Laryngeal Cancer Stage III

Stage III laryngeal cancer is a serious condition where cancer has spread beyond the voice box to nearby tissues or lymph nodes, but has not yet reached distant parts of the body. Understanding this stage and the available treatment options can help patients make informed decisions about their care.

Table of contents

• What is Stage III Laryngeal Cancer?
• How Staging Differs by Cancer Location
• Symptoms and Warning Signs
• Diagnosis and Testing
• Treatment Options
• Outlook and Survival

What is Stage III Laryngeal Cancer?

Stage III laryngeal cancer means that cancer has grown beyond the early stages but has not spread to distant parts of the body. The larynx, also called the voice box, is the part of your throat that contains the vocal cords and helps you speak, breathe, and swallow^[1].

Cancer at this stage is considered locally advanced, meaning it has either grown more extensively within the larynx itself or has spread to nearby lymph nodes (small bean-shaped structures that are part of the body’s immune system)^[3].

Doctors use two main systems to describe the extent of laryngeal cancer. The first is the number staging system, which ranges from stage 0 to stage IV. The second is the TNM system, which stands for Tumor (size and extent of the main tumor), Node (whether cancer has spread to lymph nodes), and Metastasis (whether cancer has spread to distant organs)^[1].

How Staging Differs by Cancer Location

• Supraglottis (upper part of the larynx above the vocal cords)
• Glottis (middle part including the vocal cords)
• Subglottis (lower part below the vocal cords)

Stage III laryngeal cancer is defined differently depending on where in the larynx the cancer began. The larynx has three main parts, and each has its own specific staging criteria^[1].

Cancer Starting Above the Vocal Cords (Supraglottis)

For stage III supraglottic cancer, there are two possible scenarios. In the first, the tumor has not spread beyond the larynx but has caused a vocal cord to stop moving. Alternatively, the tumor may be growing into nearby areas such as the postcricoid area, paraglottic space, pre-epiglottic tissues, or the inner part of the thyroid cartilage. In this scenario, the cancer has not yet spread to lymph nodes or distant areas^[1].

In the second scenario, the tumor may have spread to nearby structures and may have affected a vocal cord. The cancer has spread to a single lymph node on the same side of the neck as the tumor, and this lymph node does not exceed 3 centimeters (about 1.2 inches) across^[1].

Cancer Starting in the Vocal Cords (Glottis)

For stage III glottic cancer, the first possibility is that the tumor has not spread beyond the larynx but has stopped a vocal cord from moving. Another possibility is that the tumor is spreading into the paraglottic space or the inner part of the thyroid cartilage, with no spread to lymph nodes or distant areas^[1].

The second scenario involves a tumor that may have spread into structures just outside the larynx and may have affected a vocal cord. The tumor has also spread to a single lymph node that does not exceed 3 centimeters across, with no spread to distant parts of the body^[1].

Cancer Starting Below the Vocal Cords (Subglottis)

Stage III subglottic cancer follows similar patterns. In one scenario, the tumor has not spread beyond the larynx but has stopped a vocal cord from moving, or is spreading into the paraglottic space or inner thyroid cartilage. The cancer has not spread to lymph nodes or distant parts of the body^[1].

In the alternative scenario, the tumor may have spread to nearby structures just outside the larynx and may have affected a vocal cord. The cancer has spread to a nearby lymph node that does not exceed 3 centimeters across, but has not spread to distant parts of the body^[1].

Symptoms and Warning Signs

Recognizing the symptoms of stage III laryngeal cancer is important for seeking timely medical care. Many of these symptoms can be mistaken for less serious conditions, which is why persistent symptoms should always be evaluated by a healthcare provider^[4].

Common symptoms include a sore throat or cough that does not improve, voice changes such as hoarseness that persist for more than two weeks, pain or difficulties when swallowing, a lump in the neck or throat, trouble making voice sounds, and ear pain^[4].

Some symptoms require immediate medical attention. These include trouble breathing, breathing that is noisy and high-pitched (called stridor), the feeling that something is stuck in your throat, and coughing up blood^[4].

Diagnosis and Testing

Diagnosing stage III laryngeal cancer involves several steps. A healthcare provider will begin by asking about your symptoms and medical history, then perform a physical exam of your throat and neck^[4].

Several specialized tests help confirm the diagnosis. A laryngoscopy is a procedure where the doctor checks the larynx using a mirror or a thin tube-like instrument with a light and lens. This allows them to see inside the throat and voice box and may include taking tissue samples for testing^[4].

An endoscopy is a similar procedure that looks at organs and tissues inside the body, including the throat, esophagus, and windpipe. If abnormalities are found during these procedures, a biopsy (removal of tissue for laboratory testing) will be performed to check for cancer cells^[4].

Imaging tests provide detailed pictures of the inside of your body. These may include CT scans (computed tomography) or MRI scans (magnetic resonance imaging), which help determine the size of the cancer and whether it has spread to lymph nodes or other areas^[4].

Treatment Options

Treatment for stage III laryngeal cancer typically involves one or more approaches. The goal is to eliminate the cancer while preserving as much function as possible, including the ability to speak, swallow, and breathe normally^[14].

Surgery

Surgery is one of the main treatment options for stage III laryngeal cancer. For some patients, surgery may involve removing part or all of the larynx (called a laryngopharyngectomy) along with a neck dissection to remove lymph nodes in the neck^[8].

After surgery to remove the larynx, additional procedures may be needed. These can include placement of a breathing tube (called a tracheostomy) to help with breathing, and a feeding tube to ensure proper nutrition during recovery^[8].

Reconstructive surgery is often performed at the same time as cancer removal surgery. This helps improve both appearance and function of the mouth and neck^[8].

Radiation Therapy

Radiation therapy uses high-energy rays to kill cancer cells. For stage III laryngeal cancer, radiation is typically given to the tumor and lymph nodes on both sides of the neck. A specialized type called intensity-modulated radiation therapy (IMRT) may be used to reduce damage to surrounding healthy tissues^[8].

Radiation therapy may be given after surgery or as the main treatment combined with chemotherapy^[8].

Chemoradiation

Chemoradiation is one of the main treatments for stage III laryngeal cancer. This approach combines chemotherapy and radiation therapy given during the same time period. The chemotherapy makes the radiation more effective^[8].

The most commonly used chemotherapy drug in combination with radiation is cisplatin. This treatment approach can sometimes allow patients to keep their larynx while still effectively treating the cancer^[8].

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It may be given before surgery or radiation therapy to shrink the tumor. The most common chemotherapy combination for laryngeal cancer includes cisplatin and fluorouracil (also called 5-fluorouracil or 5-FU)^[8].

Supportive Care and Rehabilitation

Treatment for stage III laryngeal cancer often affects the ability to speak and swallow. Speech and language therapists play an important role in helping patients with communication, speech, and swallowing difficulties. They begin supporting patients before treatment starts and continue during and after treatment^[18].

A dietitian will help plan nutrition during and after treatment, as eating and drinking may be affected. They provide advice to help manage any changes in diet^[18].

Outlook and Survival

The outlook for stage III laryngeal cancer depends on several factors, including the tumor’s size and location, whether it has spread to lymph nodes, the patient’s overall health, and how well the cancer responds to treatment^[1].

According to statistics from England for people diagnosed between 2014 and 2016, almost 55 out of 100 adults (almost 55%) with stage III laryngeal cancer survive their cancer for 5 years or more after diagnosis^[23].

While stage III indicates advanced cancer, many patients live for several years with proper treatment. With advancements in medical technology and specialized care, many patients have the opportunity to live fulfilling lives despite their diagnosis^[21].

Research has shown that treatment choices have a significant impact on survival. Studies comparing different treatment approaches have found that surgery-based treatment may offer better outcomes than chemoradiotherapy alone for some patients with stage III laryngeal cancer^[9].

Regular follow-ups after treatment are essential. Patients typically need frequent check-ups to monitor for any signs of cancer returning and to manage any side effects from treatment. A strong support system and adherence to treatment plans are vital for achieving the best possible outcomes^[21].