Laryngeal Cancer Timeline: Laryngectomy Alone

For some advanced laryngeal cancers, surgery to remove the voice box is the only treatment needed, when the pathology report shows clear margins and no features that call for radiation.

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

Who follows this track

This track applies when the whole larynx is removed as the first treatment and the pathology report afterward is favorable: clear margins, no cancer or only limited cancer in the lymph nodes, and no growth along nerves or in small vessels. Even then, radiation is sometimes offered, so this track and the next one overlap. For many advanced cancers, the report does show features that call for radiation, and the plan moves to laryngectomy followed by radiation. This is not known for certain until after surgery.

Before surgery (weeks 0 to 4)

• Biopsy, usually in the operating room, then CT and PET-CT scans and the pathology result.

• A visit with a speech-language pathologist to learn how speech is restored after laryngectomy, and often a meeting with someone who has had the operation.

• A dental check, a dietitian visit, and support to stop smoking.

• If the airway is narrowed, a tracheostomy may be placed before surgery.

• The tumor board agrees on a recommendation.

Surgery (about week 4)

• Total laryngectomy removes the larynx. Surgery is often the main recommendation when the cancer has destroyed the cartilage or grown outside the larynx. The windpipe is brought to a permanent opening in the front of the neck (the stoma), and breathing happens through it from then on.

• Neck dissection removes lymph nodes on one or both sides of the neck. Part or all of the thyroid gland is often removed too.

• Voice prosthesis: a small one-way valve is often placed between the windpipe and the esophagus at the same operation, or a few months later. When it is placed at surgery, speaking with it usually starts about 2 to 3 weeks afterward.

• The hospital stay is commonly about 2 to 3 weeks, and some people spend time in a rehabilitation facility before going home. A temporary feeding tube through the nose provides nutrition starting a day or two after surgery, and eating by mouth usually starts 1 to 2 weeks after surgery, once a swallow test shows the throat has healed.

• The main early problem to watch for is a leak from the throat to the skin of the neck (a fistula). It affects about 1 in 10 to 1 in 4 people, usually appears around day 12, and most often heals over a few weeks with tube feeding and wound care.

Recovery (weeks 5 to 16)

• The pathology report comes back within 1 to 2 weeks and confirms that no added treatment is needed.

• A speech-language pathologist teaches use of the voice prosthesis, or an electrolarynx, which can be used right away, and stoma care. The stoma needs moist air, mucus clearing and daily cleaning for life.

• Speech becomes steadier over 3 to 6 months. By a year, about 7 in 10 people speak with a voice prosthesis.

• A stoma filter (heat and moisture exchanger) warms and moistens the air, which reduces coughing and mucus.

• Many people return to work within a few months.

Quality of life on this track

The first scores ("at diagnosis") were collected after the cancer was diagnosed and before treatment began, so they already reflect some of the burden of the cancer itself, not a person's quality of life before the cancer developed.

Average scores before and after laryngectomy (0 to 100, higher is better), from a study that followed 174 people through the first year, with a dashed point at the right edge of the timeline from a survey of 172 people about 6 years after laryngectomy:

• Overall: 58 at diagnosis, 53 at discharge from hospital, 56 about 2 months after surgery and 64 at 1 year; 65 at about 6 years. Overall quality of life ends the year better than it started.

• Swallowing: 74 at diagnosis, 68 at discharge, 75 at about 2 months and 83 at 1 year; 80 at about 6 years. Swallowing recovers and ends better than before surgery, when the tumor was in the way.

• Speech: 70 at diagnosis, 22 at discharge, 35 at about 2 months and 52 at 1 year; 69 at about 6 years. Speech takes the largest hit and is still well below its starting level at 1 year, even as a voice prosthesis and speech therapy bring it back; the 6-year survey, in which 4 in 5 people spoke with a voice prosthesis, shows how much ground is regained later.

• Mood: 65 at diagnosis, 63 at discharge, 65 at about 2 months and 72 at 1 year; 78 at about 6 years.

Where the numbers come from: a multicenter study of people having laryngectomy for cancer of the larynx or lower throat, most with stage III or IV disease and most without radiation after surgery, with questionnaires before surgery, the day before leaving hospital, at the end of inpatient rehabilitation (about 2 months after surgery) and 1 year after the first questionnaire. People who died during the year are not in the later averages, so the numbers lean toward good outcomes. The 6-year points are from a Danish and Swedish survey of 172 people a median of 6 years after laryngectomy; most of them had also had radiation, usually before a laryngectomy for a cancer that had come back, and about 1 in 10 had laryngectomy alone. In that group, 46 in 100 reported moderate or severe swallowing trouble, 57 in 100 moderate or severe voice problems, 16 in 100 screened positive for depression and 20 in 100 for anxiety. In another study, overall quality of life improved steadily through the first 2 years after laryngectomy, while anxiety and depression did not ease on their own: about 1 in 3 people screened positive for depression and 1 in 5 for anxiety at some point. Swallowing and speech are shown as 100 minus the score of the head and neck questionnaire, so that higher means better. Averages describe groups of people, not what any one person will feel. The questionnaires are described on the quality-of-life questionnaires page.

Check-ups and long-term care

• A new baseline CT or MRI scan is done within about 3 to 4 months of surgery.

• Check-ups follow the usual schedule counted from the date of surgery: 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.

• The voice prosthesis is cleaned daily and changed every few months as it wears.

• Narrowing of the throat, if it happens, is often treated by stretching (dilation). Swallowing is checked over time.

• If part of the thyroid was removed, a thyroid blood test (TSH) checks for an underactive thyroid.

• Staying off tobacco and limiting alcohol lower the chance of a new cancer.