Chemotherapy for cancer of the voicebox (larynx)
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.
Chemotherapy can be used:
at the same time as radiotherapy (chemoradiation)
before radiotherapy to shrink larger tumours and make radiotherapy more effective
to help to control the cancer and relieve symptoms (palliative chemotherapy).
The chemotherapy drugs most commonly used to treat laryngeal cancer are:
Other drugs that may be used include:
How chemotherapy is given
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A nurse will give you chemotherapy by injection into a vein (intravenously). They give the drugs through a short, thin tube (cannula) that’s put into vein in your hand. Chemotherapy can also be given through a thin tube that’s put under the skin of your chest and into a vein (central line). Some people have their chemotherapy through a thin tube that’s put into a vein in your arm up into a vein in the chest (PICC line).
We have more information about central lines and PICC lines.
While having chemotherapy, you may need to stay in hospital for a few days or you may be treated as a day patient. The treatment is generally repeated every three weeks.
Chemotherapy drugs may cause unpleasant side effects.
These can usually be controlled well with medicines and will usually go away once treatment has finished. Not all drugs cause the same side effects and some people may have very few side effects. You can talk to your doctor or nurse about what to expect from the treatment that’s planned for you. The main side effects are described in this section, as well as some ways to reduce or control them.
Risk of infection
Chemotherapy can reduce your number of white blood cells, which help fight infection. If the number of white blood cells is low, you’ll be more prone to infections. A low white blood cell count is called neutropenia.
Always contact the hospital immediately on the 24-hour contact number you’ve been given and speak to a nurse or doctor if:
You develop a high temperature - this may be over 37.5˚C (99.5˚F) or over 38˚C (100.4˚F) depending on the hospital’s policy. Follow the advice that you have been given by your chemotherapy team.
You suddenly feel unwell, even with a normal temperature.
You feel shivery and shaky.
You have any symptoms of an infection such as a cold, cough, passing urine frequently (urine infection) or diarrhoea.
If necessary, you’ll be given antibiotics to treat an infection.
You’ll have a blood test before each cycle of chemotherapy to make sure your white blood cells have recovered. Occasionally, your treatment may need to be delayed if your number of white blood cells is still low.
Anaemia (reduced number of red blood cells)
Chemotherapy may reduce the number of red bloods cells (haemoglobin) in your blood. A low level of red blood cells is known as anaemia, which can make you feel very tired and lethargic. You may also become breathless.
Anaemia can be treated with blood transfusions. This should help you feel more energetic and ease the breathlessness.
Bruising and bleeding
Chemotherapy can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. If you develop any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin, contact your doctor or the hospital straight away.
Some chemotherapy drugs can make you feel sick (nauseated) or possibly be sick (vomit). Your cancer specialist will prescribe anti-sickness (anti-emetic) drugs to prevent this. Let your doctor or nurse know if your anti-sickness drugs are not helping, as there are several different types you can take.
You’re likely to become tired and have to take things more slowly.
Try to pace yourself and save your energy for things that you want to do or that need doing. Balance rest with some physical activity – even going for short walks will help increase your energy levels.
Your mouth may become sore and you may get ulcers. Look after your mouth by gently cleaning your teeth and/or dentures morning and night and after meals. Use a soft bristled or children’s toothbrush and make sure you drink plenty of fluids.
Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given. Tell your nurse or doctor if you have any problems. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Loss of appetite
Some people find that they lose their appetite during chemotherapy. Your doctor can arrange for you to see a dietitian who will give you advice and may prescribe high-calorie drinks for you to drink until your appetite comes back.
Some chemotherapy drugs may cause hair loss. Some people may have complete hair loss including eyelashes and eyebrows. Others may only experience partial hair loss or thinning. Whether or not you lose your hair depends on what chemotherapy drugs you’re having (your doctor or nurse can tell you more about what to expect).
If you do experience hair loss, your hair should start to grow back within about 3-6 months after treatment. It may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss and how to look after your scalp.
Numbness or tingling in the hands or feet
This is due to the effect cisplatin or docetaxel has on the nerves, and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms. This problem usually improves slowly over a few months after the treatment is over. Sometimes these effects are permanent.
Some chemotherapy drugs can cause diarrhoea. This often starts several days after treatment. If you’re taking chemotherapy tablets or capsules at home, it’s important to let your doctor or nurse know if you have diarrhoea, as your treatment may need to be interrupted. Medicine can be prescribed to help. It’s important to drink plenty of fluids if you have diarrhoea.
Sore hands and feet
5FU may cause redness or soreness of the palms of the hands or soles of the feet. This is known as palmar plantar erythema. It’s usually temporary and improves when the treatment is finished.
Using unperfumed moisturising creams can often help with the symptoms. It can also help to keep your hands and feet cool and to avoid tight-fitting clothing such as socks, shoes and gloves. Your doctor may prescribe creams if needed.
Certain chemotherapy drugs, such as cisplatin, may make radiotherapy work better. Chemotherapy given at the same time as radiotherapy is called chemoradiation. It can be given instead of surgery or after surgery to reduce the risk of the cancer coming back.
However, giving the two treatments at the same time also increases the immediate side effects and risk of late effects.