Childhood Laryngeal Tumors Treatment (PDQ®)–Patient Version - National Cancer Institute

Childhood Laryngeal Tumors Treatment (PDQ®)–Patient Version

General Information About Childhood Laryngeal Cancer and Papillomatosis

KEY POINTS

Laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of the larynx.
Papillomatosis of the larynx is a condition in which papillomas have formed in the tissue that lines the larynx.
Signs and symptoms of laryngeal cancer or papillomatosis include a change in the child’s voice.
Tests that examine the throat are used to diagnose laryngeal cancer.

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.

Drawing shows areas where laryngeal cancer may form or spread, including the supraglottis, glottis (vocal cords), subglottis, thyroid, trachea, and esophagus. Also shown are the epiglottis, the upper part of the spinal column, the carotid artery, the cartilage around the thyroid and trachea, lymph nodes in the neck, and the chest. — Laryngeal cancer forms in the tissues of the larynx (area of the throat that contains the vocal cords). The larynx includes the supraglottis, glottis (vocal cords), and subglottis. The cancer may spread to nearby tissues or to the thyroid, trachea, or esophagus. It may also spread to the lymph nodes in the neck, the carotid artery, the upper part of the spinal column, the chest, and to other parts of the body (not shown).

Rhabdomyosarcoma (a malignant tumor of muscle) is the most common type of laryngeal cancer in children. 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. (See the Congenital Hemangioma section of the PDQ summary on Childhood Vascular Tumors for more information.)

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 lump in the neck or throat.
A sore throat.
A cough that does not go away.
Earache.

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

The following tests and procedures may be used:

Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
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 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.
ENLARGE
Computed tomography (CT) scan of the head and neck. The child lies on a table that slides through the CT scanner, which takes x-ray pictures of the inside of the head and neck.
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. The picture can be printed to be looked at later.
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.

A biopsy is done to diagnose laryngeal papillomatosis.

Stages of 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 system for staging childhood laryngeal cancer. The results of the tests and procedures done to diagnose laryngeal cancer are used to help make decisions about treatment.

Treatment Option Overview

KEY POINTS

There are different types of treatment for children with laryngeal cancer.
Children with laryngeal cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.
Five types of standard treatment are used:
- Laser surgery
- Radiation therapy
- Chemotherapy
- Immunotherapy
- Targeted therapy
New types of treatment are being tested in clinical trials.
Treatment for childhood laryngeal cancer may cause side effects.
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 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.

Five 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.

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.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them 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).

Chemotherapy 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. This type of cancer treatment is also called biotherapy or biologic therapy.

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.
Immune checkpoint inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a tumor cell, it stops the T cell from killing the tumor cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill tumor cells. Pembrolizumab is an immune checkpoint inhibitor being studied in the treatment of laryngeal papillomatosis that has recurred (come back).

Immune checkpoint inhibitor; the panel on the left shows the binding of proteins PD-L1 (on the tumor cell) to PD-1 (on the T cell), which keeps T cells from killing tumor cells in the body. Also shown are a tumor cell antigen and T cell receptor. The panel on the right shows immune checkpoint inhibitors (anti-PD-L1 and anti-PD-1) blocking the binding of PD-L1 to PD-1, which allows the T cells to kill tumor cells. — Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).

Immunotherapy uses the body’s immune system to fight cancer. This animation explains one type of immunotherapy that uses immune checkpoint inhibitors to treat cancer.

Targeted therapy

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

Monoclonal antibodies: This targeted therapy uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and 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 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.

For information about side effects that begin during treatment for cancer, see our Side Effects page.

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.

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.

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). These tests are sometimes called follow-up tests or check-ups.

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:

Chemotherapy and radiation therapy for rhabdomyosarcomas.
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 treatments listed below, see the Treatment Option Overview section.

Recurrent laryngeal cancer is cancer that has come back after it has been treated. 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.

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.
A clinical trial of immunotherapy (immune checkpoint inhibitor therapy using pembrolizumab).

To Learn More About Childhood Laryngeal Cancer

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

For more childhood cancer information and other general cancer resources, see the following:

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.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

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).

Permission to Use This Summary

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The best way to cite this PDQ summary is:

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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