The first 60 days: 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. Below, week by week, is what OnCo's record of Laryngeal and hypopharyngeal cancer says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Extensive disease or non-functioning larynx, Recurrent or metastatic.
- Medical oncologistNamed in the standard of care for: Early glottic cancer, Locally advanced, larynx preservable, Extensive disease or non-functioning larynx, Recurrent or metastatic.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Early glottic cancer, Locally advanced, larynx preservable, Extensive disease or non-functioning larynx, Recurrent or metastatic.
- Palliative and supportive care teamNamed in the standard of care for: Prevention.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Smoking cessation and alcohol reduction; no screening programme exists.
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).
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Glotticcancer, Supraglottic cancer, Subglottic cancer.
- Is germline (inherited) genetic testing recommended for me or my family?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?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?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?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?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?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?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?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of KEYNOTE-048 apply to someone like me?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?Guideline options include: Smoking cessation and alcohol reduction; no screening programme exists.
Any stage
- Are there clinical trials I could join, for example of Pembrolizumab, Adaptive radiotherapy (online replanning)?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?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?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?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?Open problems are where trials and second opinions matter most.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Laryngeal and hypopharyngeal cancer: the full pageCancer 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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.