Childhood Laryngeal Tumors Treatment (PDQ®): Treatment - Patient Information [NCI]

General Information About Childhood Laryngeal Cancer and Papillomatosis

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

The larynx is a part of the throat, between the base of the tongue and the trachea (windpipe). 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. The larynx is also called the voice box.

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.

Anatomy of the larynx. The larynx is a part of the throat, between the base of the tongue and the trachea. The three main parts of the larynx are the supraglottis (including the epiglottis), the glottis (including the vocal cords), and the subglottis.

Squamous cell carcinoma is the most common type of laryngeal cancer in adults, but it is rare in children.

Congenital subglottic hemangioma is the most common benign (not cancer) tumor of the larynx. For more information, see the Congenital Hemangioma section of Childhood Vascular Tumors.

Papillomatosis of the larynx is a condition in which papillomas have formed in the tissue that lines the larynx.

Papillomatosis of the larynx is a condition in which papillomas (benign tumors that look like warts) have formed in the tissue that lines the larynx. Papillomatosis may be caused by the human papillomavirus (HPV). Papillomas in the larynx may block the airway and cause trouble breathing. These growths often recur (come back) after treatment and may become cancer of the larynx.

Signs and symptoms of laryngeal cancer or papillomatosis include a change in the child's voice.

These and other signs and symptoms may be caused by laryngeal cancer, papillomatosis, or by other conditions.

Check with your child's doctor if your child has any of the following:

• Hoarseness or a change in the voice.
• Trouble or pain when swallowing.
• Trouble breathing.
• A high-pitched sound with breathing.
• A lump in the neck or throat.
• A sore throat.
• A cough that does not go away.
• Infants and young children with these tumors may grow slowly, and not eat well or meet developmental milestones such as sitting, walking, and talking in sentences.

Tests that examine the throat are used to diagnose laryngeal cancer.

In addition to asking about your child's personal and family history and doing a physical exam, your child's doctor may perform the following tests and procedures.

• Oral exam: An exam to check the oral cavity and throat to look for signs of cancer. The medical doctor may examine the oral cavity with a small long-handled mirror and lights or a fiberoptic device.
• Neck and chest x-ray: An x-ray of the neck and chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas of the body, such as the head and neck. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the larynx and neck, 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.
  
  Computed tomography (CT) scan of the head and neck. The child lies on a table that slides through the CT scanner, which takes a series of detailed x-ray pictures of the inside of the head and neck.
• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.
  
  Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.
• 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.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The sample of tissue may be removed during one of the following procedures:
  • Laryngoscopy: A procedure in which the doctor checks the larynx (voice box) with a mirror or a laryngoscope to check for abnormal areas. A laryngoscope is a thin, tube-like instrument with a light and a lens for viewing the inside of the throat and voice box. It may also have a tool to remove tissue samples, which are checked under a microscope for signs of cancer.
  • Endoscopy: A procedure to look at organs and tissues inside the body, such as the throat, esophagus, and trachea to check for abnormal areas. An endoscope (a thin, lighted tube with a light and a lens for viewing) is inserted through an opening in the body, such as the mouth. A special tool on the endoscope may be used to remove samples of tissue.

The following tests may be done on the tissue that was removed:

• Human papillomavirus (HPV) test: A laboratory test used to check DNA or RNA for certain types of HPV infection. Cells are collected from the mass in the larynx and DNA or RNA from the cells is checked to find out if an infection is caused by a type of HPV that is linked to laryngeal papillomatosis.
• Immunohistochemistry: A laboratory test that uses antibodies to check for certain antigens (markers) in a sample of a patient's tissue. The antibodies are usually linked to an enzyme or a fluorescent dye. After the antibodies bind to a specific antigen in the tissue sample, the enzyme or dye is activated, and the antigen can then be seen under a microscope. This type of test is used to help diagnose cancer and to help tell one type of cancer from another type of cancer.

A biopsy is done to diagnose laryngeal papillomatosis.

Stages of Childhood Laryngeal Cancer

There is no standard staging system for childhood laryngeal cancer.

The process used to find out if cancer has spread from the larynx to nearby areas or to other parts of the body is called staging. There is no standard staging system for childhood laryngeal cancer. The results of the tests and procedures done to diagnose laryngeal cancer are used to help make decisions about treatment.

Sometimes childhood laryngeal cancer recurs (comes back) after treatment.

Treatment Option Overview

There are different types of treatment for children 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.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children with laryngeal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:

• Pediatrician.
• Pediatric surgeon.
• Radiation oncologist.
• Pathologist.
• Pediatric ear, nose, and throat specialist.
• Social worker.
• Rehabilitation specialist.
• Psychologist.
• Child-life specialist.

Four types of standard treatment are used:

Laser surgery

Laser surgery uses a laser beam (a narrow beam of intense light) to turn the cancer cells into a gas that evaporates (dissolves into the air). Laser surgery is used to treat laryngeal cancer and papillomatosis. Sometimes pulmonary function tests are done to see if a person is healthy enough for surgery.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer.

Radiation therapy may be given if the tumor is likely to spread. It is used to treat laryngeal cancer.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

The following types of immunotherapy are used to treat laryngeal papillomatosis:

• Interferon: Interferon affects the division of cancer cells and can slow tumor growth.
• Vaccine therapy: A cancer treatment that uses a substance or group of substances to stimulate the immune system to find the tumor and kill it.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Monoclonal antibodies are a type of targeted therapy.

• Monoclonal antibodies: Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Bevacizumab is a type of monoclonal antibody used to treat laryngeal papillomatosis.

Targeted therapy is being studied for the treatment of childhood laryngeal cancer that has recurred (come back).

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI website.

Treatment for childhood laryngeal cancer may cause side effects.

To learn more about side effects that begin during treatment for cancer, visit Side Effects.

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. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

As your child goes through treatment, they will have follow-up tests or check-ups. Some of the tests that were done to diagnose the cancer may be repeated 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.

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 child's condition has changed or if the cancer has recurred (come back).

Treatment of Childhood Laryngeal Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of newly diagnosed laryngeal cancer in children may include the following:

• Laser surgery and radiation therapy for squamous cell cancer.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Recurrent Childhood Laryngeal Cancer

For information about the treatment listed below, see the Treatment Option Overview section.

Treatment of recurrent laryngeal cancer in children may include the following:

• A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Childhood Laryngeal Papillomatosis

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of newly diagnosed laryngeal papillomatosis in children may include the following:

• Laser surgery for papillomatosis and other benign tumors.

For papillomas that recur (come back) after being removed by laser surgery four times in one year, treatment may include:

• Immunotherapy, such as interferon or vaccine therapy.
• Laser surgery combined with targeted therapy using bevacizumab.

To Learn More About Childhood Laryngeal Cancer

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

• Head and Neck Cancer Home Page
• Lasers to Treat Cancer
• Immunotherapy to Treat Cancer
• Computed Tomography (CT) Scans and Cancer
• Targeted Therapy to Treat Cancer

For more childhood cancer information and other general cancer resources, visit:

• About Cancer
• Childhood Cancers
• CureSearch for Children's Cancer
• Late Effects of Treatment for Childhood Cancer
• Adolescents and Young Adults with Cancer
• Children with Cancer: A Guide for Parents
• Cancer in Children and Adolescents
• Staging
• Coping with Cancer
• Questions to Ask Your Doctor about Cancer
• For Survivors and Caregivers

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. 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 come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

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Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of childhood laryngeal cancer and papillomatosis. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

Clinical Trial Information

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.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

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PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Laryngeal Tumors Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/head-and-neck/patient/child/laryngeal-treatment-pdq. Accessed <MM/DD/YYYY>.

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Last Revised: 2022-08-24

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