Carcinoma of the larynx Epidemiology Accounts

Carcinoma of the larynx • Epidemiology • Accounts for 1% of all new cancers diagnosed in the U. S. and 0. 75% of all cancer deaths. • Accounts for 30% in all head and neck cancers. • More frequently happened in patients at 50~70 years of age. • M: F ratio: 5~10: 1 (foreign country)， 6. 75: 1(shanghai).

Carcinoma of the larynx • Etiology • Cigarette • Wine (combined smoking and alcohol abuse increases the risk by 50% over the additive rate ) • air pollution • Virus (HPV) • precancerous lesions (Leukoplakia, Papilloma) • sex hormones

Leukoplakia of the larynx

Carcinoma of the larynx • Pathology • Nearly 98% are squamous cell carcinoma. • adenocarcinoma and undifferentiated carcinoma is rare.

Carcinoma of the larynx • Clinical classification: • Glottic (60%)：well differentiated, late metastasis • Supraglottic (30%)：poor differntiated, early metastasis • Subglottic (6%)：poor differentiated, early metastasis

Anatomic divisions of the larynx

Carcinoma of the larynx • Spread of tumor Direct spread Supraglottic cancer→ epiglottis, pre-epiglottic space, vallecula, and tongue base. piriform sinus, lateral wall of hypopharynx. paraglottic space, ventricle or the VC.

Carcinoma of the larynx • Spread of tumor Direct spread Glottic cancer→ anteriorly, contralateral VC. posteriorly, arytenoid cartilage superiorly, supraglottic area. inferiorly, paraglottic space and subglottic area.

Carcinoma of the larynx • Spread of tumor Direct spread Subglottic cancer→superiorly, glottis. anteriorly and laterally, strap muscle and thyroid gland. posteriorly, esophagus.

Carcinoma of the larynx • Spread of tumor Lymph nodes metastases • Supraglottic cancer →have a propensity to spread to cervical lymph nodes bilaterally at the early stages. • Generally, the risk of occult or actual metastases from T 1, T 2, T 3 and T 4 tumors is 20, 40, 60, and 80%.

Carcinoma of the larynx • Spread of tumor Lymph nodes metastases Glottic cancer →CV is virtually devoid of lymphatics, involvement of cervical nodes at the early stages is not common. ＜ 8% of patients with T 1 and T 2 tumors will have nodal involvement.

Carcinoma of the larynx • Spread of tumor Lymph nodes metastases Glottic cancer →Only at the later stages, prelaryngeal nodes, paratracheal nodes and other cervical nodes could be involved.

Carcinoma of the larynx • Spread of tumor Lymph nodes metastases Subglottic cancer →tend to spread to paratracheal lymphatics and then to superior mediastinual nodes.

Carcinoma of the larynx • Spread of tumor Distant metstases via blood Distant metastasis only occurs in the very later stage of laryngeal carcinoma.

Carcinoma of the larynx • Clinical manifestations • Supraglottic carcinoma： • Might be asymptomatic • Foreign body sensation • Pain while swallowing • Throat burns • Enlargement of cervical lymph nodes

Carcinoma of the larynx • Clinical manifestations • Glottic carcinoma： • Hoarsenenss is the early symptom • Respiratory obstruction will happen in late stage

Carcinoma of the larynx • Clinical manifestations • Subglottic carcinoma： • There are no definitive symptoms in the early stage. • Dyspnea and lymph nodes metastasis is the late symptoms

Supraglottic carcinoma

Glottic carcinoma

Carcinoma of the larynx • Physical examination • Laryngoscopic examination can find a mass on one or both vocal cords • fixation of the vocal cords is common • mass in the neck

Carcinoma of the larynx

Carcinoma of the larynx • Differential diagnosis • Tuberculosis of the larynx ：chest X-ray film • Papilloma of the larynx • Syphilis of the larynx

Treatment • The modality of treatment depends on: • the exact site of the lesion • early or advanced stage • presence or absence of neck metastasis • distant metastasis • age and sometimes the patient’s wish

Treatment • Early laryngeal carcinoma (T 1/T 2) is usually managed with single modality of treatment and responds well to radiation, transoral laser resection, or partial laryngeal surgery. • Primary cure rates of 80 to 85% are expected.

Treatment • The management of advanced laryngeal carcinoma is more controversial. • The aim is to optimize disease-free and overall survival while preserving quality of life.

Treatment • Generally, combined therapy is widely used, as it shows better survival rates than singlemodality treatment. • Surgery + radiotherapy or radiotherapy + surgery are two commonly used modalities.

Surgical treatment • Partial laryngectomy • Laryngofissure with cordectomy • Vertical partial laryngectomy • Frontolateral partial laryngectomy • Horizontal vertical partial laryngectomy • Supracricoid partial laryngectomy • Near total laryngectomy(Pearson’s operation) • Transoral laser resection

Surgical treatment • Total laryngectomy • Neck dissection • Radical neck dissection • Functional neck dissection • Selective neck dissection

Surgical treatment • Rehabilitation of speech after total laryngectomy • Blom- Singer valve • Esophageal speech • Electrical larynx

Radiotherapy • T 1 N 0 M 0 tumors located at the mid-portion of the VC • Contraindication for surgery because of poor general condition • Pre-operative irradiation for some advanced tumors

Other treatment modality • Chemotherapy • Genetherapy