Duke specialists detect and treat throat cancer (pharyngeal cancer), voice box cancer (laryngeal cancer), and cancer of the tonsils. We use sophisticated surgical techniques to remove tumors, and we do everything possible to preserve your ability to speak and function normally. If you've been diagnosed with the type of human papillomavirus (HPV) that increases your risk for throat cancer, we work closely with you to tailor treatment to your specific situation. Our goal is to detect cancer early, personalize your treatment options, and increase your chances for a positive outcome.
When detected early, these types of cancer are highly curable -- often with either surgery or radiation therapy alone. More advanced cancers are generally treated with various combinations of treatment options.
MRI and CT imaging technology pinpoints the precise location of the tumor, and then beams of high-energy X-rays destroy the cancer cells. This targeted radiation treatment, used before and/or after surgery, minimizes damage to surrounding healthy tissue.
Removes the tumor and surrounding tissues. Nearby lymph nodes may also need to be removed. Every surgery is different depending on the location and size of the tumor and whether it has spread. Our surgeons use a wide range of surgical approaches, including laser surgery, which can reduce damage to surrounding structures. Our doctors also employ robotic tools, which increase precision and allow them to remove hard-to-reach tumors.
In some cases, the entire voice box, including the vocal cords, may need to be removed. This is called a total laryngectomy.
Before surgery, your doctor will discuss the nature of your surgery, including how long your hospital stay should be, whether you need any additional treatments besides surgery, and when you will likely resume drinking and eating. A speech-language pathologist will educate you about what changes to expect with breathing and swallowing. They will also review communication options in detail.
After surgery, your doctor will meet with you periodically to evaluate your healing and determine when it is safe for you to eat and drink. A speech pathologist will review your communication options, which may include:
- Speaking with a handheld artificial (electronic) larynx.
- Learning to speak with esophageal speech.
- Using tracheo-esophageal speech via a tracheo-esophageal puncture (TEP) procedure. This is the gold-standard of post-laryngectomy communication. Your ENT surgeon may perform TEP surgery at the same time as your laryngectomy, or it can be done later. The TEP surgery or “puncture” creates a small opening in the wall between your trachea and esophagus. Then a small voice prosthesis device is placed, which allows air to flow from your lungs into your esophagus. This air allows the esophagus to vibrate and make sound. You’ll only need to undergo surgery once, but the voice prosthesis must be changed by a speech pathologist every few months.
Medicines that kill cancer cells or stop them from growing are used to treat throat and voice box cancers, both before and after surgery. Our medical oncologists consider your specific type of tumor and assess the risks versus benefits before recommending chemotherapy as part of your personalized treatment plan. We routinely combine the newest chemotherapy drugs with standard drug regimens to achieve a better response, fewer side effects, and improved quality of life.
A relatively new treatment option, immunotherapy takes advantage of a person's own immune system to help kill cancer cells. There are several FDA-approved options that can be delivered via oral medications or IV infusion. Depending on each person's cancer type and stage, treatment history, and overall health, immunotherapy may be prescribed alone or in combination with another type of therapy, such as chemotherapy.
Another newer form of treatment, targeted therapy can help stop or slow the growth or spread of cancer by targeting specific aspects of your tumor's biology. Targeted therapies may be delivered in pill form or through onsite IV infusion and are often used in combination with another treatment like chemotherapy or radiation.
Duke Health offers locations throughout the Triangle. Find one near you.
Reconstruction and Rehabilitation
Because throat and voice box cancers can cause problems with speaking, breathing, and swallowing, we partner with speech, physical, and occupational therapists who can help you improve those functions. After more extensive surgeries, some patients may require an additional graft or flap reconstructive surgery to repair the area where tissue was removed. Our expert team of sub-specialized head and neck reconstructive surgeons will coordinate this complex care with your surgical team, often at the same time as your cancer surgery.
These tests assess your ability to swallow and talk as needed.
A small sample of tissue is removed and examined under a microscope to look for the presence of cancer.
CT, MRI, and PET scans may be used to locate cancer, identify its type, and determine whether it has spread. We use the latest MRI technology to ensure superior imaging and CT imaging to produce detailed images with less exposure to radiation.
A lighted tube is inserted in the mouth to help your doctor identify cancer and determine its extent, its size, and what structures are involved.
Why Choose Duke
Nationally Ranked Cancer Program
As a National Cancer Institute-designated Comprehensive Cancer Center, we are recognized for exploring new treatment opportunities through ongoing clinical trials. We offer you the latest research discoveries before they are available elsewhere. In addition, since 1973, Duke has been a member of the National Comprehensive Cancer Network (NCCN), which sets industry standards for safety and quality.
Techniques to Preserve Function
Our physicians are specially trained in surgical and medical techniques that preserve the structure of your voice box as well as your ability to speak.
A Comprehensive Team
Our specialists -- otolaryngologists who are experts in head and neck surgery; medical, surgical, and radiation oncologists; radiologists; dentists; reconstructive surgeons; and oral surgeons -- work together to ensure you receive the best possible care. Specially trained nurses, occupational therapists, voice therapists, and speech pathologists help you maintain or regain your ability to talk, eat, swallow, and perform other daily functions. Social workers, psychologists, and palliative care experts help you cope with the emotional and psychological effects often associated with cancer. Physical therapists and cancer nutritionists help you maintain your strength and stamina through exercise and good eating habits.
Our surgical specialists are expertly equipped to remove tumors in the head and neck, and use a variety of tools, including laser surgery and robotic surgery. These advanced techniques and tools increase surgical precision and remove hard-to-reach tumors in the throat and voice box. They also require smaller incisions, which shortens patient recovery time.
Where you receive your cancer care is important. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our cancer program is nationally ranked, and the highest ranked program in North Carolina, according to U.S. News & World Report for 2021–2022.