One of the questions patients with laryngeal cancer ask most often is this:
Will I lose my voice completely?
This is a natural worry, but I want you to know this: the voice can often be preserved, and when it cannot, there are methods that usually make it possible to speak again.1,2
What decides whether the voice can be kept?
The larynx (voice box) is the organ that houses our vocal cords. The treatment plan depends on where the tumour is located, its size and its stage. The choice of treatment also weighs how to keep talking, eating and breathing as normally as possible.3
The aim of treatment is to clear the cancer completely while preserving the patient’s quality of life and voice as much as possible.1
How does treatment of early disease affect the voice?
If the disease is caught at an early stage, the voice can usually be preserved by removing only the part containing the tumour, or with radiotherapy. In fact, many patients keep their voice after treatment; how it sounds afterwards depends on how extensive the treatment had to be.1,3
For early cancer of the vocal cords, radiotherapy and laser surgery through the mouth are both accepted options. After laser surgery the voice depends on how much tissue had to be removed; radiotherapy makes the voice hoarse while it is given, and most such early side effects settle four to six weeks after it ends.1
When only part of the larynx is removed (partial laryngectomy), as much of it as possible is left in place so that speech and swallowing can still work; most people keep at least some ability to speak.3,4
What happens if the whole larynx is removed?
At more advanced stages, it is sometimes necessary to remove the entire larynx. Even so, many tumours beyond the early stage can be treated with radiotherapy and chemotherapy together, which leaves the larynx in place; removing the larynx gives better results when the tumour has grown through the cartilage into the neck.1
After the whole larynx is removed (total laryngectomy), the windpipe opens into a permanent hole in the front of the neck (a stoma), through which you breathe. The passage from the throat to the gullet is usually not affected, although swallowing difficulty of some degree has been reported in as many as 42% of patients three years after the operation.4,5
In this case, although the natural voice is lost, it is usually possible to speak again using methods such as a voice prosthesis, an electrolarynx or oesophageal speech:1,2
- Voice prosthesis: The most common way of restoring speech. A small one-way valve is placed in a hole made between the windpipe and the gullet; when the stoma is covered with a finger, air from the lungs passes through the valve to the mouth and makes a voice.2,6
- Electrolarynx: A battery-operated device held at the corner of the mouth or against the neck that makes a vibrating sound; the mouth and tongue shape this sound into words, and the voice is mechanical.6
- Oesophageal speech: With training, some people learn to swallow air into the gullet and force it back out; the vibrations it makes in the throat are turned into speech.6
Learning to speak again takes time and effort, and the voice does not sound the same as before.6
What does speech therapy do?
According to the guidelines, speech and swallowing should be assessed by a speech and swallowing therapist before treatment, and the expected effects of the cancer and its treatment explained.5
After laser surgery or radiotherapy, voice therapy works on how well the voice carries, its pitch and voice fatigue. After the whole larynx has been removed, the therapist shows you the different ways of communicating and plays a major part in helping you learn to speak; this support needs to be long-term.2,5,6
When should hoarseness be examined?
And there is one thing I particularly want to emphasise:
If your hoarseness has lasted for more than two weeks, do not wait for it to ‘pass’. Be sure to see an ENT specialist. Early diagnosis increases both the success of treatment and the chance of preserving the voice.1,7
Cancers that start on the vocal cords often cause hoarseness, which can lead to their being found very early. Some cancers that start above or below the vocal cords do not change the voice and are more often found at a later stage.7
These signs also need examining if they last more than a few weeks:7
- A sore throat that does not go away
- Pain or difficulty on swallowing
- Ear pain
- Difficulty breathing
- Weight loss
- A lump or swelling in the neck
References
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Jones TM, De M, Foran B, Harrington K, Mortimore S. Laryngeal cancer: United Kingdom National Multidisciplinary guidelines. J Laryngol Otol. 2016;130(S2):S75-S82. doi:10.1017/S0022215116000487 ↩
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Cancer Research UK. Speaking after a laryngectomy [Internet]. London: Cancer Research UK; [reviewed 2024 Sep 20; cited 2026 Oct 5]. Available from: cancerresearchuk.org ↩
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National Cancer Institute. Laryngeal cancer treatment (PDQ®)–patient version [Internet]. Bethesda (MD): National Cancer Institute; [updated 2025 Feb 12; cited 2026 Oct 5]. Available from: cancer.gov ↩
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American Cancer Society. Surgery for laryngeal and hypopharyngeal cancer [Internet]. Atlanta (GA): American Cancer Society; [revised 2026 May 28; cited 2026 Oct 5]. Available from: cancer.org ↩
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Clarke P, Radford K, Coffey M, Stewart M. Speech and swallow rehabilitation in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S176-S180. doi:10.1017/S0022215116000608 ↩
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American Cancer Society. After laryngeal and hypopharyngeal cancer treatment [Internet]. Atlanta (GA): American Cancer Society; [revised 2026 May 28; cited 2026 Oct 13]. Available from: cancer.org ↩
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American Cancer Society. Signs and symptoms of laryngeal and hypopharyngeal cancer [Internet]. Atlanta (GA): American Cancer Society; [revised 2026 May 28; cited 2026 Oct 12]. Available from: cancer.org ↩