Laryngeal Cancer Timeline: Laryngectomy Followed by Radiation

When the pathology report after a total laryngectomy shows features such as growth through the cartilage or several involved lymph nodes, radiation to the neck usually follows, starting within about 6 weeks of surgery and lasting 6 to 6.5 weeks.

 

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.

Laryngectomy followed by radiation Laryngectomy followed by radiation When the removed tissue shows features such as growth through cartilage or several lymph nodes; radiation ideally starts within 6 weeks Diagnosis and planning Treatment Side effects and healing Quality of life Overall Swallowing Speech Mood average scores; higher is better Check-ups and scans Long-term care Survival 5-year overall FIRST 6 MONTHS (BY WEEK) 6 TO 12 MONTHS YEARS 1 TO 5 AND BEYOND Wk 0 Wk 4 Wk 8 Wk 12 Wk 16 Wk 20 9 mo 1 yr 2 yr 3 yr 4 yr 5 yr + Check-ups count from the end of treatment: every 1 to 3 months in the first year, 2 to 6 months in the second, 4 to 8 months in years 3 to 5, then yearly. Scores 0-100; higher is better Week 0 is the biopsy that confirms the cancer. Times are typical ranges and vary from person to person. General education only. doctorlansford.com Biopsy Tumor board agrees on a recommendation CT, PET/CT, pathology result Meet the team, dental check, voice and swallow test, dietitian Total laryngectomy and neck dissection, then about 5 weeks of healing Hospital about 2 to 3 weeks; eating by mouth after 1 to 2 weeks Radiation, 5 days a week, 6 to 6.5 weeks Feeding tube after surgery, and for some during radiation (usually temporary) Sore throat during radiation: peak, then heal Speech therapy with voice prosthesis; swallowing dips around radiation, then improves Treatment ends: follow-up clock starts PET/CT about 12 weeks after radiation Stoma care and voice prosthesis changes; dental visits and possible fluoride treatments Thyroid blood test (TSH) every 6 to 12 months for 3 years Swallowing exercises; lymphedema care; no tobacco 60 at ~4 yr 71 at ~4 yr 53 at ~4 yr 79 at ~4 yr Dashed: one survey about 4 years after treatment, not followed over time All treatments: about 54 in 100 alive at 5 years with stage III, 45 to 54 in 100 with stage IV (national cancer registries) Laryngectomy is linked with better survival than larynx preservation when cancer has destroyed the cartilage

Teal words in the timeline are links. On a phone, swipe sideways to see the whole graphic.

Who follows this track

This is the most common surgical track for advanced laryngeal cancer. Radiation is usually added when the removed tissue shows a large tumor, growth through the cartilage or into the neck, several involved lymph nodes, cancer growing along nerves or in small vessels, spread below the vocal cords, or margins that are close but clear. When cancer is found at the margin or outside a lymph node, chemotherapy is usually added as well (see laryngectomy followed by chemoradiation).

Before surgery and surgery (weeks 0 to 6)

The steps before surgery and the operation itself, including the stoma, neck dissection, voice prosthesis and hospital stay, are the same as on the laryngectomy alone timeline. The early dental check matters most on this track: teeth in poor condition are treated or removed before radiation starts, to lower the risk of osteoradionecrosis.

Healing before radiation (weeks 4 to 10)

The surgical sites heal for about 5 to 6 weeks. During this time the pathology report comes back, the radiation oncologist plans treatment, and a custom mask is made to hold the head still during treatment. Speech therapy with the voice prosthesis or electrolarynx begins. Radiation ideally starts within about 6 weeks of surgery, a timing that national cancer centers track as a measure of quality. Ideally the whole course, from surgery to the end of radiation, is finished within about 100 days.

Radiation (about weeks 10 to 16)

  • Radiation is given 5 days a week (Monday to Friday) for about 6 to 6.5 weeks. Each visit is short; most of the time is spent positioning.

  • Side effects build gradually and are usually worst in the last week or two and for a couple of weeks afterward: throat soreness (mucositis), dry mouth, taste changes, swallowing trouble, skin changes around the stoma and neck, tiredness and weight loss.

  • The stoma and skin around it can become sore during radiation, and the voice prosthesis may need extra attention.

  • A feeding tube is used by some people during radiation and is usually temporary.

Recovery (months 4 to 12)

  • Swallowing often dips around the time of radiation and then improves over the following months.

  • The voice with the prosthesis usually becomes steadier as swelling settles.

  • Return to work often takes about 6 months or more.

  • A new baseline scan is done after treatment, often a PET-CT scan about 12 weeks after radiation.

Quality of life on this track

In a study that surveyed people about 4 years after laryngectomy and radiation, average scores (0 to 100; higher is better) were 60 for overall quality of life, 71 for swallowing, 53 for speech and 79 for mood. These people were surveyed once, years after treatment, rather than followed over time, so the timeline shows these scores as dashed outlines. In another study, swallowing scores years after laryngectomy were higher than after chemoradiation. Swallowing and speech are shown as 100 minus the score of the head and neck questionnaire, so that higher means better. The questionnaires are described on the quality-of-life questionnaires page.

Check-ups and long-term care

  • Check-ups follow the usual schedule counted from the end of radiation: 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.

  • Stoma care, a stoma filter, and voice prosthesis changes every few months continue for life.

  • Dental visits and possible fluoride treatments continue for life.

  • A thyroid blood test (TSH) every 6 to 12 months for the first 3 years checks for an underactive thyroid, which is especially common after radiation combined with removal of part of the thyroid.

  • Swallowing exercises, stretching of a narrowed throat when needed, and lymphedema care continue as needed.

Go to Laryngeal Cancer Treatment Timelines >>
Go to Laryngectomy Alone Timeline >>
Go to Laryngectomy Followed by Chemoradiation Timeline >>
Go to Radiation Therapy >>
Go to Throat Cancer Treatments >>
 

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