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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 T1, T2, T3 and T4 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 T1 and T2 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 (T1/T2) 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 single- modality 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 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 • T1N0M0 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