Early Laryngeal Cancer Treatment: What to Expect Over Time
Early-stage (stage I or II) cancer of the larynx (voice box) has one of the best outlooks of any head and neck cancer: most people are cured and keep their natural voice box. Laser surgery through the mouth and radiation give similar cure rates, so the choice often turns on the tumor's location, voice, convenience and the person's priorities.
About these pages
This page covers the steps that every treatment track shares for early laryngeal cancer: squamous cell carcinoma of the larynx that is still small (stage T1 or T2) and has not spread to the lymph nodes in the neck (see throat tumors, squamous cell carcinoma of the mouth and throat and larynx tumors). It explains how a track is chosen and links to a separate timeline page for each of three tracks. Every timeline uses the same time scale, starting at the biopsy that confirms the cancer, so the tracks can be compared side by side.
Larger or more advanced laryngeal cancers (stage III and IV) follow a different set of tracks, covered on the advanced laryngeal cancer timelines page.
The times shown are typical ranges. Every person is different, and a care team may move faster or slower depending on the situation. These pages are a map rather than a rulebook.
The larynx and its three parts
The larynx sits in the front of the neck. It makes the voice (the vocal cords vibrate to make sound), lets air pass to the lungs, and closes during swallowing to keep food and liquid out of the airway. Where the cancer starts matters, because each part behaves differently:
The glottis (vocal cords). Most laryngeal cancers start here. Because even a small growth on a vocal cord changes the voice, these cancers are often found early, when hoarseness is the only symptom (see voice problems). The vocal cords have very few lymph channels, so early glottic cancer rarely spreads to the lymph nodes in the neck, and the neck is usually not treated.
The supraglottis (above the vocal cords), including the epiglottis, the flap that covers the airway during swallowing. This area has many lymph channels: about 13 to 37 percent of early supraglottic cancers have hidden cancer in neck lymph nodes that look normal on scans. For this reason, treatment almost always includes the neck, often on both sides.
The subglottis (below the vocal cords). Cancers rarely start here and are not covered in detail on these pages.
What "early stage" means
T1: the cancer is in one area of the larynx and the vocal cords move normally. On the vocal cords, T1a means one cord is involved and T1b means both are.
T2: the cancer has spread to a nearby area of the larynx, or a vocal cord moves less than normal. A T2 cancer with a vocal cord that moves less (sometimes called T2b) is somewhat harder to control.
N0 and M0: no cancer in the neck lymph nodes, and no spread to distant parts of the body.
Stage I is T1 N0 M0, and stage II is T2 N0 M0. A very early, surface-only form, carcinoma in situ, is usually removed through the mouth or treated with radiation.
Step 1: The scope exam and the biopsy (week 0)
Hoarseness that lasts more than a few weeks usually leads to a look at the vocal cords with a thin camera passed through the nose, done in the office with numbing spray (see fiberoptic laryngoscopy). A video exam with a strobe light (videostroboscopy) shows how the vocal cords vibrate and records a starting point for the voice.
A biopsy, a small piece of the abnormal area looked at under a microscope, is the only way to confirm cancer (see understanding pathology results). The timelines count from this biopsy as week 0.
Direct laryngoscopy (operating-room biopsy): under general anesthesia, the surgeon looks at the larynx through a metal tube placed in the mouth, usually with a microscope. Even when a diagnosis was made in the office, this exam under anesthesia is generally recommended for laryngeal cancer, because it maps exactly where the tumor is and how far it reaches, and shows whether the whole tumor can be seen through the mouth. The throat and esophagus are often checked at the same time. Most people go home the same day.
Office biopsy: a sample taken through the scope in the clinic confirms the diagnosis in most cases and can shorten the time to diagnosis by more than a week. It is useful when anesthesia carries extra risk.
Needle biopsy (FNA) of the neck: used only when a lymph node in the neck looks suspicious (see fine-needle aspiration).
Removing a very small growth completely at the time of the biopsy is sometimes possible when it is tiny and limited to one vocal cord, so the biopsy also serves as the treatment.
After an operating-room biopsy, a sore throat and worse hoarseness for several days are common, and a short period of voice rest may be advised. Serious breathing problems are uncommon (under 1 percent in large studies). Results usually come back within about a week.
Step 2: Scans and other tests (weeks 0 to 2)
Scans show exactly where the cancer is and whether it has spread. Some centers do them before the operating-room biopsy, because swelling after a biopsy can make the images harder to read.
CT scan of the neck with contrast, with thin slices through the larynx: shows the size of the tumor, whether it has reached the cartilage, and whether any lymph nodes look abnormal. An MRI scan is sometimes added when the cartilage is hard to judge on CT.
Chest CT (often): checks the lungs for spread or for a separate lung problem, which matters for people who have smoked.
PET-CT scan (sometimes): not routine for small vocal cord cancers; used more often for supraglottic cancers or when the stage is unclear.
Breathing tests (pulmonary function tests): before an open partial laryngectomy, to make sure the lungs can handle small amounts of food or liquid slipping toward the airway while swallowing is relearned.
Blood tests and pre-anesthesia tests before surgery.
For very small vocal cord cancers (T1), the full set of scans may not be needed.
Step 3: Meeting the team (weeks 1 to 3)
Care is planned by a team rather than a single doctor:
Head and neck surgeon: performs the biopsy and any surgery and leads follow-up exams.
Radiation oncologist: explains and oversees radiation. Many people meet both the surgeon and the radiation oncologist before deciding, ideally in one visit, because both main options are reasonable for most early laryngeal cancers.
Speech-language pathologist: records the voice and how hoarseness affects daily life, and checks swallowing (with a small camera or a special X-ray) when the cancer is above the vocal cords or open surgery or neck radiation is planned (see swallow evaluations). These starting measurements help track recovery.
Dentist: before radiation, examines the teeth and takes X-rays. Any teeth that need to be removed come out at least 2 weeks before radiation starts so the gums can heal. Radiation to the vocal cords alone gives the mouth and jaw very little radiation; when the neck is treated, dental effects are larger.
Medical oncologist: only when chemotherapy is being considered, which is uncommon for stage I and II.
Audiologist: a starting hearing test when the chemotherapy drug cisplatin is possible, since it can damage hearing.
Dietitian, social worker and tobacco treatment specialist: help with weight, stress, transportation, work and money concerns, and stopping smoking, which matters most right at diagnosis.
Step 4: The tumor board and the decision (weeks 2 to 4)
At a multidisciplinary tumor board, surgeons, radiation and medical oncologists, radiologists, pathologists, speech-language pathologists and others review the biopsy, the scans, the photos or video of the larynx, and the person's health, breathing, voice and swallowing. The board agrees on a recommendation, and the final decision is made by the person together with the doctors. Many people bring a family member or friend and a list of questions (see making the most of a voice visit).
Care teams aim to start treatment within about 30 days of diagnosis, because long delays (beyond about 6 to 7 weeks) are linked with worse results.
How a track is chosen
For most early laryngeal cancers, surgery through the mouth and radiation give similar cure and survival rates and similar long-term voice. The tumor board weighs:
Where the tumor is and how far it reaches: one vocal cord or both, the front junction of the vocal cords (anterior commissure), spread above or below the cords, and whether the vocal cords move normally.
Whether the whole tumor can be seen through the mouth, which depends on the person's anatomy, teeth, jaw and neck.
Expected voice and swallowing. After a small laser removal, the voice is often close to normal. Larger removals, deeper into the vocal cord or across both cords, can leave a breathy voice, which can favor radiation.
Time and travel: laser surgery is usually one procedure, while radiation means daily weekday visits for about 3 to 7 weeks.
Keeping options open: radiation can usually be given only once to the same area. Laser surgery first leaves radiation available for a recurrence or a later new cancer; radiation first leaves surgery available.
Overall health, fitness for anesthesia, lung function, and tobacco and alcohol use.
The person's own priorities, including voice demands at work (for example, teachers, singers and call-center workers).
A single treatment is the goal. Combining surgery and radiation for limited disease adds side effects and is used only when the pathology report after surgery calls for it.
The three treatment tracks
Teal words and numbered tracks are links. On a phone, swipe sideways to see the whole graphic.
Each track has its own timeline page:
Transoral laser surgery: removal of the tumor through the mouth with a microscope and laser, usually as a day procedure, followed by voice therapy. For supraglottic cancers, the neck lymph nodes are removed as well.
Radiation: radiation once a day, Monday through Friday, for about 3 to 7 weeks, without surgery. For supraglottic cancers, the neck is treated as well.
Open partial laryngectomy: removal of part of the larynx through a cut in the neck, keeping the rest, with a temporary tracheostomy and feeding tube and a longer recovery. It is used less often today, mainly for tumors that cannot be removed well through the mouth.
When more treatment follows surgery
The removed tissue is checked under a microscope, especially the margins (the rim of normal tissue around the tumor) and any lymph nodes.
Clear margins and no worrisome features: no more treatment, only regular follow-up. This is the usual result.
Cancer at the edge (positive margin): a second operation to remove more tissue if possible, or radiation. Some surgeons plan a "second-look" exam under anesthesia in the first months.
Other worrisome features, such as close margins or cancer around nerves or blood vessels, or one lymph node with cancer after supraglottic surgery: radiation may be recommended or considered.
Cancer growing outside a lymph node (extranodal extension): radiation with chemotherapy, usually cisplatin.
Radiation after surgery is best started within about 6 weeks of the operation and usually takes 30 to 33 treatments (6 to 6½ weeks).
Reading the timelines
Each track page has a timeline with rows for diagnosis and planning, treatment, side effects and healing, quality of life, check-ups and scans, long-term care, and survival. Teal words in each timeline are links to related pages on this site.
The quality-of-life row shows average scores that patients reported in published studies, for overall quality of life, swallowing, voice and mood. Scores run from 0 to 100 (20 to 100 for one swallowing questionnaire), higher is better, and a change of about 10 points is generally noticeable. These averages describe groups of people, not what any one person will feel. The questionnaires behind the scores are described on the quality-of-life questionnaires page.
The survival row shows disease-specific survival, the share of people who do not die of laryngeal cancer within 5 years, because it is the measure with the strongest published data for early laryngeal cancer. Overall survival, being alive from any cause, is lower because many people with laryngeal cancer also have heart or lung disease or develop a new cancer.
Recovery at a glance
| Laser surgery | Vocal cord radiation | Open partial laryngectomy | Supraglottic surgery and neck dissection | Supraglottic or neck radiation | |
|---|---|---|---|---|---|
| Hospital stay | None or 1 night | None | About 1 to 2 weeks or more | A few days or longer | None |
| Worst side effects | First few days | Last weeks of treatment and 1 to 2 weeks after | First 1 to 2 weeks | First 1 to 2 weeks | Last weeks of treatment and 1 to 2 weeks after |
| Short-term effects mostly healed | About 2 to 6 weeks | About 3 to 4 weeks after treatment ends | Weeks to months | Weeks to months | About 4 to 6 weeks or more after treatment ends |
| Voice and swallowing settle | About 3 to 6 months (longer after bigger surgery) | 6 to 12 months | About 6 months or more | About 6 months or more | 6 to 12 months |
Checking that the treatment worked
After surgery, the larynx is checked with a scope at each visit, starting a few weeks after the operation. Normal healing tissue can look irregular for up to about 3 months.
After radiation, the first check is usually 4 to 8 weeks after treatment. If a scan is used to check the result, a PET-CT is usually done at least 12 weeks after radiation, because earlier scans can show false alarms from normal healing. For small vocal cord cancers, a careful scope exam may be enough. When the 3-month check is clear, routine repeat scans are usually not needed unless symptoms appear.
Outlook
Early laryngeal cancer has one of the best outlooks of any head and neck cancer. For vocal cord (glottic) cancer, about 5 years after treatment:
| T1a | T1b | T2 | |
|---|---|---|---|
| Cancer controlled in the larynx by the first treatment | About 90 to 95% | About 83 to 93% | About 70 to 89% |
| Not dying of laryngeal cancer (disease-specific survival) | About 97 to 99% | About 95% | About 90 to 94% |
| Alive from any cause (overall survival) | About 80 to 90% | About 80 to 90% | About 75 to 80% |
Even when the cancer comes back, it can often still be cured with more treatment, which is why survival from the cancer is higher than control by the first treatment.
In a study comparing the two main treatments for cancer of one vocal cord, about 97 percent of people treated with laser surgery and 92 percent treated with radiation kept their larynx, with similar survival.
Supraglottic cancer has good results that are somewhat lower than vocal cord cancer, partly because of hidden spread to the lymph nodes. Control in the larynx after transoral surgery is about 90 percent for T1 and 83 percent for T2. Overall 5-year survival for early supraglottic cancer is about 64 percent, and many of those deaths come from other health conditions rather than the cancer.
If the cancer comes back
Most recurrences happen in the first 2 to 3 years; in one study, about 8 out of 10 happened within 2 years. A recurrence found early can often still be cured.
After laser surgery: repeat laser surgery or radiation are often possible, and many people keep their voice box.
After radiation: surgery is the main treatment. Sometimes a partial laryngectomy is possible; often removal of the whole larynx (total laryngectomy) is needed, after which people speak using other methods, such as a voice prosthesis (see the advanced laryngeal cancer timelines page).
Long-term health
New (second) cancers: survivors of laryngeal cancer have a higher chance of a new, separate cancer, mainly in the lungs, mouth, throat, larynx or esophagus, about 3 to 5 percent per year, highest in people who keep smoking. The lung is the most common site. People aged 50 to 80 who have smoked 20 pack-years or more qualify for a yearly low-dose CT scan of the chest for lung cancer screening.
Smoking: in people treated with radiation for early vocal cord cancer, continued smoking was the strongest predictor of the cancer coming back, more than tumor size. Quitting before treatment is linked with better results and a lower chance of losing the voice box, and it is never too late to benefit. Help is available through nicotine replacement, prescription medicines and counseling, and the national quitline at 1-800-QUIT-NOW (1-800-784-8669). Cutting back on alcohol also matters.
Voice: voice usually improves over 6 to 12 months, and over the long term, people treated with surgery and with radiation report similar voice quality. Voice therapy helps after any of the treatments.
Swallowing: long-term swallowing problems are uncommon after treatment for small early cancers and more likely after supraglottic treatment, neck radiation or larger surgery. Coughing or choking while eating, pneumonia or weight loss can be checked with a swallow study (see swallowing problem treatments).
After neck radiation: a slow thyroid (hypothyroidism) affects about 1 in 5 people by 5 years and is found with a TSH blood test every 6 to 12 months; radiation to the vocal cords alone rarely affects the thyroid. Radiation can also narrow the neck (carotid) arteries over years, so a neck ultrasound about every 3 years may be suggested, along with control of blood pressure, cholesterol and blood sugar.
Dental health: after radiation, dental visits and possible fluoride treatments continue, and any dentist is told about the radiation before a tooth extraction or implant.
Lymphedema (swelling under the chin, in the neck or inside the throat) can follow neck surgery or radiation and responds best to therapy started early.
Emotional health: worry, sadness and anxiety are very common, and between about 1 in 4 and more than half of people with head and neck cancer have significant distress at some point. Counseling, support groups and medicines all help (see cancer information resources). In the U.S., the 988 Suicide and Crisis Lifeline is available by call or text.
Daily life: tiredness is common during radiation and for weeks to months afterward, and gentle exercise such as walking helps. Most people return to work and usual activities; jobs that use the voice heavily may take longer.
Follow-up schedule
Regular check-ups find any return of cancer early, when it can usually still be treated successfully. The follow-up clock starts at the end of treatment, so the first year runs from the end of treatment until 1 year later. A common schedule, based on national cancer guidelines:
| Time after the end of treatment | How often check-ups happen |
|---|---|
| Year 1 | Every 1 to 3 months |
| Year 2 | Every 2 to 6 months |
| Years 3 to 5 | Every 4 to 8 months |
| After 5 years | Once a year |
Each visit includes a head and neck exam with a scope exam of the larynx through the nose, and check-ins about voice, swallowing, weight, mood, smoking and alcohol. Scans are used when symptoms or the exam call for them. A survivorship care plan, a written summary of the treatment and follow-up plan, is shared with the primary care doctor.
Symptoms that need attention
Emergency care right away: trouble breathing or noisy, high-pitched breathing; coughing up or vomiting more than a small amount of blood, or bleeding that won't stop; stroke symptoms (sudden weakness, facial droop, trouble speaking or seeing).
A prompt call to the care team: fever over 100.4°F (38°C) after recent surgery; being unable to swallow liquids or keep fluids down; pain not controlled by medicine; losing weight without trying.
Report at the next visit, or sooner if worsening: hoarseness that gets worse after it had been improving; a new lump in the neck; ear pain; new trouble swallowing, or coughing or choking while eating; new swelling in the neck or under the chin; feeling depressed, anxious or hopeless. Most recurrences are first noticed by the person.
Questions people often ask the care team
Is the cancer glottic or supraglottic, and what is the T stage?
Which treatments are reasonable in this case, and why?
What will the voice likely sound like after each option?
Will the neck lymph nodes need treatment?
How long will treatment take, and how long is the recovery?
Will a feeding tube or a breathing tube be needed?
What happens if the cancer comes back after each option?
Who answers calls about problems after hours?
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