General Information About Laryngeal Cancer
Stages of Laryngeal Cancer
Recurrent Laryngeal Cancer
Treatment Option Overview
Treatment Options by Stage

Stage I Laryngeal Cancer Stage II Laryngeal Cancer Stage III Laryngeal Cancer Stage IV Laryngeal Cancer

Treatment Options for Recurrent Laryngeal Cancer
To Learn More About Laryngeal Cancer
Get More Information From NCI
Changes to This Summary (05/06/2008)
About PDQ

General Information About Laryngeal Cancer

Key Points for This Section

Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx. Use of tobacco products and drinking too much alcohol can affect the risk of developing laryngeal cancer. Possible signs of laryngeal cancer include a sore throat and ear pain. Tests that examine the throat and neck are used to help detect (find), diagnose, and stage laryngeal cancer. Certain factors affect prognosis (chance of recovery) and treatment options.

Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx.

The larynx (voice box) is located just below the pharynx (throat) in the neck. The larynx contains the vocal cords, which vibrate and make sound when air is directed against them. The sound echoes through the pharynx, mouth, and nose to make a person's voice.

Most laryngeal cancers form in squamous cells, the thin, flat cells lining the inside of the larynx.

There are three main parts of the larynx:

• Supraglottis: The upper part of the larynx above the vocal cords, including the epiglottis.
• Glottis: The middle part of the larynx where the vocal cords are located.
• Subglottis: The lower part of the larynx between the vocal cords and the trachea (windpipe).

Use of tobacco products and drinking too much alcohol can affect the risk of developing laryngeal cancer.

Possible signs of laryngeal cancer include a sore throat and ear pain.

These and other symptoms may be caused by laryngeal cancer or by other conditions. A doctor should be consulted if any of the following problems occur:

• A sore throat or cough that does not go away.
• Trouble or pain when swallowing.
• Ear pain.
• A lump in the neck or throat.
• A change or hoarseness in the voice.

Tests that examine the throat and neck are used to help detect (find), diagnose, and stage laryngeal cancer.

The following tests and procedures may be used:

• Physical exam of the throat and neck: An examination in which the doctor feels for swollen lymph nodes in the neck and looks down the throat with a small, long-handled mirror to check for abnormal areas.
• Laryngoscopy: A procedure in which the doctor examines the larynx (voice box) with a mirror or with a laryngoscope (a thin, lighted tube).
• Endoscopy: A procedure to look at organs and tissues inside the body to check for abnormal areas. An endoscope (a thin, lighted tube) is inserted through an incision (cut) in the skin or opening in the body, such as the mouth. Tissue samples and lymph nodes may be taken for biopsy.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.
• Barium swallow: A series of x-rays of the esophagus and stomach. The patient drinks a liquid that contains barium (a silver-white metallic compound). The liquid coats the esophagus and stomach, and x-rays are taken. This procedure is also called an upper GI series.

Certain factors affect prognosis (chance of recovery) and treatment options.

Prognosis (chance of recovery) depends on the following:

• The stage of the disease.
• The location and size of the tumor.
• The grade of the tumor.
• The patient's age, gender, and general health, including whether the patient is anemic.

Treatment options depend on the following:

• The stage of the disease.
• The location and size of the tumor.
• Keeping the patient's ability to talk, eat, and breathe as normal as possible.
• Whether the cancer has come back (recurred).

Smoking tobacco and drinking alcohol decrease the effectiveness of treatment for laryngeal cancer. Patients with laryngeal cancer who continue to smoke and drink are less likely to be cured and more likely to develop a second tumor. After treatment for laryngeal cancer, frequent and careful follow-up is important.

Stages of Laryngeal Cancer

Key Points for This Section

After laryngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the larynx or to other parts of the body. There are three ways that cancer spreads in the body. The following stages are used for laryngeal cancer: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV

After laryngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the larynx or to other parts of the body.

The process used to find out if cancer has spread within the larynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests ¹ used to diagnose laryngeal cancer are often also used to stage the disease.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for laryngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the larynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I laryngeal cancer depends on where cancer is found in the larynx:

• Supraglottis: Cancer is in one area of the supraglottis only and the vocal cords can move normally.
• Glottis: Cancer is in one or both vocal cords and the vocal cords can move normally.
• Subglottis: Cancer is in the subglottis only.

Stage II

In stage II, cancer is in the larynx only. Stage II laryngeal cancer depends on where cancer is found in the larynx:

• Supraglottis: Cancer is in more than one area of the supraglottis or surrounding tissues.
• Glottis: Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords do not move normally.
• Subglottis: Cancer has spread to one or both vocal cords, which may not move normally.

Enlarge

Pea, peanut, walnut, and lime show tumor sizes.

Stage III

Stage III laryngeal cancer depends on whether cancer has spread from the supraglottis, glottis, or subglottis.

In stage III cancer of the supraglottis:

• cancer is in the larynx only and the vocal cords do not move normally, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
• cancer is in one area of the supraglottis only and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and the vocal cords can move normally; or
• cancer is in more than one area of the supraglottis or surrounding tissues and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and/or the vocal cords do not move normally.

In stage III cancer of the glottis:

• cancer is in the larynx only and the vocal cords do not move normally, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
• cancer is in one or both vocal cords and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and the vocal cords can move normally; or
• cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords do not move normally. The cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters.

In stage III cancer of the subglottis:

• cancer is in the larynx only and the vocal cords do not move normally; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
• cancer is in the subglottis only and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or
• cancer has spread to one or both vocal cords, which may not move normally, and to one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters.

Stage IV

Stage IV is divided into stage IVA, stage IVB, and stage IVC. Each substage is the same for cancer in the supraglottis, glottis, or subglottis.

• In stage IVA:
  • cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus, and may have spread to one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or
  • cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Vocal cords may not move normally.
• In stage IVB:
  • cancer has spread to the space in front of the spinal column and surrounds the carotid artery, or has spread to parts of the chest and may have spread to one or more lymph nodes anywhere in the neck (the lymph nodes may be any size); or
  • cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery or to parts of the chest. Vocal cords may not move normally.
• In stage IVC, cancer has spread beyond the larynx to other parts of the body.

Recurrent Laryngeal Cancer

Recurrent laryngeal cancer is cancer that has recurred (come back) after it has been treated. The cancer is most likely to come back in the first 2 to 3 years. It may come back in the larynx or in other parts of the body.

Treatment Option Overview

Key Points for This Section

There are different types of treatment for patients with laryngeal cancer. Three types of standard treatment are used: Radiation therapy Surgery Chemotherapy New types of treatment are being tested in clinical trials. Chemoprevention Radiosensitizers Patients may want to think about taking part in a clinical trial. Patients can enter clinical trials before, during, or after starting their cancer treatment. Follow-up tests may be needed.

There are different types of treatment for patients with laryngeal cancer.

Different types of treatment are available for patients with laryngeal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types of standard treatment are used:

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Radiation therapy may work better in patients who have stopped smoking before beginning treatment. External radiation therapy to the thyroid or the pituitary gland may change the way the thyroid gland works. The doctor may test the thyroid gland before and after therapy to make sure it is working properly.

Surgery

Surgery (removing the cancer in an operation) is a common treatment for all stages of laryngeal cancer. The following surgical procedures may be used:

• Cordectomy: Surgery to remove the vocal cords only.
• Supraglottic laryngectomy: Surgery to remove the supraglottis only.
• Hemilaryngectomy: Surgery to remove half of the larynx (voice box). A hemilaryngectomy saves the voice.
• Partial laryngectomy: Surgery to remove part of the larynx (voice box). A partial laryngectomy helps keep the patient's ability to talk.
• Total laryngectomy: Surgery to remove the whole larynx. During this operation, a hole is made in the front of the neck to allow the patient to breathe. This is called a tracheostomy.
• Thyroidectomy: The removal of all or part of the thyroid gland.
• Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site ².

Chemoprevention

Chemoprevention is the use of drugs, vitamins, or other substances to reduce the risk of developing cancer or to reduce the risk cancer will recur (come back). The drug isotretinoin is being studied to prevent the development of a second cancer in patients who have had cancer of the head or neck.

Radiosensitizers

Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment Options by Stage

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Treatment of stage I laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis, treatment may include the following:

• Radiation therapy.
• Supraglottic laryngectomy.

If cancer is in the glottis, treatment may include the following:

• Radiation therapy.
• Cordectomy.
• Partial laryngectomy, hemilaryngectomy, or total laryngectomy.
• Laser surgery.

If cancer is in the subglottis, treatment may include the following:

• Radiation therapy with or without surgery.
• Surgery alone.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I laryngeal cancer ³. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ⁴.

Treatment of stage II laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis, treatment may include the following:

• Radiation therapy.
• Supraglottic laryngectomy or total laryngectomy with or without radiation therapy.
• A clinical trial of radiation therapy.
• A clinical trial of chemoprevention.

If cancer is in the glottis, treatment may include the following:

• Radiation therapy.
• Partial laryngectomy, hemilaryngectomy, or total laryngectomy.
• Laser surgery.
• A clinical trial of radiation therapy.
• A clinical trial of chemoprevention.

If cancer is in the subglottis, treatment may include the following:

• Radiation therapy with or without surgery.
• Surgery alone.
• A clinical trial of radiation therapy.
• A clinical trial of chemoprevention.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II laryngeal cancer ⁵. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ⁴.

Treatment of stage III laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis or glottis, treatment may include the following:

• Surgery with or without radiation therapy.
• Radiation therapy with or without surgery.
• A clinical trial of radiation therapy.
• A clinical trial of chemotherapy combined with radiation therapy, with or without laryngectomy.
• A clinical trial of radiosensitizers.
• A clinical trial of chemoprevention.

If cancer is in the subglottis, treatment may include the following:

• Laryngectomy plus total thyroidectomy and removal of lymph nodes in the throat, usually followed by radiation therapy.
• Radiation therapy with or without surgery.
• A clinical trial of radiation therapy.
• A clinical trial of chemotherapy.
• A clinical trial of radiosensitizers.
• A clinical trial of chemoprevention.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III laryngeal cancer ⁶. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ⁴.

Treatment of stage IV laryngeal cancer depends on where cancer is found in the larynx.

If cancer is in the supraglottis or glottis, treatment may include the following:

• Total laryngectomy with radiation therapy.
• Radiation therapy with or without surgery.
• A clinical trial of radiation therapy.
• A clinical trial of chemotherapy combined with radiation therapy, with or without laryngectomy.
• A clinical trial of chemotherapy.
• A clinical trial of radiosensitizers.
• A clinical trial of chemoprevention.

If cancer is in the subglottis, treatment may include the following:

• Laryngectomy plus total thyroidectomy and removal of lymph nodes in the throat, usually with radiation therapy.
• Radiation therapy.
• A clinical trial of radiation therapy.
• A clinical trial of chemotherapy combined with radiation therapy.
• A clinical trial of chemotherapy.
• A clinical trial of radiosensitizers.
• A clinical trial of chemoprevention.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV laryngeal cancer ⁷. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ⁴.

Treatment Options for Recurrent Laryngeal Cancer

Treatment of recurrent laryngeal cancer may include the following:

• Surgery with or without radiation therapy.
• Radiation therapy.
• Chemotherapy.
• A clinical trial of chemotherapy as palliative therapy to relieve symptoms caused by the cancer and improve quality of life.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent laryngeal cancer ⁸. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site ⁴.

To Learn More About Laryngeal Cancer

For more information from the National Cancer Institute about laryngeal cancer, see the following:

• Throat (Laryngeal and Pharyngeal) Cancer Home Page ⁹
• What You Need To Know About™ Cancer of the Larynx ¹⁰
• Smoking and Cancer Home Page ¹¹ (Includes help with quitting)
• Head and Neck Cancer: Questions and Answers ¹²
• Lasers in Cancer Treatment: Questions and Answers ¹³

For general cancer information and other resources from the National Cancer Institute, see the following:

• What You Need to Know About™ Cancer - An Overview ¹⁴
• Understanding Cancer Series: Cancer ¹⁵
• Staging: Questions and Answers ¹⁶
• Chemotherapy and You: Support for People With Cancer ¹⁷
• Radiation Therapy and You: Support for People With Cancer ¹⁸
• Coping with Cancer ¹⁹
• Support and Resources ²⁰
• Cancer Library ²¹
• Information For Survivors/Caregivers/Advocates ²²

Get More Information From NCI

Call 1-800-4-CANCER

For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

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The NCI's LiveHelp® ²³ online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

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For more information from the NCI, please write to this address:

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Search the NCI Web site

The NCI Web site ²⁴ provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.

There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

Find Publications

The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator ²⁵. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

Changes to This Summary (05/06/2008)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Several enhancements have been made to this summary to better explain certain medical concepts and to help readers find information about clinical trials. The following changes were made:

• Text describing the way cancer spreads in the body was added to the Stages ²⁶ section.
• Information about patients taking part in clinical trials and about follow-up tests was added to the Treatment Option Overview ²⁷ section.
• Links to ongoing clinical trials listed in NCI's PDQ Cancer Clinical Trials Registry were added to the Treatment Options ²⁸ section.
• A new section called "To Learn More ²⁹" was added. It includes links to more information about this type of cancer and about cancer in general.
• The "Get More Information from NCI" section (originally called "To Learn More") was revised.

About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site ²⁴. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Listings of clinical trials are included in PDQ and are available online at NCI's Web site ³⁰. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

Not normal. An abnormal lesion or growth may be cancerous, premalignant (likely to become cancer), or benign.

Treatment given after the primary treatment to increase the chances of a cure. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, or biological therapy.

A condition in which the number of red blood cells is below normal.

A series of x-rays of the esophagus. The x-ray pictures are taken after the person drinks a solution that contains barium. The barium coats and outlines the esophagus on the x-ray. Also called esophagram and upper GI series.

The removal of cells or tissues for examination by a pathologist. The pathologist may study the tissue under a microscope or perform other tests on the cells or tissue. There are many different types of biopsy procedures. The most common types include: (1) incisional biopsy, in which only a sample of tissue is removed; (2) excisional biopsy, in which an entire lump or suspicious area is removed; and (3) needle biopsy, in which a sample of tissue or fluid is removed with a needle. When a wide needle is used, the procedure is called a core biopsy. When a thin needle is used, the procedure is called a fine-needle aspiration biopsy.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.

A group of abnormal cells that remain in the tissue in which they first formed. These abnormal cells may become cancer and spread into nearby normal tissue.

A tough, flexible tissue that lines joints and gives structure to the nose, ears, larynx, and other parts of the body.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.

The use of drugs, vitamins, or other agents to try to reduce the risk of, or delay the development or recurrence of, cancer.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

An operation on the vocal cords or on the spinal cord.

A series of detailed pictures of areas inside the body taken from different angles. The pictures are created by a computer linked to an x-ray machine. Also called CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.

To heal or restore health; a treatment to restore health.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

A thin, tube-like instrument used to look at tissues inside the body. An endoscope has a light and a lens for viewing and may have a tool to remove tissue.

A procedure that uses an endoscope to examine the inside of the body. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. It may also have a tool to remove tissue to be checked under a microscope for signs of disease.

The flap that covers the trachea during swallowing so that food does not enter the lungs.

The muscular tube through which food passes from the throat to the stomach.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

Monitoring a person's health over time after treatment. This includes keeping track of the health of people who participate in a clinical study or clinical trial for a period of time, both during the study and after the study ends.

The middle part of the larynx; the area where the vocal cords are located.

The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer.

An operation to remove one side of the larynx (voicebox).

A cut made in the body to perform surgery.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, implant radiation therapy, and radiation brachytherapy.

Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.

A drug that is used in the treatment of acne and psoriasis and is being studied in cancer prevention. It is a type of retinoid. Also called 13-cis retinoic acid.

Cancer that forms in tissues of the larynx (area of the throat that contains the vocal cords and is used for breathing, swallowing, and talking). Most laryngeal cancers are squamous cell carcinomas (cancer that begins in flat cells lining the larynx).

An operation to remove all or part of the larynx (voice box).

A thin, tube-like instrument used to examine the larynx (voice box). A laryngoscope has a light and a lens for viewing and may have a tool to remove tissue.

Examination of the larynx (voice box) with a mirror (indirect laryngoscopy) or with a laryngoscope (direct laryngoscopy).

The area of the throat containing the vocal cords and used for breathing, swallowing, and talking. Also called voice box.

A device that concentrates light into an intense, narrow beam used to cut or destroy tissue. It is used in microsurgery, photodynamic therapy, and for a variety of diagnostic purposes.

A surgical procedure that uses the cutting power of a laser beam to make bloodless cuts in tissue or to remove a surface lesion such as a tumor.

An area of abnormal tissue. A lesion may be benign (noncancerous) or malignant (cancerous).

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.

The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).

A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.

The National Cancer Institute, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. The National Cancer Institute conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the National Cancer Institute Web site at http://www.cancer.gov. Also called NCI.

NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the Federal Government's principal agency for cancer research. It conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://www.cancer.gov. Also called National Cancer Institute.

A part of the body that performs a specific function. For example, the heart is an organ.

Treatment given to relieve the symptoms and reduce the suffering caused by cancer and other life-threatening diseases. Palliative cancer therapies are given together with other cancer treatments, from the time of diagnosis, through treatment, survivorship, recurrent or advanced disease, and at the end of life.

An operation to remove part of the larynx (voice box).

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

The hollow tube inside the neck that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). The pharynx is about 5 inches long, depending on body size. Also called throat.

An exam of the body to check for general signs of disease.

The main endocrine gland. It produces hormones that control other glands and many body functions, especially growth.

The original tumor.

The likely outcome or course of a disease; the chance of recovery or recurrence.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Giving off radiation.

A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.

A drug that makes tumor cells more sensitive to radiation therapy.

To come back or to return.

Cancer that has recurred (come back), usually after a period of time during which the cancer could not be detected. The cancer may come back to the same place as the original (primary) tumor or to another place in the body. Also called recurrence.

Treatment with anticancer drugs directed to a specific area of the body.

Refers to a new primary cancer in a person with a history of cancer.

A problem that occurs when treatment affects healthy tissues or organs. Some common side effects of cancer treatment are fatigue, pain, nausea, vomiting, decreased blood cell counts, hair loss, and mouth sores.

Flat cell that looks like a fish scale under a microscope. These cells cover inside and outside surfaces of the body. They are found in the tissues that form the surface of the skin, the lining of the hollow organs of the body (such as the bladder, kidney, and uterus), and the passages of the respiratory and digestive tracts.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Abnormal cells are found in the lining of the larynx. These abnormal cells may become cancer and spread into nearby normal tissue.

Cancer is found only in the area where it started. Stage I laryngeal cancer depends on where cancer is found in the larynx. If it started in the supraglottis, then cancer is in one area of the supraglottis only and the vocal cords can move normally. If it started in the glottis, then cancer is in one or both vocal cords and the vocal cords can move normally. If it started in the subglottis, then cancer is in the subglottis only.

Cancer that is found in the larynx. The exact definition of stage II depends on where the cancer started. If it started in the supraglottis, then cancer is in more than one area of the supraglottis or glottis or region near the supraglottis. If it started in the glottis, then cancer has spread to the supraglottis and/or the subglottis, and/or the vocal cords do not move normally. If it started in the subglottis, then cancer has spread to the vocal cords, which may not move normally.

In stage III laryngeal cancer, one of the following is found: (1) cancer is in the larynx only and the vocal cords do not move normally; cancer may have spread to tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or (2) cancer is in one area of the larynx, the vocal cords move normally, and cancer is found in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or (3) cancer is in more than one area of the larynx or in the vocal cords (which may not move normally) and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, one of the following is true: (1) cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or (2) cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Vocal cords may not move normally. In stage IVB, one of the following is true: (1) cancer has spread to the space in front of the spinal column and surrounds the carotid artery, or has spread to parts of the chest and may have spread to one or more lymph nodes anywhere in the neck (the lymph nodes may be any size); or (2) cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest. Vocal cords may not move normally. In stage IVC, cancer has spread beyond the larynx to distant parts of the body.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, one of the following is found: (1) cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or (2) cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Vocal cords may not move normally.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVB, one of the following is found: (1) cancer has spread to the space in front of the spinal column and surrounds the carotid artery, or has spread to parts of the chest and may have spread to one or more lymph nodes anywhere in the neck (the lymph nodes may be any size); or (2) cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest. Vocal cords may not move normally.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVC, cancer has spread beyond the larynx to distant parts of the body.

Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

In medicine, treatment that experts agree is appropriate, accepted, and widely used. Health care providers are obligated to provide patients with standard therapy. Also called best practice and standard of care.

An organ that is part of the digestive system. The stomach helps digest food by mixing it with digestive juices and churning it into a thin liquid.

The lowest part of the larynx; the area from just below the vocal cords down to the top of the trachea.

An operation to remove the supraglottis, which is part of the larynx (voice box) above the vocal cords.

The upper part of the larynx (voice box), including the epiglottis; the area above the vocal cords.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Treatment with anticancer drugs that travel through the blood to cells all over the body.

Treatment.

A gland located beneath the voice box (larynx) that makes thyroid hormone and calcitonin. The thyroid helps regulate growth and metabolism.

Surgery to remove part or all of the thyroid.

A group or layer of cells that work together to perform a specific function.

An operation to remove all of the larynx (voice box).

The airway that leads from the larynx (voice box) to the bronchi (large airways that lead to the lungs). Also called windpipe.

Surgery to create an opening (stoma) into the windpipe. The opening itself may also be called a tracheostomy.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

A blood vessel that carries blood to the heart from tissues and organs in the body.

A nutrient that the body needs in small amounts to function and stay healthy. Sources of vitamins are plant and animal food products and dietary supplements. Some vitamins are made in the human body from food products. Vitamins are either fat-soluble (can dissolve in fats and oils) or water-soluble (can dissolve in water). Excess fat-soluble vitamins are stored in the body’s fatty tissue, but excess water-soluble vitamins are removed in the urine. Examples are vitamin A, vitamin C, and vitamin E.

One of two small bands of muscle within the larynx that vibrates to produce the voice.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.