Laryngeal and Hypopharyngeal Cancer

ON THIS PAGE: You will find a drawing of the main body parts affected by laryngeal and hypopharyngeal cancer. Use the menu to see other pages.

The next section in this guide is Risk Factors and Prevention . It explains the factors that may increase the chance of developing laryngeal or hypopharyngeal cancer and what people can do to lower their risk. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find out more about screening for laryngeal and hypopharyngeal cancer. You will also learn the risks and benefits of screening. Use the menu to see other pages.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

• Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

• Lower the number of people who develop the disease

Learn more about the basics of cancer screening .

Screening information for laryngeal and hypopharyngeal cancer

People who drink alcohol and/or use tobacco should receive a general screening examination at least once a year, even if they are not experiencing any symptoms. This is a simple and quick procedure in which the doctor looks in the nose, mouth, and throat for abnormalities and feels for lumps in the neck. If anything unusual is found, the doctor will recommend a more extensive examination.

The next section in this guide is Symptoms and Signs . It explains what body changes or medical problems laryngeal and hypopharyngeal cancers can cause. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If the cancer has spread, it is called metastasis. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

How laryngeal and hypopharyngeal cancers are diagnosed

There are many tests used for diagnosing laryngeal and hypopharyngeal cancer. Not all tests described here will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of earlier medical tests

The following tests may be used to diagnose laryngeal or hypopharyngeal cancer:

• Physical examination/lab tests. The doctor will feel for any lumps in the neck, lip, gums, and cheeks. The doctor will inspect the nose, mouth, throat, and tongue for abnormalities and often use a mirror to get a clearer view of these structures. Although there is no specific blood test that detects laryngeal or hypopharyngeal cancer, several laboratory tests, including blood and urine tests, may be done to help determine the diagnosis and learn more about the disease.

• Laryngoscopy. A laryngoscopy can be performed in 3 ways:

  • Indirect laryngoscopy. Before this procedure, the doctor often sprays the mouth and throat with a local anesthetic to numb the area and prevent gagging. The doctor then uses a small, long-handled mirror to see the vocal folds.

  • Fiber optic laryngoscopy. During this procedure, the doctor inserts a flexible, lighted tube through the person’s nose or mouth and down the throat to view the larynx and hypopharynx. The nose is often sprayed with a local anesthetic to make the procedure more comfortable.

  • Direct laryngoscopy. This procedure is done in an operating room, and the person receives a sedative or general anesthetic to block the awareness of pain. The doctor then views the larynx and hypopharynx using an instrument called a laryngoscope. A sample of tissue for a biopsy (see below) is often taken during a direct laryngoscopy. Frequently, the doctor will recommend a triple endoscopy, a procedure done under general anesthesia to examine the ear, nose, and throat area, as well as the trachea and the bronchus, which are located next to the lung and the esophagus.

• Videostroboscopy. This fiber optic video technique is used so the doctor can better see the larynx. It is performed in the same way as an indirect laryngoscopy (see above). It is used to view the vocal folds and can detect motion abnormalities and other changes in vibration that are often important for finding a tumor. Videostroboscopy helps determine the location and size of a tumor, as well as how the tumor has affected the function of the larynx and hypopharynx. Videostroboscopy is useful because the results frequently allow the doctor to find potential changes in the larynx before they are visible to the eye alone.

• Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the cancer. For instance, during a fine needle aspiration biopsy , cells are taken using a thin needle inserted directly into the tumor. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease.

• Biomarker testing of the tumor . Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. This may also be called molecular testing of the tumor. Results of these tests can help determine your treatment options .

The following imaging tests may be used to determine if and how much the cancer has spread:

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of soft tissue, such as the tonsils and the base of the tongue. MRI can be used to measure the tumor’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Positron emission tomography (PET)-CT scan. A PET scan is usually combined with a CT scan. However, you may hear your doctor refer to this procedure just as a PET scan. A PET-CT scan creates pictures of organs and tissues in the body. A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive sugar substance is injected into the body. This sugar substance is taken up by cells that use the most energy. Because cancer tends to use energy actively, it absorbs more of the radioactive substance. However, the amount of radiation in the substance is too low to be harmful. A scanner then detects this substance to produce images of the inside of the body.

• Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The amount of radiation in the tracer is too low to be harmful. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark. For people with head and neck cancer, a bone scan is recommended if there are signs that the cancer has spread to the bone.

• Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. This test can detect the spread of cancer to the liver or the cervical lymph nodes in the neck.

• X-ray/barium swallow/dental exams. An x-ray is a way to create a picture of the structures inside the body using a small amount of radiation. Sometimes, the patient will be asked to swallow barium, which coats the mouth and throat, to enhance the image on the x-ray. This is called a barium swallow. A barium swallow is used to identify abnormalities along the throat and esophagus. A special type of barium swallow, called a "modified barium swallow," may be needed to evaluate difficulties with swallowing and choking while eating.

  A dentist may take extensive x-rays of the teeth, mandible (jawbone), and maxilla (upper jaw), including a panoramic radiograph, which is a panoramic view of the mouth, often called a Panorex. If there are signs of cancer, the doctor may recommend a computed tomography scan (see above).

After diagnostic tests are done, your doctor will review the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages and Grades . It explains the system doctors use to describe the extent of the disease and how the cancer cells look under a microscope. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will learn about the different types of treatments doctors use for people with laryngeal and hypopharyngeal cancer. Use the menu to see other pages.

This section explains the types of treatments, also known as therapies, that are the standard of care for laryngeal and hypopharyngeal cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.

How laryngeal and hypopharyngeal cancers are treated

Laryngeal and hypopharyngeal cancers can often be successfully eliminated, especially if they are found early. Although eliminating the cancer is the primary goal of treatment, preserving the function of the affected organs is also very important. When doctors plan treatment, they consider how the treatment plan might affect the person’s quality of life, including how the person feels, looks, talks, eats, and breathes. Cancers of the larynx and hypopharynx and their treatments can significantly impact these functions, so treatment decisions should be made carefully.

In cancer care, different types of doctors and other specialists often work together to create a patient’s overall treatment plan, which combines different types of treatments. This is called a multidisciplinary team . An evaluation should be done by each specialist before any treatment begins.

This team may include medical oncologists, radiation oncologists, surgeons, otolaryngologists (ear, nose, and throat doctors), maxillofacial prosthodontists (specialists who perform restorative surgery to the head and neck areas), dentists, physical therapists, speech language pathologists, audiologists, and mental health professionals. Diagnostic radiologists and pathologists also are an integral part of the treatment team because they help with diagnosis and staging. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, dietitians, and others.

There are 3 main treatment options for laryngeal and hypopharyngeal cancer: radiation therapy, surgery, and therapies using medication, such as chemotherapy. One or a combination of these therapies may be used to treat the cancer. Surgery and radiation therapy are the most common treatments. Chemotherapy may be used before or during radiation therapy and/or surgery to increase the chance of destroying cancer cells.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is particularly important for laryngeal and hypopharyngeal cancer because there are different treatment options. Learn more about making treatment decisions .

The common types of treatments used for laryngeal and hypopharyngeal cancer are described below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

• Preserving the larynx

• Radiation therapy

• Surgery

• Chemotherapy

• Targeted therapy

• Immunotherapy

• Physical, emotional, and social effects of cancer

• Metastatic cancer

• Remission and chance of recurrence

• If treatment does not work

Preserving the larynx

The first goal of treatment for nearly all patients is to preserve the function of the larynx, whenever possible.

This is particularly true for those with early-stage (T1 or T2) laryngeal cancer, In these cases, surgery or radiation therapy may be used to cure the cancer and preserve the function of the larynx.

For most people with a T3 laryngeal tumor and some people with a T4 laryngeal tumor, combined chemotherapy and radiation therapy can preserve the larynx with good function. For very large laryngeal tumors, total laryngectomy may be the better treatment option.

For more information on the stages of laryngeal cancer, see Stages and Grades .

Before deciding on a treatment plan, talk with your doctor about testing how well your voice works and how well you can swallow. This may include seeing other specialists, such as a speech language pathologist.

This information is based on ASCO recommendations for larynx preservation in the treatment of laryngeal cancer . Please note that this link takes you to another ASCO website.

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Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A newer method of external-beam radiation therapy, known as intensity modulated radiation therapy (IMRT), allows effective doses of radiation therapy to be delivered while reducing the damage to healthy cells.

When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.

New clinical trials are researching the use of proton beam therapy to see if this can further reduce the damage to healthy tissues during therapy. Proton beam therapy is a type of external-beam radiation therapy that uses protons rather than x-rays (photons) to destroy cancer cells.

Radiation therapy alone can be the main treatment for head and neck cancer or used after surgery to destroy small areas of cancer that could not be removed during the operation. It is often used in combination with chemotherapy to treat many cancers of the head and neck.

Before treatment begins

Before beginning radiation therapy for any head and neck cancer, people should receive a thorough examination from an oncologic dentist. An oncologic dentist is a dentist with experience caring for the dental and oral health of people with cancer. Since radiation therapy can cause tooth decay, damaged teeth may need to be removed before treatment begins. Often, tooth decay can be prevented with proper treatment from a dentist. After radiation therapy for laryngeal and hypopharyngeal cancer, dental care should continue to help prevent further dental problems. People may receive fluoride treatment to prevent dental cavities. Learn more about dental health during cancer treatment .

It is also important that people receive counseling and evaluation from a speech language pathologist who has experience caring for people with head and neck cancer. Since radiation therapy may cause swelling and scarring, the voice and swallowing are often affected. Speech language pathologists can provide people with exercises and techniques to help prevent long-term speech and swallowing problems.

Chemoradiotherapy

Depending on the stage of the cancer, a combination of chemotherapy and radiation therapy may be used. Another term for this is concomitant chemoradiotherapy. Chemotherapy enhances the effectiveness of radiation therapy. Chemoradiotherapy can help people avoid having surgery and can preserve the larynx and its ability to function. This is the preferred standard treatment approach for many patients. However, combining chemotherapy and radiation therapy can cause more side effects than treatment with radiation therapy alone. Be sure to talk with your health care team about possible side effects and what to expect.

Side effects of radiation therapy

Radiation therapy to the head and neck may cause redness or skin irritation to the treated area, swelling, dry mouth or thickened saliva from damage to salivary glands (which can be temporary or permanent), bone pain, nausea, fatigue, mouth sores and/or sore throat, difficulty opening the mouth, and dental problems (usually preventable, see above). Other side effects may include lymph fluid buildup called lymphedema ; pain or difficulty swallowing; hoarseness or changes in the voice; loss of appetite, due to a change in sense of taste; hearing loss due to a buildup of fluid in the middle ear or nerve damage; buildup of earwax, which dries out because of the radiation therapy’s effect on the ear canal; and scarring (fibrosis). Talk with your doctor or nurse about how any side effects that you may experience will be managed.

Radiation therapy may also cause a condition called hypothyroidism , in which the thyroid gland, which is located in the neck, slows down and causes the person to feel tired and sluggish. Every person who receives radiation therapy to the neck area should have their thyroid gland checked regularly. Hypothyroidism can be treated effectively with lifelong supplements of thyroid hormone.

Most long-term side effects of radiation therapy can be prevented or reduced. It is important that all members of the multidisciplinary treatment team see the patient before radiation therapy begins in order to prevent or reduce long-term problems. Learn more about the basics of radiation therapy .

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Surgery

During surgery, a surgical oncologist removes the cancerous tumor and some healthy tissue around it, called a margin. A surgical oncologist is a doctor who specializes in treating cancer using surgery. The goal of surgery is to remove the entire tumor and leave negative margins. Having negative margins mean that there is no trace of cancer in the healthy tissue that was removed during the operation.

If surgery is recommended for you, talk with your health care team about the possible side effects from the specific surgery you will have.

The most common surgical procedures used to treat laryngeal or hypopharyngeal cancer include:

• Partial laryngectomy. This is the removal of part of the larynx, which helps preserve the patient’s natural voice. The following are some of the different types of partial laryngectomies:

  • Supraglottic laryngectomy. During this procedure, the surgeon removes the area above the vocal folds. If part of the hypopharynx is removed along with the cancer, this procedure is called a partial pharyngectomy.

  • Cordectomy . The removal of a vocal fold.

  • Vertical hemilaryngectomy. The removal of 1 side of the larynx.

  • Supracricoid partial laryngectomy. The removal of the vocal folds and the area surrounding them.

• Total laryngectomy. This procedure removes the entire larynx. During the operation, a hole called a stoma is made in the front of the neck through the windpipe, so the person can breathe. This is called a tracheostomy (see below). Because the vocal folds have been removed, people can no longer speak using their vocal folds after a total laryngectomy. A speech pathologist can teach people to speak in a different way after surgery.

• Laryngopharyngectomy. A laryngopharyngectomy is the removal of the entire larynx, including the vocal folds and part or all of the pharynx. After this surgery, doctors must reconstruct the pharynx using flaps of skin from the forearm, other parts of the body, or a segment of the intestine. Like a total laryngectomy, people can no longer speak using the vocal folds after laryngopharyngectomy. They may also have difficulty swallowing. A speech pathologist can help people learn to speak and swallow afterward.

• Neck dissection. If the cancer has spread to the lymph nodes in the neck, some of these lymph nodes may need to be surgically removed. This is called a neck dissection. There are several types of neck dissections, such as a partial neck dissection, modified neck dissection, or selective neck dissection. Depending on the stage and location of the cancer, some or all the lymph nodes in the neck may have to be removed. Patients with laryngeal cancer who receive radiation therapy or chemoradiotherapy (see above) usually do not need a neck dissection. A patient may have varying degrees of stiffness in the shoulder and the neck and loss of sensation in the neck after this type of surgery.

• Laser surgery. Laser surgery uses a beam of light to remove a small tumor in the larynx or perform a partial laryngectomy. This tool is a relatively new treatment approach that should only be performed by an experienced doctor.

Other types of surgery that may be used during treatment for laryngeal or hypopharyngeal cancer include:

• Tracheostomy. As part of both a partial and total laryngectomy, the surgeon makes a hole called a stoma in the front of the neck into the windpipe or trachea. This surgical procedure may also be called a tracheotomy. A tube is often inserted to keep the hole open. Air enters and leaves the windpipe, called the trachea, and lungs through the stoma, so the person can breathe.

  For people who have a partial laryngectomy, the stoma is usually temporary. After recovery from the partial laryngectomy, the tube is removed, the hole heals shut, and the person can then breathe and talk in the same way as before the surgery. In some cases, the voice may be hoarse or weak, but it usually gets better as the person recovers from surgery.

  For people who have a total laryngectomy, the stoma is permanent. The tube is removed but the person will continue to breathe through the stoma and must learn to speak in a new way.

• Reconstruction. Reconstruction, or plastic surgery, is aimed at restoring a person’s appearance and function of the affected area. For example, if the surgery requires major tissue removal, reconstructive or plastic surgery may be done to replace the missing tissue. Talk with your doctors about what to expect before your first surgery and what reconstruction options may be available.

Sometimes, it is not possible to completely remove the cancer using surgery. In these cases, other treatments will be recommended.

Learn more about the basics of cancer surgery .

Side effects of surgery

Before any surgery, talk with your doctor about what you can expect after your specific type of surgical procedure. In general, surgery often causes swelling of the mouth and throat, making it difficult to breathe. After the operation, the lungs and windpipe produce a great deal of mucus. The mucus is removed with a small suction tube until the person learns to cough through the stoma. Similarly, saliva may need to be suctioned from the mouth because swelling in the throat can prevent swallowing.

In addition, surgery may cause permanent loss of voice or impaired speech, difficulty swallowing or talking, lymphedema, facial disfigurement, numbness in parts of the neck and throat, and less mobility in the shoulder and neck area. Surgery can also decrease thyroid gland function, especially after a total laryngectomy.

Rehabilitation of lost or altered physical functions and emotional support services are important parts of care after surgery. This may take time and require the expertise of different members of the treatment team. Patients are encouraged to talk with their health care team about what to expect before having surgery and how their recovery will be managed.

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Therapies using medication

The treatment plan may include medications used to destroy cancer cells. Medication may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Medication may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.

This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications, be sure to ask your health care team about how to safely store and handle them.

The types of medications used for laryngeal and hypopharyngeal cancer include:

• Chemotherapy

• Targeted therapy

• Immunotherapy
  

Each of these types of therapies is discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases .

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.

For laryngeal and hypopharyngeal cancer, chemotherapy may be used before surgery, radiation therapy, or both. This is called neoadjuvant therapy. Chemotherapy may also be given at the same time as radiation therapy. This is called concomitant chemoradiation.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, lowered blood counts, nausea and vomiting, hair loss, loss of appetite, diarrhea, dry mouth, hearing loss, and open sores in the mouth that can lead to infections. Talk with your doctor about possible side effects of chemotherapy prescribed for you.

Learn more about the basics of chemotherapy .

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Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them.

Cetuximab (Erbitux) is a targeted therapy approved for use in combination with radiation therapy for head and neck cancer that has not spread. It is also approved for use with chemotherapy to treat patients with metastatic cancer (see below).

Talk with your doctor about possible side effects for a specific targeted therapy and how they can be managed. Learn more about the basics of targeted treatments .

Immunotherapy

Immunotherapy uses the body's natural defenses to fight cancer by improving your immune system's ability to attack cancer cells.

There are 2 immunotherapy drugs, nivolumab (Opdivo) and pembrolizumab (Keytruda), that are approved for the treatment of patients with recurrent or metastatic squamous cell carcinoma. Immunotherapy in combination with chemotherapy and radiation therapy may also be used in clinical trials.

Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy .

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Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.

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Metastatic cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Talk with your doctor about getting a second opinion at a center with specialized expertise in head and neck cancer, so you are comfortable with your chosen treatment plan. Learn more about getting a second opinion before starting treatment.

Typically, the treatment recommendation includes systemic chemotherapy, either using standard drugs or drugs being studied as part of a clinical trial. Your treatment plan may also include a combination of targeted therapy, immunotherapy, surgery, or radiation therapy. Some clinical trials focus on treating tumors with specific genetic changes, called mutations. To participate in these kinds of clinical trials, a sample of the tumor will undergo molecular testing. These kinds of laboratory tests look for specific genes, proteins, or other factors unique to the tumor. Palliative care will also be important to help relieve symptoms and side effects.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.

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Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence .

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Most recurrences in the same place or in the neck happen in the first 18 to 24 months after the original treatment. People who stop using tobacco and alcohol , preferably before treatment begins, have a better chance of living longer. Using tobacco during radiation therapy may take away much of the benefit that the radiation therapy offers. Research shows that people who continue to smoke during radiation therapy have poorer 5-year overall survival and a higher chance that the cancer comes back than people who quit before radiation therapy begins. Quitting tobacco and/or alcohol is difficult, so reach out to your health care team about ways they can help.

If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. In particular, treatment planning when there is tumor spread and growth to distant organs (called M1 or distant metastasis; see Stages and Grades ) requires very careful evaluation and treatment. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery, radiation therapy, and therapies using medication, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat recurrent laryngeal and hypopharyngeal cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with cancer recurrence .

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If treatment does not work

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.

People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced cancer care planning and end of life care for people with advanced head and neck cancer .

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss .

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The next section in this guide is About Clinical Trials . It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about the scientific research being done to learn more about laryngeal and hypopharyngeal cancers and how to treat them. Use the menu to see other pages.

Doctors are working to learn more about laryngeal and hypopharyngeal cancers, ways to prevent them, how to best treat them, and how to provide the best care to people diagnosed with either of these diseases. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the best diagnostic and treatment options for you.

• Radiation therapy approaches. Researchers are evaluating more effective ways of using radiation therapy. A promising approach called radiosensitization involves giving drugs that make the cancer cells more sensitive to radiation therapy so they can be destroyed more easily. Another approach is called hyperfractionated radiation therapy. It gives radiation therapy in several small doses per day. Researchers are also studying proton therapy , which uses protons rather than x-rays to treat cancer.

• Targeted and tumor-specific therapy. More and more knowledge of the biology of cancer is leading to the development of targeted therapies (see Types of Treatment ), in addition to immunotherapy (see below). Many new drugs are in various stages of development.

• Immunotherapy. Immunotherapy , also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. Nivolumab and pembrolizumab have been approved to treat this disease (see Types of Treatment ), and other types of immunotherapy drugs are being studied in clinical trials.

• Chemoprevention. Researchers are evaluating the benefits of using chemoprevention as a way to prevent the development of a second cancer after treatment for laryngeal or hypopharyngeal cancer has finished. Chemoprevention is the use of drugs or supplements to lower the risk of cancer.

• Photodynamic therapy. During photodynamic therapy, a substance that is sensitive to light, called photosensitive, is injected into the blood. Cancer cells hold onto the substance longer than healthy cells. Then, lasers are directed at the area of the tumor, and the substance in the cells is activated to destroy the cancer cells.

• Palliative care/supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current laryngeal and hypopharyngeal cancer treatments to improve comfort and quality of life for patients.

Looking for More About the Latest Research?

If you would like more information about the latest areas of research in laryngeal and hypopharyngeal cancer, explore these related items that take you outside of this guide:

• To find clinical trials specific to your diagnosis, talk with your doctor or search online clinical trial databases .

• Listen to a podcast from an ASCO expert discussing highlights from the 2022 and 2020 ASCO Annual Meetings.

• Review other research announced at recent scientific meetings about head and neck cancer on the Cancer.Net Blog .

• Visit the website of Conquer Cancer, the ASCO Foundation , to find out how to help support cancer research. Please note that this link takes you to a different ASCO website.

The next section in this guide is Coping with Treatment . It offers some guidance in how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will read about your medical care after cancer treatment is completed and why this follow-up care is important. Use the menu to see other pages.

Care for people diagnosed with laryngeal or hypopharyngeal cancer does not end when active treatment has finished. Your health care team will continue to check that the cancer has not come back, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Health care providers want to keep track of your recovery in the months and years ahead. People recovering from laryngeal or hypopharyngeal cancer should receive regular follow-up medical and dental examinations to check for signs of recurring cancer or a second primary cancer, which is a new type of cancer that develops somewhere else in the body. These regular examinations can also help with the management of any late or long-term side effects from cancer treatment.

A common follow-up care schedule for people after treatment for either of these types of cancer is every 2 months for the first year, every 4 months for the second year, every 6 months for the third year, and once a year after that. Diagnostic tests and examinations may be repeated to look for a recurrence or monitor the progress of ongoing treatment.

Cancer rehabilitation may be recommended, and this could mean any of a wide range of services, such as physical therapy, occupational therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent as possible. Learn more about cancer rehabilitation.

Learn more about the importance of follow-up care .

Watching for recurrence

One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a health care provider familiar with your medical history can give you personalized information about your risk of recurrence. Your medical provider will ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer first diagnosed and the types of treatment given.

If a person uses tobacco, it is important to be monitored for possible second cancers that may occur in the lung, esophagus, and other locations in the head and neck, even without recurrence of the first cancer. Joining a clinical trial researching new ways to prevent these diseases may be an option.

The anticipation before having a follow-up test or waiting for test results may add stress to you or a family member. This is sometimes called “scanxiety.” Learn more about how to cope with this type of stress .

Managing long-term and late side effects

Most people expect to have side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years after treatment has ended. Long-term and late effects can include both physical and emotional changes.

Talk with your medical provider about your risk of developing such side effects based on your diagnosis, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may have certain physical examinations, scans, or blood tests to help find and manage them. For example, people who had radiation therapy should have their thyroid function checked regularly.

Cancer rehabilitation

Rehabilitation is a major part of follow-up care after treatment for head and neck cancer. However, people should meet with all rehabilitation specialists before their treatment begins. Following treatment, people may receive physical therapy to maintain range of movement and speech-language therapy to regain such skills as talking and swallowing. When the cancer treatment impairs swallowing, exercise plans can often be designed to strengthen and maintain the ability to eat and swallow. Many people who have been treated for head and neck cancer have difficulty eating. Listen to a podcast about managing eating challenges after treatment.

It is important that people receive early evaluation by a speech language pathologist and other members of the health care team to start specific treatment programs and avoid later problems. Supportive care to manage symptoms and maintain nutrition during treatment may also be recommended. Some people may need to learn new ways to eat or prepare food. A registered dietitian may be helpful to consult.

Sometimes rehabilitation requires developing a new voice. Options include:

• Esophageal speech. Some people can learn to use the throat muscles of the esophagus to produce sound. This is called esophageal speech.

• Electrolarynx. Some people use a mechanical battery-powered device called an electrolarynx to speak. This device produces vibration that is transmitted through the tissues of the neck or is delivered into the mouth through a plastic tube to produce speech.

• Tracheoesophageal (TE) voice restoration. TE voice restoration is used by many people after a laryngectomy. TE speech is similar to normal laryngeal speech because it uses air from the lungs to power speech production just as it did before laryngectomy. A small, removable device, called a voice prosthesis, sits inside the stoma and allows air from the lungs to pass into the esophagus for sound production. The sound then travels into the mouth for speech.

Not every person is interested in or can learn all of these voice methods. It is important to meet with an experienced speech language pathologist before surgery to understand what rehabilitation will be needed and to select the best method or methods for the individual, if necessary.

People may look different, feel tired, and be unable to talk or eat the way they used to before treatment. People who have a tracheostomy need to learn how to take care of the stoma and keep it clean. Some people may experience depression . The health care team can help people adjust and connect them with both physical and emotional support services.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed

This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their primary care doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship . It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.

ON THIS PAGE: You will find some questions to ask your doctor or other members of the health care team to help you better understand your diagnosis, treatment plan, and overall care. Use the menu to see other pages.

Talking often with the health care team is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for a digital list and other interactive tools to manage your care. It may also be helpful to ask a family member or friend to come with you to appointments to help take notes.

Questions to ask after getting a diagnosis

• What type of head and neck cancer do I have? Where exactly is it located?

• What is the stage and grade of the cancer? What do these classifications mean?

• Can you explain my pathology report (laboratory test results) to me?

• Will my cancer be genetically tested?

• What is the likelihood that this cancer is curable?

Questions to ask about choosing a treatment

• What are my treatment options?

• What clinical trials are available for me? Where are they located, and how do I find out more about them?

• What treatment plan do you recommend? Why?

• What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

• What are the possible side effects of each treatment option, both in the short term and the long term?

• What can be done to prevent or manage these side effects?

• Should I talk with another doctor to get a second opinion?

• Who will be part of my health care team, and what does each member do?

• Who will be leading my overall treatment?

• Should I see any other specialists before starting treatment? Should I talk with a radiation oncologist, medical oncologist, or plastic surgeon?

• Can you recommend an oncologic dentist before treatment begins?

• Can you recommend a speech pathologist before treatment begins?

• If I’m worried about managing the costs of cancer care, who can help me?

• What support services are available for me? To my family?

• If I have questions or problems, who should I call?

Questions to ask about managing side effects

• What kind of mouth rinses or toothpaste can I use?

• How should I treat symptoms related to dry mouth?

• If I smoke, will quitting help this treatment work better?

• How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

• Will treatment affect my ability to speak, eat, and swallow? How can this be managed?

• Could this treatment affect my sex life? If so, how and for how long?

• Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?

Questions to ask about having surgery

• What type of surgery will I have?

• Will lymph nodes need to be removed? If so, what type of neck dissection will be done? What does this mean?

• How likely is it that I will lose my voice box (larynx)? If this is necessary, what are the options available for voice/speech rehabilitation?

• Will major reconstruction be needed? How will this affect my ability to speak and eat?

• How long will the operation take?

• How long will I be in the hospital?

• Can you describe what my recovery from surgery will be like?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this surgery? Will this affect my ability to move my shoulder?

• What can be done to prevent or relieve the side effects?

Questions to ask about having radiation therapy

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• Will there be any lasting side effects, such as loss of saliva, loss of taste, or permanent difficulty swallowing?

• How will I be able to eat a balanced diet if treatment affects my ability to eat the foods I am used to eating?

• What can be done to prevent or relieve the side effects?

Questions to ask about having therapies using medication

• What type of treatment is recommended?

• What is the goal of this treatment?

• How long will it take to give this treatment?

• Will I receive this treatment at a hospital or clinic? Or will I take it at home?

• What side effects can I expect during treatment?

• Who should I contact about any side effects I experience? And how soon?

• What are the possible long-term or late effects of having this treatment?

• What can be done to prevent or relieve the side effects?

Questions to ask about planning follow-up care

• What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

• What kind of dental care do I need? How often should I see the dentist?

• What long-term side effects or late effects are possible based on the cancer treatment I received?

• Do I need to make changes in my diet? Are there certain foods that I should avoid? Can I drink alcohol?

• Will I need cancer rehabilitation services after treatment? What can I expect?

• If I smoke, how can you help me quit?

• What follow-up tests will be needed, and how often will I need them?

• How do I get a treatment summary and survivorship care plan to keep in my personal records?

• Who will be leading my follow-up care?

• What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources . It offers more resources on this website that may be helpful to you. Use the menu to choose a different section to read in this guide.