In a total laryngectomy, the entire larynx is removed. This procedure is usually performed on patients with Stage III and IV cancers. After the voice box is taken out, the windpipe (trachea) is attached to an opening in the neck through which the patient will breathe. These holes, or stomas, require special protection and cleaning.

Patients are no longer able to use their vocal cords to speak after a total laryngectomy. Rehabilitation requires developing a new voice by using esophageal speech or a tracheoesophageal fistula. Esophageal speech requires the patient to take air into the esophagus and slowly release the air through the area where the pharynx connects with the esophagus to produce sounds. A tracheoesophageal fistula, which is created by inserting a valve between the trachea and the esophagus, forces air into the esophagus during expiration to produce sounds. Patients may also use an electrolarynx as a sounding source. This device is held in place outside the larynx and produces a sound that is articulated into speech.

Other surgical procedures include partial laryngectomy, which preserves some of the voice box and is used to remove smaller cancers; and neck dissection, which removes lymph nodes in the neck that contain cancer.

Total or partial pharyngectomy removes all or part of the hypopharynx. Following this procedure, a surgeon may reconstruct the throat so that the patient can swallow. A tracheotomy is used when the tumor is too large to remove. In this procedure, a hole is made in the neck to bypass the tumor and allow the patient to breathe.

A cordectomy removes only the vocal cords and a supraglottic laryngectomy removes only the supraglottis. Laser surgery, a procedure that uses a narrow beam of infrared light, is being tested in clinical trials for very early cancers of the larynx.

Surgery for early larynx cancer can be done by carbon dioxide laser. It is fast, and in selected patients a very efficient way to treat the laryngeal cancer.

Radiation therapy uses high-energy rays to kill cancer cells and shrink tumors. The rays may be delivered from a machine outside of the body (external beam radiation) or from a device implanted inside the body near the cancer. Radiation is often the main treatment for laryngeal and hypopharyngeal cancer, and is used for small cancers instead of surgery. However, radiation can also be used to destroy cancer cells remaining after surgery. Radiation can help to ease symptoms such as pain, bleeding and difficulty in swallowing.

Certain drugs can make cancer cells more sensitive to radiation. Clinical trials are testing these radiosensitizing drugs. Clinical trials are also examining the effectiveness of giving radiation in several small doses several times a day, which is called hyperfractionated radiation therapy.

Side effects of radiation therapy may include sunburned or tanned skin in the treated area. This will fade six months to a year after treatment. Other side effects include fatigue and nausea.

Chemotherapy is the use of powerful drugs to kill cancer cells or shrink tumors. The drugs may be given orally or injected into a vein or muscle. Chemotherapy in combination with radiation therapy has been shown to control large cancers. The treatment can also help to ease symptoms when a cancer is too large to be removed surgically and to help patients who are too ill for surgery. Side effects of chemotherapy are fatigue, nausea and hair loss. The extent and duration of these effects depend on the type of drug, the dosage and the duration of treatment.

Because people with cancer of the larynx have a higher risk of developing other cancers in the head and neck area, chemoprevention therapy is being studied in clinical trials. This type of treatment uses drugs to prevent second cancers from developing in the mouth, throat, windpipe, nose or esophagus.

Treatment for laryngeal cancer depends on where the cancer is found in the larynx. Chemoprevention therapy is often added after primary therapy to decrease the incidence of second cancers.

Stage I: Cancer that begins in the supraglottis may be treated with external beam radiation therapy or surgery to remove the supraglottis (supraglottic laryngectomy) or the larynx. Cancer in the glottis may be treated with radiation therapy or surgery to take out a vocal cord (cordectomy), part of the larynx (hemilaryngectomy) or the entire larynx. Laser surgery may also be used. If the cancer is in the subglottis, treatment will probably involve radiation therapy or a hemilaryngectomy.

Stage II: Depends on where the cancer is located. Cancer in the supraglottis may be treated with external beam radiation therapy, surgery to remove the supraglottis (supraglottic laryngectomy) or the entire larynx or surgery followed by radiation therapy. Cancer in the glottis may be treated with radiation therapy or surgery (hemilaryngectomy or total laryngectomy). If the cancer is in the subglottis, treatment may also involve radiation therapy or surgery (hemilaryngectomy or total laryngectomy). Patients with any of these types of cancer may also enroll in a clinical trial.

Stage III: Treatment for cancer in the supraglottis can include surgery to remove the cancer with or without radiation therapy, radiation therapy followed by laryngectomy if the radiation does not shrink the cancer or a clinical trial with combination therapy (radiation therapy and chemotherapy). Cancer in the glottis can be treated the same way. Cancer in the subglottis may be treated with surgery to remove the larynx, some of the surrounding tissue and the thyroid gland. Surgery is usually followed by radiation therapy. Radiation therapy and chemotherapy may also be used, and patients may enroll in a clinical trial.

Stage IV: Patients with cancer in the supraglottis or glottis may undergo laryngectomy followed by radiation therapy, chemotherapy or a clinical trial. Patients with cancer in the subglottis may undergo total laryngectomy, removal of the thyroid gland and removal of some of the tissue around the larynx and the lymph nodes in the neck. Surgery is usually followed by radiation therapy. If these patients cannot have surgery they may receive radiation therapy and/or chemotherapy or enroll in a clinical trial.