, and improved quality of life.

Immunotherapy
Immunotherapy takes advantage of your immune system to help kill cancer cells. There are several FDA-approved options that can be delivered via oral medications or IV infusion.

Targeted Therapy
Targeted therapy can help stop or slow the growth or spread of cancer by targeting specific aspects of your tumor's biology. Targeted therapies may be delivered in pill form or through onsite IV infusion.

Microvascular Reconstruction
People who undergo more extensive surgeries may require an additional surgery called graft or flap reconstruction to repair the area where tissue was removed. Our expert team of sub-specialized head and neck reconstructive surgeons may perform this at the same time as your cancer surgery.

Rehabilitation Services 
Voice box cancer treatment can lead to complications like problems with speaking, breathing, eating, or swallowing; nerve weakness; or lymphedema. Speech therapists, physical therapists, and occupational therapists can help you improve your function.

Support Services
Social workers, psychologists, and palliative care experts help you cope with the emotional and psychological effects often associated with cancer. 

Nationally Ranked Cancer Program
As a National-Cancer-Institute-designated Comprehensive Cancer Center, we are recognized for exploring new treatment opportunities through ongoing clinical trials. We offer you the latest research discoveries before they are available elsewhere. In addition, since 1973, Duke has been a member of the National Comprehensive Cancer Network (NCCN), which sets industry standards for safety and quality.

Techniques to Preserve Function
Our physicians are specially trained in techniques that preserve the structure of your voice box as well as your ability to speak. Our surgical specialists are expertly equipped to remove tumors using a variety of tools, including transoral laser microsurgery (TLM) and transoral robotic surgery (TORS). These advanced techniques and tools increase surgical precision, reduce damage to surrounding structures, and help surgeons remove hard-to-reach tumors in the voice box. They also require smaller incisions, which shortens recovery time.

A Team Approach to Comprehensive Care
Our specialists -- otolaryngologists, oncologists, surgeons, radiologists, and others – gather weekly conferences to discuss complex cases. This cooperation means you benefit from an experienced team of experts who provide a range of perspectives. We also work closely with speech-language pathologists who can help you address problems with communication and swallowing that can result from voice box cancer. Oral medicine specialists can help treat oral health concerns related to cancer and its treatment.

We Prioritize Your Convenience
Medical oncologists, radiation oncologists, and surgical oncologists often meet with individual patients at the same time, saving you time. You may also be able to undergo an ultrasound and biopsy on the same day as your initial evaluation appointment.

Clinical Trials Access
As a Duke patient, you may be eligible to participate in clinical trials studying new or improved therapies for voice box cancer.