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.

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

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 (0 to 100, higher is better). The solid points come from a study that followed people through the first year after laryngectomy, nearly all of whom had radiation afterward; the dashed points come from two surveys taken once, about 3 years and about 6 years after laryngectomy.

• Overall: 78 at diagnosis, 38 at 1 month, 51 at 3 months (around the end of radiation), 60 at 6 months and 67 at 1 year; 76 at about 3 years and 65 at about 6 years.

• Swallowing: 92 at diagnosis, 58 at 1 month, 80 at 3 months, 85 at 6 months and 88 at 1 year; 85 at about 3 years and 80 at about 6 years.

• Speech: 63 at diagnosis, 7 at 1 month, 13 at 3 months, 18 at 6 months and 20 at 1 year; 74 at about 3 years and 69 at about 6 years. Speech takes the largest hit: a month after surgery almost everyone rated speech as a severe problem, and at 1 year it was still far below its starting level even as voice prostheses and speech therapy brought it back. The 3- and 6-year surveys, in which most people spoke with a voice prosthesis, show how much ground is regained later.

• Mood: 73 at diagnosis, 68 at 1 month, 85 at 3 months, 91 at 6 months and 94 at 1 year; 77 at about 3 years and 78 at about 6 years.

Where the numbers come from: the solid points are from a study in Vietnam of 42 people followed from before total laryngectomy to 1 year after; 39 of them had radiation after surgery; its overall scores are shown on the same higher-is-better scale as the other timelines. The 3-year points are from an Italian study that surveyed people at least 2 years (on average about 3 years) after laryngectomy with a voice prosthesis followed by radiation, and compared them with people treated with chemoradiation: the laryngectomy group scored lower for overall quality of life, physical and social functioning, smell and taste, and speech, and about the same for swallowing. The 6-year points are from a Danish and Swedish survey of 172 people a median of 6 years after laryngectomy, most of whom had radiation before a laryngectomy for a cancer that had come back; 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. The first-year scores on the laryngectomy-alone timeline come from a larger study in which most people had no radiation after surgery; its overall and swallowing scores at 1 year (64 and 83) are close to the ones here, while its speech score (52) is much higher, which may reflect differences in voice rehabilitation between the two countries as much as the radiation itself. An older study that surveyed people about 4 years after laryngectomy and radiation found 60 for overall quality of life, 71 for swallowing, 53 for speech and 79 for mood. 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

• 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.