Radiotherapy for cancer of the voicebox (larynx)
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells.
How radiotherapy is used to treat laryngeal cancer depends on the cancer’s stage.
Radiotherapy for early stage cancers
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Radiotherapy can be used on its own if you have an early stage laryngeal cancer. Sometimes doctors advise you to have radiotherapy when surgery is likely to affect your speech or swallowing.
Radiotherapy for locally-advanced cancers
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If the cancer is larger or has spread to lymph nodes (glands) or tissue nearby, you may have radiotherapy in combination with other treatments.
It can be given:
after surgery to destroy any remaining cancer cells and reduce the risk of cancer coming back (adjuvant radiotherapy)
after surgery at the same time as chemotherapy (adjuvant chemoradiation)
at the same time as chemotherapy (chemoradiation) instead of surgery
with a targeted therapy drug.
Radiotherapy for advanced cancers
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Sometimes it isn’t possible to cure a cancer and the main aim of treatment is to reduce the symptoms (palliative radiotherapy).
Radiotherapy can be used to shrink a tumour that is causing swallowing or breathing problems. It can also relieve symptoms if the cancer has spread to other parts of the body.
How radiotherapy is given
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Treatment is usually given as a series of short, daily treatments in the hospital radiotherapy department. Each treatment is called a fraction. Radiotherapy can be given in different ways and you will usually have it as an outpatient.
The treatments are normally given from Monday-Friday with a rest at the weekend. However, sometimes you may also have treatment at the weekend, or more than one treatment each day - this is called hyperfractionation.
Radiotherapy treatment usually lasts 3-7 weeks. Your clinical oncologist will talk to you about your treatment plan and possible side effects.
If you’re having radiotherapy to relieve symptoms, you may only need a short course or a single dose.
Conformal radiotherapy (CRT)
This is one of the most common types of radiotherapy used for early laryngeal cancers. A special attachment to the radiotherapy machine arranges the radiation beams to match the shape of the cancer. Shaping the radiotherapy beams reduces the radiation received by surrounding healthy cells.
Intensity-modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT)
These treatments are now available in many hospitals. The radiotherapy is shaped even more accurately to the exact shape of the cancer.
IMRT shapes the radiotherapy beams and allows different doses to be given to different parts of the treatment area. This can reduce the damage to healthy tissue.
IGRT involves having images taken before each treatment.
These can be used to adjust the treatment area if the shape or size of the tumour changes.
When possible, doctors give IMRT and IGRT to treat locally-advanced and advanced laryngeal cancer. These treatments can help to reduce the risk of some long-term radiotherapy side effects, such as damage to the salivary glands which causes a dry mouth.
Planning your radiotherapy
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Your treatment will be carefully planned by a clinical oncologist to make sure it’s as effective as possible. You will have a CT (computerised tomography) scan taken of the area to be treated. This scan takes lots of images from different angles to build up a three-dimensional picture of the area. At the same time, the radiographers will take measurements from you.
Planning is important and may take a few visits. Your first planning visit will take 30-60 minutes. During the visit, the staff in the radiotherapy department will explain what to expect during your treatment.
It’s important that you’re able to lie still, in exactly the same position, each time the treatment is given. To help you to do this, a special mask (or shell) of your head and shoulders is made.
Before treatment, the radiographer will fit a see-through mesh or plastic mask over your head and neck. They then fix it to the couch to hold you in the right position. The mask is designed so you can see and breathe normally while you’re wearing it.
It can feel claustrophobic at first, but most people soon get used to it. You will have it on for up to 15 minutes at a time.
The mask is made on one of your first visits to the radiotherapy department. The radiographer or the mask room technician will explain the whole process to you before your mask is made.
You will need to wear the mask for the planning sessions and you won’t be able to speak while you have the mask on.
The radiographers will tell you how to signal to them if you want to communicate.
Marks are drawn on the mask to help the radiographer position you accurately and to show where the radiotherapy rays will be directed.
The radiographer’s measurements and the information from the scans are put into a computer that’s used to help your doctors plan your treatment precisely. The planning process may take 7-10 days to complete, and then the treatment can start. We have more information about radiotherapy masks.
Before each session of radiotherapy, the radiographers will position you carefully on the couch with the mask fitted. They will make sure that you’re comfortable.
The treatment only takes a few minutes. During this time, you’ll be left alone in the room. The radiographers will watch you from another room and you can raise your arm to signal to them if you need to. You have to lie still while the treatment is given, but you won’t feel the radiotherapy. It’s similar to having an x-ray.
Some treatment rooms have CD or MP3 players so you can listen to music to help you relax during your treatment. If you’d like to listen to your own music, ask your radiographers if this is possible.
You may hear a slight buzzing noise from the radiotherapy machine while your treatment is being given.
Radiotherapy does not make you radioactive and it’s perfectly safe for you to be with other people, including children and pregnant women, throughout your treatment.
Radiotherapy can cause some general side effects. How you are affected will depend on the dose of radiotherapy and the length of your treatment. Side effects can be more severe if you have radiotherapy combined with chemotherapy.
Side effects usually begin to develop after two weeks of radiotherapy. They may continue to get worse for 7-10 days after treatment ends before gradually improving. Most people find that their side effects improve 4-8 weeks after radiotherapy finishes, or when combined treatments end.
Before you start your treatment, your cancer specialist or nurse will explain the likely side effects and how they can be controlled and managed.
Radiotherapy often makes you feel tired, especially towards the end of treatment and if you’re travelling a long way each day.
Try to rest regularly. It can help to balance this with some gentle physical activity, such as short walks. This will help you feel more energetic.
The skin at the front of your neck will gradually become red or darker. If you’re dark skinned, your skin may get darker or develop a blue or black tinge. Your skin may also feel sore and itchy like sunburn. Skin changes usually start about two weeks after radiotherapy begins and last until about four weeks after it finishes.
Your radiographer or specialist nurse will tell you how to look after the skin in the treated area. They will usually give you the following advice:
Keep the area clean, washing it gently with lukewarm water and unperfumed soap, then carefully pat dry with a clean, soft towel.
Avoid using scented products on the treated area, as these can irritate the skin. Check with your radiographer or nurse before you put anything on your skin in the treated area.
When having a shower, use a very gentle stream of lukewarm water.
Use a simple unperfumed moisturiser such as aqueous cream.
Wear loose cotton clothes with no tight collars. When you’re outside, use a scarf to protect your skin from the sun or cold winds.
If you shave, wax or use hair removal creams, wait until a few weeks after radiotherapy is over before using them and wait until any skin reaction has healed. You can use an electric razor instead during your treatment.
The radiotherapy staff will advise you on how to look after your skin. They can prescribe creams for you to use if your skin becomes very sore. If your skin peels or cracks, you may need a dressing on the area. A district nurse or practice nurse from your GP surgery can do this for you.
For at least a year after radiotherapy, it’s important to protect the treated area from strong sunshine. Even after this time, the skin will be more delicate, so you’ll still have to take extra care.
Use a suncream with a high sun protection factor (SPF 30 or higher) and cover the area with a light scarf. It’s important to remember that you can burn through clothing if you’re out in hot sun for a long time.
Sore throat and difficulty swallowing
The lining of your throat may become sore and inflamed, making it difficult to swallow. Your doctor can prescribe liquid painkillers to help with this. Try to take these before meal times.
Your nurse or radiographer will give you advice on foods that are easy to swallow. They may also give you nutritious or high-calorie drinks. Most people manage to eat soft, moist foods until the soreness has settled. This is usually a few weeks after the radiotherapy has finished, but may continue for longer.
Some people find the soreness stops them from eating or drinking enough. This is more common if you have radiotherapy and chemotherapy at the same time (chemoradiation).
Sometimes if this happens, your doctor might suggest you have nutritional support (artificial feeding) so that you don’t lose too much weight. This means giving you liquid food containing all the nutrients you need through a feeding tube that goes into your stomach. You can also have liquids and medicines through it.
Nutritional support can:
prevent weight loss
make sure you’re getting enough fluids
help you to feel less weak or tired
ease the pressure of having to eat.
The liquid feeds can be given through:
a thin tube that’s passed up your nose and down into your stomach (called a nasogastric or NG tube)
a tube that’s inserted through the skin and into the stomach (called a percutaneous endoscopic gastrostomy or PEG tube).
Your doctor and dietitian will talk to you about this and explain which tube is most suitable for you. Even if you have a feeding tube, you should still try to swallow whatever you can.
Occasionally, some people need help with nutrition before radiotherapy because they’ve lost a lot of weight or have swallowing problems. Having liquid feeds through a tube will give you enough calories to help prevent any unplanned breaks in your treatment.
We have more information about nutritional support, diet and coping with eating problems.
Dry mouth or throat
Radiotherapy to the larynx can affect the salivary glands, making you produce less saliva. The lining of your mouth and throat can become dry. This can make eating and speaking difficult.
Saliva helps keep your mouth clean, so it’s important to brush your teeth with a soft toothbrush twice a day and to use mouthwashes regularly. Try drinking sips of water regularly throughout the day to keep your mouth moist. Your doctor can prescribe artificial saliva sprays and gels to help.
Sometimes a dry mouth can continue for a few months after your treatment has finished. For some people, it may be permanent.
Thick sticky saliva (mucus)
You may have a build-up of sticky mucus in your throat. It’s a good idea to always have tissues handy, as you might need to spit often to get rid of this. Rinsing your mouth regularly can help with the mucus. Your specialist nurse can give you more advice.
Your voice may already be hoarse and it may get worse during radiotherapy. Your doctor will let you know about the risk of permanent voice changes. Try to rest your voice by not straining it and avoid smoky places. Your voice should gradually improve and get stronger after your radiotherapy is over. A speech and language therapist can advise you on voice exercises to speed up your recovery. Your doctor or specialist nurse can arrange this for you.
Loss of appetite
You may not feel like eating if your mouth is sore. This can be at its worst towards the end of radiotherapy and in the first couple of weeks after it’s finished. It’s important to try to eat, even if you don’t feel like it. You can also see a dietitian, who may ask you to have some high-calorie or nutritious drinks until your appetite returns.
Loss of taste
Your sense of taste may change or you may find everything tastes the same. This should get better, but it may take up to a few months after radiotherapy has finished.
Radiotherapy to the throat won’t cause you to lose the hair on your head. But if you have any facial hair, it may fall out and this can be permanent.
Radiotherapy may cause swelling in your throat. Very rarely, this can lead to breathing problems, which need to be treated straight away. If you develop any difficulties with your breathing or if your breathing sounds different, tell a doctor or contact the hospital as soon as possible. Very rarely, people need an operation to help them to breathe but this should be short term.