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Cancer of the voice box, a head and neck cancer, announces itself with hoarseness and is highly curable when caught early, by laser surgery or radiotherapy that preserve the voice. Advanced disease is treated with chemoradiation to keep the larynx where possible, with total laryngectomy for the most extensive tumours or when other treatment fails.
Laryngeal squamous cell carcinoma arises in the glottis (vocal cords), supraglottis or subglottis; hypopharyngeal cancer arises just behind and below and is grouped with it. Persistent hoarseness leads to early diagnosis of glottic tumours, which are treated with transoral laser microsurgery or radiotherapy alone with excellent cure rates. Locally advanced disease is treated with concurrent cisplatin chemoradiation, established by RTOG 91-11 as the best way to keep the larynx, while tumours that have destroyed cartilage or the larynx's function are best treated with total laryngectomy and postoperative radiotherapy, followed by voice rehabilitation with a voice prosthesis. Hypopharyngeal cancer presents late, with swallowing difficulty and neck nodes, and often needs laryngopharyngectomy. Smoking cessation is the most important single intervention.
About 190,000 new cases a year worldwide, overwhelmingly in smokers and heavy drinkers; early vocal cord cancers are cured in more than nine in ten patients, while hypopharyngeal cancer has among the worst outlooks in head and neck oncology.
Site decides cause and behaviour: HPV drives oropharyngeal cancer, EBV drives nasopharyngeal cancer, tobacco drives oral and laryngeal cancer; all drain into the neck node levels that surgeons and radiotherapists map.
Same organ: Acinic cell carcinoma of the salivary glands, Carcinoma ex pleomorphic adenoma, Multiple endocrine neoplasia type 1 (MEN1), Multiple endocrine neoplasia type 2 (MEN2A and MEN2B), Hyperparathyroidism-jaw tumour syndrome (CDC73-related parathyroid carcinoma), Oropharyngeal cancer (tonsil and base of tongue), Oral cavity cancer (mouth and tongue), Head and neck squamous cell carcinoma, Nasopharyngeal carcinoma, Salivary gland cancers, Papillary thyroid cancer, Follicular thyroid cancer, Medullary thyroid cancer, Anaplastic thyroid cancer, Thyroid cancer, Nasal cavity and paranasal sinus cancers (including esthesioneuroblastoma), NUT carcinoma (midline carcinoma with NUTM1 rearrangement), Parathyroid carcinoma, Multiple endocrine neoplasia syndromes (MEN1, MEN2, MEN4), HPV-positive oropharyngeal cancer, HPV-negative head and neck squamous cell carcinoma (including HPV-negative oropharyngeal cancer), Recurrent or metastatic head and neck squamous cell carcinoma, Hypopharyngeal cancer, Adenoid cystic carcinoma, Salivary duct carcinoma, Mucoepidermoid carcinoma, Oral tongue and floor of mouth cancer, Buccal mucosa and gingivobuccal cancer (oral cancer in India), Lip cancer, Locoregionally advanced nasopharyngeal carcinoma (stage III to IVA), Recurrent and metastatic nasopharyngeal carcinoma, Esthesioneuroblastoma (olfactory neuroblastoma), Sinonasal undifferentiated carcinoma (SNUC) and SWI/SNF-deficient sinonasal carcinoma
Transoral laser microsurgery or radiotherapy alone; both cure most patients and preserve the voice.
Concurrent cisplatin chemoradiation (RTOG 91-11); induction chemotherapy for selection in some centres.
Total laryngectomy with neck dissection and postoperative radiotherapy or chemoradiation; voice prosthesis rehabilitation.
Salvage laryngectomy after radiotherapy failure; pembrolizumab-based therapy for metastatic disease (KEYNOTE-048).
Smoking cessation and alcohol reduction; no screening programme exists.
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Patients with head and neck squamous cell cancer that has recurred or spread should be treated first with pembrolizumab: alone if their tumour is strongly PD-L1 positive and they can wait for a slower response, or with chemotherapy if the tumour is bulky or PD-L1 low. Cetuximab-based chemotherapy is no longer the default. Long-term follow-up shows a small but real group of patients alive at four to five years, which was almost unheard of before.
Concurrent chemoradiation remains standard, but the excess of late non-cancer deaths is a reminder that swallowing dysfunction and aspiration after chemoradiation carry long-term risk.
Concurrent cisplatin chemoradiation is the standard larynx-preserving treatment for advanced laryngeal cancer where the larynx is still functioning; laryngectomy is reserved for extensive disease or salvage.
Organ preservation is an accepted alternative to laryngectomy for hypopharyngeal cancer; concurrent chemoradiation has largely replaced sequential induction chemotherapy and radiotherapy.
Organ preservation became a legitimate goal in laryngeal cancer; RTOG 91-11 later refined the approach to concurrent chemoradiation.
Query for this cancer: (TITLE:"Laryngeal and hypopharyngeal cancer" OR ABSTRACT:"Laryngeal and hypopharyngeal cancer" OR TITLE:"Larynx cancer" OR ABSTRACT:"Larynx cancer" OR TITLE:"Voice box cancer" OR ABSTRACT:"Voice box cancer" OR TITLE:"Glottic cancer" OR ABSTRACT:"Glottic cancer" OR TITLE:"Supraglottic cancer" OR ABSTRACT:"Supraglottic cancer" OR TITLE:"Hypopharynx cancer" OR ABSTRACT:"Hypopharynx cancer") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Laryngeal and hypopharyngeal cancer, not a curated reading list.
The targets of this cancer's medicines and the ones linked to it directly.
Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes.
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Bleeding that does not stop by itself, bleeding from more than one site, or new bruising in several places or one large area.
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
Reactions around the moment a drug is given: chills, fever or breathlessness from antibodies (infusion reactions), true allergy (hypersensitivity, rarely anaphylaxis), and leakage of a damaging drug into tissue around the vein (extravasation).
See all on the product pages:CetuximabCisplatinPembrolizumab·Printable cards in the navigator
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