CARCINOMA OF LARYNX-DIAGNOSIS & TREATMENT

BY: ASEEM GARGAVA 38/08

Diagnosis

History: any patient may present with: ..A sore throat that does not go away ..Dysphagia ..A change or hoarseness in voice ..Pain in the ear ..A lump in the neck It is a dictum that any patient in cancer age

group having persistant or gradually increasing hoarseness of voice for 3 weeks must have laryngeal examination to exclude cancer

Indirect laryngoscopy:

Appearance of lesion:1.epiglottis2.vocalcords-raised nodule3.ant.commisure-granulation tissue4.subglottic-submucosal nodule

Vocal cord mobility Extent of disease-vallecula,base of

tongue,pyriform fossa should be checked

Examination of neck

Done to find :-1.extralaryngeal spread of disease2.nodal metastasis

Midline swellings with tenderness

Radiography

Xray chest Soft tissue neck- lateral view-

extension of lesion & destruction of thyroid cartilage seen.

Contrast laryngograms-dionosil(radio-opaque dye)- outlines the surface extent of tumor

Ctscans

Direct laryngoscopy

To see :-1.hidden areas of larynx2.extent of disease

Microlaryngoscopy

For small lesions of vocal cords To take more accurate biopsy

specimens without damaging the cord

Supravital staining & biopsy

Toludine blue applied to lesion, washed with saline and examined under operating microscope.

Ca in situ & superficial carcinomas take up dye while leukoplakia doesnt – helps in selecting biopsy area.

Treatment

Depends upon:a) The site of lesionb) The extent of spreadc) Metastasis

Treatment maybe:a) Radiotherapyb) Surgery: conservative laryngeal

surgery or total laryngectomyc) Combined therapy

Radiotherapy

Reserved for early lesions which neither impair cord mobilty nor invade cartilage or cervical nodes.

90% success rate with voice preservation cancer with mobile cord.

70-90% in superficial exophytic lesions esp. at tip of epiglottis & aryepiglottic folds.

Surgery(conservative surgery)

Cordectomy via laryngofissure Partial frontolateral laryngectomy Partial horizontal laryngectomy

Surgery(total laryngectomy)

Entire larynx including hyoid,pre-epiglottic space,strap muscles & 1or more rings of trachea are removed.

Lower tracheal stump is sutured to skin.

Combined with block dissection for nodal metastasis

Indications for total laryngectomy:

T3 (i.e. with fixed cords)

All T4 lesions. Invasion of thyroid or cricoid cartilage. Bilateral arytenoid involvement. Lesions of posterior commissure. Failure after radiotherapy or conservative

surgery. Transglottic cancersC/I: DISTANT METASTASIS

Combined therapy

Surgical ablation along with pre- or post-operative radiation to decrease the incidence of recurrence

Preoperative radiation also render fixed nodes resectable.

a) Early supraglottic and glottic tumor of stage I and II----radiotherapy

Five year survival rate: Stage I: 90% Stage II:70%b)Endoscopic CO2 laser

c) Advanced tumor: total or subtotal laryngectomy

Rehabilitation

By the following methods:

A) Written language

B) Oesophageal speech

C) Artificial larynx: i) Electrolarynx ii) Tran oral pneumatic device D) Tracheo-oesphageal speech

Electrolarynx

Tracheo-oesophageal speech

Reference:Disease of Ear, Nose and Throat byPL Dhingra

Bailey and Love’s Short Practice Of Surgery

THANK- YOU