Laryngeal and hypopharyngeal cancer
Cancer of the voice box 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.
Overview
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.
State of the art
- Larynx preservation with chemoradiation cures most locally advanced cancers while keeping the voice, but late toxicity and non-cancer deaths have tempered enthusiasm for it in the most extensive tumours.
- Transoral laser surgery and single-fraction-savvy radiotherapy schedules give early glottic cancer cure rates above 90 percent.
- Voice prostheses after laryngectomy restore intelligible speech for most patients.
Anatomy and lymph node drainage
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.
- Oral cavity and tongue
- Oropharynx: tonsil, base of tongue (HPV)
- Nasopharynx (EBV)
- Larynx and hypopharynxGlottic (vocal cord) cancer · Supraglottic cancer · Subglottic cancer (rare) · Hypopharyngeal cancer (pyriform sinus, postcricoid, posterior wall)
- Parotid and other salivary glands
- Thyroid
- level I (submandibular)
- level II (upper jugular)
- level III-IV (jugular)
- level V (posterior)
- level VI (central, thyroid)
- retropharyngeal (nasopharynx)
Same organ: 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)
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.
- AI in radiologyEstablished
- cfDNA fragmentomicsEstablished
- Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood)Standard of care
- DNA methylation profilingEstablished
- HCC surveillance in cirrhosis (ultrasound + AFP)Standard of care
- High-risk pancreatic surveillance (CAPS / PRECEDE)Established
- A 28-day national pathway for people with a positive multi-cancer blood test
- A breath test to rule out cancer in people with vague symptoms
- A cancer blood test for older people arriving at A&E with unexplained symptoms
- A legislated, publicly reported 28-day standard from urgent referral to diagnosis
- A live national dashboard of stage at diagnosis as the scorecard for early detection
- A single 'cancer check at 60' appointment bundling all screening tests
Background: Alpha-fetoprotein (AFP), Barrett's oesophagus, CA 19-9, Early detection, Faecal immunochemical test (FIT). Also on OnCo: Symptoms and red flags · Early detection roadmap.
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
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.
Subtypes & biomarkers
top- Glottic (vocal cord) cancer
- Supraglottic cancer
- Subglottic cancer (rare)
- Hypopharyngeal cancer (pyriform sinus, postcricoid, posterior wall)
- Stage and cartilage invasion on CT
- Vocal cord mobility
- Smoking and alcohol exposure
- PD-L1 (recurrent disease)
How often this target appears
- 1873Billroth performs the first total laryngectomy
- 1991VA Larynx trial: induction chemotherapy and radiotherapy preserve the larynx in two thirds
- 2003RTOG 91-11: concurrent cisplatin chemoradiation best for larynx preservation
- 2013Long-term RTOG 91-11 data show more non-cancer deaths after concurrent treatment
What is in development for Laryngeal and hypopharyngeal cancer, drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
Hypopharyngeal cancer survival has barely improved.
Choosing between preservation and laryngectomy in T4 disease.
Long-term swallowing and airway function after chemoradiation.
Persistently high incidence where smoking remains common.
Trials
topTrials recruiting now
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Landmark trials
Expert centres
topExpert centres
- Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer CenterBaltimore, USNewsweek oncology #10NCI comprehensivevia Pembrolizumab
- Aarhus University HospitalAarhus, DKvia IMRT / IGRT (modern external beam)
- Alliance for Clinical Trials in OncologyChicago, IL, USvia Pembrolizumab
- American Society for Radiation OncologyArlington, VA, USvia IMRT / IGRT (modern external beam)
- Cancer Research UKLondon, GBvia Alcohol reduction, pricing and cancer warning labels
- Centre Antoine LacassagneNice, FRvia IMRT / IGRT (modern external beam)
- Centre Oscar LambretLille, FRvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Comprehensive Cancer Center Freiburg (CCCF)Freiburg im Breisgau, DEvia IMRT / IGRT (modern external beam)
- European Society for Radiotherapy and OncologyBrussels, BEvia IMRT / IGRT (modern external beam)
- Geneva University Hospitals (HUG)Geneva, CHvia IMRT / IGRT (modern external beam)
- GOG FoundationPhiladelphia, PA, USvia Pembrolizumab
- Groote Schuur Hospital / University of Cape TownCape Town, ZAvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Hacettepe University Cancer InstituteAnkara, TRvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Ho Chi Minh City Oncology HospitalHo Chi Minh City, VNvia IMRT / IGRT (modern external beam)
- Hokkaido University HospitalSapporo, JPvia IMRT / IGRT (modern external beam)
- Hunan Cancer HospitalChangsha, CNvia IMRT / IGRT (modern external beam)
- Indiana University Melvin and Bren Simon Comprehensive Cancer CenterIndianapolis, IN, USNCI comprehensivevia Cisplatin
- Institut BergoniéBordeaux, FRvia IMRT / IGRT (modern external beam)
- Institut Jules BordetBrussels, BEvia Pembrolizumab
- Institut National d'Oncologie, RabatRabat, MAvia IMRT / IGRT (modern external beam)
- Institut Salah AzaïezTunis, TNvia IMRT / IGRT (modern external beam)
- Institute of Oncology LjubljanaLjubljana, SIvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via Alcohol reduction, pricing and cancer warning labels
- via IMRT / IGRT (modern external beam)
- International Extranodal Lymphoma Study GroupBellinzona, CHvia IMRT / IGRT (modern external beam)
- IRCCS Humanitas Research HospitalRozzano (Milan), ITvia IMRT / IGRT (modern external beam)
- Istanbul University Institute of OncologyIstanbul, TRvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Juravinski Cancer Centre / Escarpment Cancer Research InstituteHamilton, ON, CAvia IMRT / IGRT (modern external beam)
- Kenyatta National HospitalNairobi, KEvia IMRT / IGRT (modern external beam)
- Korle Bu Teaching HospitalAccra, GHvia IMRT / IGRT (modern external beam)
- Lagos University Teaching HospitalLagos, NGvia IMRT / IGRT (modern external beam)
- via Pembrolizumab
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- National Cancer Institute (NIH)Bethesda, MD, USvia Smoking cessation in cancer patients
- via IMRT / IGRT (modern external beam)
- National Institute of Oncology, HungaryBudapest, HUvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Ocean Road Cancer InstituteDar es Salaam, TZvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Rajiv Gandhi Cancer Institute and Research CentreNew Delhi, INvia IMRT / IGRT (modern external beam)
- Rambam Health Care CampusHaifa, ILvia IMRT / IGRT (modern external beam)
- Rigshospitalet, Copenhagen University HospitalCopenhagen, DKvia IMRT / IGRT (modern external beam)
- Royal Adelaide HospitalAdelaide, AUvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Siriraj Hospital, Mahidol UniversityBangkok, THvia IMRT / IGRT (modern external beam)
- Tata Medical Center, KolkataKolkata, INvia IMRT / IGRT (modern external beam)
- Tawam HospitalAl Ain, AEvia IMRT / IGRT (modern external beam)
- Tel Aviv Sourasky Medical CenterTel Aviv, ILvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- TROG Cancer ResearchNewcastle, NSW, AUvia IMRT / IGRT (modern external beam)
- UMC Utrecht Cancer CenterUtrecht, NLvia IMRT / IGRT (modern external beam)
- University of Malaya Medical CentreKuala Lumpur, MYvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- via Cetuximab
- Velindre Cancer CentreCardiff, GBvia IMRT / IGRT (modern external beam)
- via IMRT / IGRT (modern external beam)
- Zhejiang Cancer HospitalHangzhou, CNvia IMRT / IGRT (modern external beam)
Questions to ask
topQuestions to ask your oncologist about Laryngeal and hypopharyngeal cancer
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Stage and cartilage invasion on CT, Vocal cord mobility, Smoking and alcohol exposure, PD-L1), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Glotticcancer, Supraglottic cancer, Subglottic cancer.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Early glottic cancer
- For my situation (early glottic cancer), which of the standard options do you recommend and why?Why: Guideline options include: Transoral laser microsurgery or radiotherapy alone; both cure most patients and preserve the voice.
Locally advanced, larynx preservable
- For my situation (locally advanced, larynx preservable), which of the standard options do you recommend and why?Why: Guideline options include: Concurrent cisplatin chemoradiation (RTOG 91-11); induction chemotherapy for selection in some centres.
- Am I a candidate for Cisplatin, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of RTOG 91-11 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Extensive disease or non-functioning larynx
- For my situation (extensive disease or non-functioning larynx), which of the standard options do you recommend and why?Why: Guideline options include: Total laryngectomy with neck dissection and postoperative radiotherapy or chemoradiation; voice prosthesis rehabilitation.
Recurrent or metastatic
- For my situation (recurrent or metastatic), which of the standard options do you recommend and why?Why: Guideline options include: Salvage laryngectomy after radiotherapy failure; pembrolizumab-based therapy for metastatic disease (KEYNOTE-048).
- Am I a candidate for Pembrolizumab, Cetuximab, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-048 apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Prevention
- For my situation (prevention), which of the standard options do you recommend and why?Why: Guideline options include: Smoking cessation and alcohol reduction; no screening programme exists.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
- I read that “Hypopharyngeal cancer survival has barely improved”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
- I read that “Choosing between preservation and laryngectomy in T4 disease”. How does that affect my plan?Why: Open problems are where trials and second opinions matter most.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
8targets
2drugs
3companies
2trials
2Latest papers
topQuery 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.
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