Early Laryngeal Cancer Timeline: Transoral Laser Surgery

Many early (stage I or II) laryngeal cancers are removed through the mouth with a microscope and laser, usually as a day procedure with no cuts on the neck. The voice is often worse for a few weeks and then improves over the following months with voice therapy.

This page is one of three treatment-track timelines for early laryngeal cancer. The steps before treatment, how a track is chosen and the follow-up schedule are covered on the early laryngeal cancer treatment timelines page.

Who follows this track

Transoral laser surgery suits a well-exposed cancer on one vocal cord (T1a) and many early supraglottic cancers, as long as the surgeon can see the whole tumor through the mouth. It also appeals to people who want a single treatment, have trouble traveling daily, or want to keep radiation in reserve for a recurrence or a later new cancer. When the tumor involves both vocal cords or their front junction (anterior commissure) and a larger removal would harm the voice, or when the larynx is hard to see through the mouth, radiation or, less often, open partial laryngectomy may be preferred.

Before surgery (weeks 0 to 4)

The scope exam, biopsy, scans, meetings with the care team, voice and swallowing baseline and the tumor board's recommendation are the same on every track and are described on the overview page. The exam under anesthesia that maps the tumor is often done at the same sitting as the laser removal, and for a very small growth on one vocal cord the biopsy and the removal can be a single procedure.

Surgery (about week 4)

• Under general anesthesia, the surgeon places a metal tube in the mouth to see the larynx and removes the tumor with a microscope and usually a CO2 laser, with a rim of normal tissue around it (see throat tumor treatments).

• There are no cuts on the outside of the neck. Most people go home the same day or after one night, and a breathing tube in the neck (tracheostomy) is rarely needed for T1 cancers.

• For supraglottic cancers (above the vocal cords), the lymph nodes in the neck, often on both sides, are removed with a neck dissection at the same operation or shortly after. The hospital stay is then a few days or longer, a drain may sit in the neck for a short time, and swallowing is often harder at first because the supraglottis helps protect the airway. Some people need a temporary feeding tube or breathing tube.

On this track, surgery is the end of treatment, so the follow-up clock starts on the day of surgery.

Pathology results (about week 5)

About a week after surgery, the pathologist's report describes the tumor and its margins, the rim of normal tissue around it (see understanding pathology results). In this timeline the margins are clear and no further treatment is given. If cancer reaches the edge, a second operation to remove more tissue or radiation usually follows, and other worrisome features may lead to radiation. Some surgeons plan a "second-look" exam under anesthesia in the first several months to make sure no cancer was left behind.

Healing (weeks 4 to 56)

• First few days: sore throat and a hoarse or breathy voice. Voice rest is often advised for a few days, up to about a week, and acid-reducing medicine may be prescribed. Most people eat normally within days and return to most activities quickly.

• From about week 2: voice therapy with a speech-language pathologist often starts, commonly weekly for 8 or more sessions; it improves results.

• Weeks 2 to 6: the surgery area heals and can look white or bumpy on the scope exam, which is normal healing. The first scope check after surgery comes a few weeks after the operation.

• About 3 months: healing is complete in about 3 out of 4 people, and the biggest voice gains are under way.

• About 6 months: healing is complete in nearly everyone. After a small removal, the voice usually reaches its best by about 6 to 12 months and is often close to normal (see voice problems).

• If a larger part of the vocal cord was removed, the voice may stay breathy. A small procedure to bring the vocal cords closer together (medialization) can help some people, usually at least 6 months after surgery.

• After supraglottic surgery, swallowing therapy helps the return to a full diet (see swallowing problem treatments). Shoulder or neck stiffness and numbness of the neck skin can follow a neck dissection, and physical therapy helps (see the neck dissection recovery page).

• Return to work is often within 1 to 2 weeks after vocal cord surgery; jobs that use the voice heavily may take longer.

Quality of life on this track

Average scores before surgery and over the 2 years after (0 to 100, higher is better):

• Overall: 77 before surgery, 81 at 6 weeks, 83 at 3 months, and 81 at 6 months, 1 year and 2 years. Overall quality of life stays steady or improves slightly.

• Voice: reported separately for men and women. Men: 62 before, 69 at 6 weeks, 80 at 3 months, 82 at 6 months, 87 at 1 year and 86 at 2 years. Women: 80 before, 85 at 6 weeks, 90 at 3 and 6 months and 1 year, and 93 at 2 years. On average, people rated their speech better after surgery than before, because the cancer itself had already affected the voice.

• Swallowing: 97 before and 96 to 98 at every point afterward, so swallowing is barely affected by laser surgery on the vocal cords.

• Mood: 72 before, 85 at 6 weeks and 3 months, 87 at 6 months, 88 at 1 year and 90 at 2 years, as the worry of the diagnosis eases.

Where the numbers come from: a study that followed people having laser surgery for small vocal cord cancers (stage T1 and limited T2), with questionnaires before surgery and at 6 weeks, 3 months, 6 months, 1 year and 2 years. People whose cancer came back were not included in the averages, so the numbers lean toward good outcomes. The swallowing numbers come from the swallowing part of a general head and neck questionnaire. A second study of laser surgery found a similar pattern, with overall scores of 72 before and 76 at 1 year and voice handicap scores falling from 22 to 15 over the first year. Averages describe groups of people, not what any one person will feel. The questionnaires are described on the quality-of-life questionnaires page.

Survival on this track

About 5 years after treatment, about 97 to 99 percent of people with a T1a vocal cord cancer, about 95 percent with T1b, and about 90 to 94 percent with T2 do not die of laryngeal cancer (disease-specific survival). Overall survival, from any cause, is about 80 to 90 percent for T1 and 75 to 80 percent for T2. Laser surgery and radiation give similar survival, and laser surgery keeps the voice box slightly more often.

Check-ups and long-term care

• Check-ups follow the usual schedule counted from the end of treatment: every 1 to 3 months in the first year, every 2 to 6 months in the second, every 4 to 8 months in years 3 to 5, then yearly.

• Each visit includes a scope exam of the larynx in the office (see fiberoptic laryngoscopy). Normal healing tissue can look irregular for up to about 3 months. Scans are used when symptoms or the exam call for them, so new or worsening hoarseness, ear pain, pain or trouble swallowing is reported to the care team promptly.

• If the cancer comes back, repeat laser surgery or radiation are often possible, and many people still keep their voice box.

• Without radiation, the thyroid, carotid artery and dental effects of radiation do not apply, and radiation remains available if it is ever needed. Regular dental care continues as usual.

• Staying tobacco-free lowers the chance of a new cancer in the lungs, mouth, throat or esophagus, and people who have smoked heavily may qualify for yearly lung cancer screening.