Laryngeal squamous cell carcinoma is a serious condition affecting the voice box, but advances in medicine offer various approaches to manage symptoms, preserve function, and improve quality of life for those diagnosed with this disease.

How Doctors Approach Treating Voice Box Cancer

When someone receives a diagnosis of laryngeal squamous cell carcinoma, the treatment plan becomes deeply personal. The voice box, or larynx, isn’t just another body part—it helps people speak, breathe, and swallow. Because of these vital functions, doctors aim to control the cancer while preserving as much normal function as possible.^[1]

Treatment decisions depend heavily on where the cancer is located within the larynx and how far it has spread. The larynx has three main parts: the supraglottis (upper part), the glottis (middle part where the vocal cords sit), and the subglottis (lower part). More than half of laryngeal cancers start in the glottis, while about 35% begin in the supraglottis, and only about 5% in the subglottis.^[1]

The stage of the disease matters enormously. Early-stage cancer—when it’s small and hasn’t spread—often responds very well to treatment, with cure rates ranging from 75% to 95% depending on the exact location and size of the tumor.^[7] Later stages require more aggressive approaches and may involve combining different types of treatment. Your age, overall health, and personal preferences all play important roles in crafting the right treatment strategy.^[1]

Medical societies and cancer centers have developed standard treatments based on years of research and clinical experience. At the same time, researchers continue testing new therapies in clinical trials—carefully designed studies that evaluate promising treatments before they become widely available. Many patients with laryngeal cancer may have the option to participate in these trials, which can provide access to cutting-edge approaches.^[7]

Standard Treatment Methods for Laryngeal Cancer

Surgery for Removing the Cancer

Surgery is often the first treatment considered, particularly when laryngeal cancer is caught early. The main goal is to remove all cancer tissue while preserving as much larynx function as possible—an approach called laryngeal preservation.^[10]

For very small tumors, surgeons may use transoral surgery, which means operating through the mouth without making any cuts on the outside of the neck. This approach often involves lasers to precisely remove cancerous tissue. It’s less invasive and typically leads to faster recovery.^[13]

When cancer is more extensive or located in difficult-to-reach areas, doctors may recommend open surgery, which involves making an incision in the neck. There are several types of open procedures. A partial laryngectomy removes only part of the larynx, while a total laryngectomy removes the entire voice box. When the whole larynx is removed, patients will need a stoma—a permanent opening in the front of the neck for breathing.^[8]

Surgeons may also need to remove lymph nodes from the neck if cancer has spread there. The supraglottic area, in particular, has rich lymphatic drainage, which means cancer starting in the upper larynx often spreads to neck lymph nodes. About 25% to 50% of patients with supraglottic cancer have lymph node involvement when first diagnosed.^[7]

Recovery from laryngeal surgery can be lengthy and requires significant support. Patients who have their larynx removed will work with speech therapists to learn new ways to communicate, whether through devices, special techniques, or other methods. The adjustment period can be challenging, but specialized teams provide guidance throughout the process.^[8]

Radiation Therapy

Radiotherapy uses high-energy rays to kill cancer cells. It’s a common treatment for laryngeal cancer and can be used in several ways. For early-stage disease, radiation alone may effectively eliminate the cancer while preserving the larynx and its functions. This approach often appeals to patients who want to avoid surgery and maintain their natural voice.^[8]

Radiation is typically delivered over several weeks in small daily doses. The treatment itself is painless, though it can cause side effects over time. Common problems include sore throat, difficulty swallowing, changes in taste, dry mouth, and skin irritation in the treated area. These effects usually improve after treatment ends, though some may persist.^[10]

For more advanced cancers, radiation is often combined with chemotherapy—a combination called chemoradiotherapy. Using both treatments together can be more effective than either alone, though it also tends to cause more side effects. This combined approach has become a standard option for patients with advanced disease who want to preserve their larynx.^[8]

Sometimes radiation is given after surgery to kill any remaining cancer cells and reduce the risk of the disease coming back. This is called adjuvant radiotherapy. For patients whose cancer cannot be cured, radiation can still help control symptoms and improve quality of life.^[8]

Chemotherapy

Chemotherapy refers to drugs that kill cancer cells or stop them from growing. These medications travel throughout the body via the bloodstream, which makes them useful when cancer has spread beyond the larynx or when doctors want to treat areas that might harbor hidden cancer cells.^[10]

In laryngeal cancer treatment, chemotherapy is rarely used alone. More commonly, it’s combined with radiation (chemoradiotherapy) for advanced cancers. The chemotherapy drugs make cancer cells more sensitive to radiation, improving treatment effectiveness. Common chemotherapy drugs used for laryngeal cancer include cisplatin and carboplatin, though other medications may also be chosen based on individual circumstances.^[10]

Another use of chemotherapy is before surgery or radiation, which is called neoadjuvant chemotherapy. The goal is to shrink the tumor, making it easier to remove or treat with radiation. This approach can sometimes convert an inoperable tumor into one that can be surgically removed.^[8]

Chemotherapy causes various side effects because it affects not just cancer cells but also healthy cells that divide rapidly, such as those in the digestive system, hair follicles, and blood-producing bone marrow. Patients may experience nausea, vomiting, hair loss, fatigue, increased infection risk, and mouth sores. Managing these side effects is an important part of cancer care, and doctors have many medications and strategies to help.^[10]

For patients whose cancer has spread to distant parts of the body (metastatic cancer) or has returned after initial treatment, chemotherapy may help control the disease and relieve symptoms, even if cure isn’t possible. The focus shifts to maintaining quality of life while slowing cancer progression.^[8]

Targeted Therapy and Immunotherapy

Targeted medicines are newer drugs designed to attack specific features of cancer cells while causing less damage to normal cells than traditional chemotherapy. One commonly used targeted therapy for laryngeal cancer is cetuximab, which blocks a protein called EGFR (epidermal growth factor receptor) found on the surface of many cancer cells. Blocking EGFR can slow or stop cancer growth.^[8]

Cetuximab may be combined with radiation therapy or chemotherapy for advanced disease. It can also be used when cancer has spread to other parts of the body or cannot be cured. Side effects of cetuximab differ from standard chemotherapy and commonly include skin rash, diarrhea, and allergic reactions.^[8]

Immunotherapy drugs help the body’s own immune system recognize and attack cancer cells. Some cancer cells have ways of hiding from the immune system or turning off immune responses. Immunotherapy drugs called checkpoint inhibitors can remove these brakes, allowing immune cells to attack the tumor.^[10]

For laryngeal cancer, the immunotherapy drug nivolumab has been approved for certain situations, particularly for recurrent squamous cell carcinoma of the head and neck that has not responded to platinum-based chemotherapy. Nivolumab blocks a checkpoint protein called PD-1, reactivating the immune response against cancer.^[10]

Immunotherapy drugs cause different side effects than chemotherapy because they work by stimulating the immune system. This can sometimes lead to the immune system attacking normal body tissues, causing problems like inflammation of the lungs, intestines, liver, or hormone-producing glands. Most of these effects are manageable, but they require careful monitoring.^[10]

Treatment Approaches Being Tested in Clinical Trials

While standard treatments work well for many patients, researchers continually seek better options—treatments that are more effective, have fewer side effects, or work for cancers that resist current therapies. This is where clinical trials come in. These carefully monitored studies test new drugs, new combinations of existing treatments, or new ways of delivering therapy.^[7]

Understanding Clinical Trial Phases

Clinical trials happen in stages, each with a specific purpose. Phase I trials test whether a new treatment is safe and determine the best dose. They involve small numbers of patients and focus primarily on safety rather than effectiveness. Phase II trials enroll more patients and evaluate whether the treatment actually works against the cancer while continuing to monitor safety. Phase III trials are large studies comparing the new treatment directly against current standard treatments to determine if the new approach is better.^[7]

Patients in clinical trials receive very close monitoring and often have access to treatments years before they become widely available. However, trials also involve uncertainties—the new treatment might not work as hoped, or it might cause unexpected side effects. Participation is always voluntary, and patients can withdraw at any time.^[7]

New Immunotherapy Approaches

Beyond the already-approved immunotherapy drugs, researchers are testing additional checkpoint inhibitors and combinations of immunotherapy drugs for laryngeal cancer. The goal is to find ways to make the immune system even more effective at fighting cancer cells.^[10]

Some trials investigate combining immunotherapy with chemotherapy or radiation. The idea is that chemotherapy or radiation might make cancer cells more visible to the immune system, enhancing the immunotherapy’s effectiveness. Early results from some of these combination studies have shown promise in various head and neck cancers, including laryngeal cancer.^[10]

Researchers are also studying biomarkers—biological indicators that help predict which patients are most likely to benefit from immunotherapy. For example, tumors with high levels of PD-L1 protein or those with certain genetic characteristics might respond better to checkpoint inhibitors. Understanding these factors could help doctors personalize treatment choices.^[10]

Novel Targeted Therapies

Scientists continue searching for new molecular targets in laryngeal cancer cells. Beyond EGFR, researchers are investigating drugs that block other growth signals, interfere with blood vessel formation that tumors need, or exploit specific genetic vulnerabilities in cancer cells.^[10]

Some experimental drugs target the PI3K/AKT/mTOR pathway, a cellular signaling system that controls cell growth and survival. When this pathway becomes overactive, it can drive cancer growth. Drugs that block different points in this pathway are being tested in combination with standard treatments.^[10]

Other trials explore drugs that target angiogenesis—the formation of new blood vessels that tumors create to supply themselves with nutrients. By cutting off this blood supply, these drugs aim to starve the tumor. While this approach has shown benefit in some other cancers, researchers are still determining its role in laryngeal cancer treatment.^[10]

Advanced Radiation Techniques

Radiation therapy technology continues to advance, and clinical trials test whether newer, more precise delivery methods can improve outcomes while reducing side effects. Intensity-modulated radiation therapy (IMRT) uses computer planning to shape radiation beams very precisely to the tumor while minimizing exposure to surrounding healthy tissues like the salivary glands, which helps reduce dry mouth and other complications.^[7]

Even more advanced is proton beam therapy, which uses protons instead of traditional x-rays. Protons deposit most of their energy directly at the tumor site with less radiation passing through to healthy tissues beyond. Some trials are comparing proton therapy to standard radiation for laryngeal cancer to see if it offers advantages.^[7]

Combining Treatments in New Ways

Many current clinical trials don’t test entirely new drugs but instead investigate new combinations or sequences of existing treatments. For example, some studies examine whether giving immunotherapy before surgery (neoadjuvant immunotherapy) can shrink tumors and activate the immune system, potentially improving long-term outcomes.^[10]

Other trials look at “de-intensification” strategies for certain patients with excellent prognosis. The question is whether some people might be treated with lower doses of radiation or less intensive chemotherapy while still achieving cure, thereby reducing long-term complications. This approach is particularly relevant for younger patients and those whose tumors are associated with HPV infection, which tend to respond very well to treatment.^[7]

Personalized Medicine and Genetic Testing

As scientists learn more about the genetic changes that drive laryngeal cancer, treatment is becoming more personalized. Some clinical trials use molecular profiling—detailed analysis of the genetic and protein characteristics of each patient’s tumor—to select the most appropriate targeted therapy.^[10]

Certain genetic mutations or alterations might make tumors vulnerable to specific drugs. For instance, tumors with mutations in genes involved in DNA repair might respond better to certain chemotherapy drugs. Trials testing this “precision medicine” approach aim to match each patient with treatments most likely to work based on their tumor’s unique biology.^[10]

Finding and Joining Clinical Trials

Patients interested in clinical trials can search for studies through several resources. The U.S. National Cancer Institute maintains a comprehensive database of trials at cancer.gov. Major cancer centers like Dana-Farber, Memorial Sloan Kettering, and MD Anderson also list their open studies. In Europe, similar registries exist for trials conducted in various countries.^[2]

Discussing clinical trials with your oncology team is important. They can explain which trials might be suitable based on your specific cancer characteristics, previous treatments, and health status. They can also help weigh the potential benefits against the uncertainties and additional monitoring requirements that trials involve.^[7]

Most Common Treatment Methods

• Surgery
  • Transoral surgery using lasers for small tumors accessed through the mouth
  • Partial laryngectomy removing only part of the larynx
  • Total laryngectomy removing the entire voice box
  • Lymph node removal from the neck when cancer has spread
  • Creation of a stoma for breathing when larynx is removed
• Radiation Therapy
  • External beam radiation delivered daily over several weeks
  • Used alone for early-stage disease to preserve the larynx
  • Combined with chemotherapy for advanced cancers
  • Given after surgery to reduce recurrence risk
  • Palliative radiation to control symptoms in advanced disease
• Chemotherapy
  • Cisplatin and carboplatin as common drug choices
  • Combined with radiation (chemoradiotherapy) for advanced stages
  • Given before surgery to shrink tumors (neoadjuvant)
  • Used after surgery to eliminate remaining cancer cells (adjuvant)
  • Administered for metastatic or recurrent disease
• Targeted Therapy
  • Cetuximab blocking EGFR protein on cancer cells
  • Combined with radiation or chemotherapy
  • Used when cancer has spread or cannot be cured
  • Different side effect profile than traditional chemotherapy
• Immunotherapy
  • Nivolumab for recurrent squamous cell carcinoma
  • Checkpoint inhibitors removing immune system brakes
  • Used after chemotherapy has stopped working
  • Being tested in combination with other treatments in clinical trials