Carcinoma of larynx

dr. Sofyan Suri SH, Sp.THT

Faculty of MedicineYARSI University

Jakarta

Normal Larynx

Normal vs. Cancerous

Normal Cancer (beginning stage)

Squamous Ca of larynx

Normal larynx

Aetiology Classification and staging Supraglottic, glottic and subglottic

cancer Diagnosis Treatment Vocal rehabilitation

Aetiology

Classification and staging

TNM classification and staging Classification by AJCC

TNM classification and staging

Helps to determine :a) The extentb) Treatment modalitiesc) Prognosis

AJCC classification

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECKLARYNX

MOST COMMON NONCUTANEOUS SITE OF SCC IN THE HEAD AND NECK

SUPRAGLOTTIC: EMBRYOLOGICALLY DERIVED FROM BUCCOPHARYNX

GLOTTIC AND SUBGLOTTIC: DERIVED FROM TRACHEOBRONCIAL TREE

TNM CLASSIFICATION DEPENDS UPON VOCAL CORD INVOLVEMENT AND TUMOR EXTENSION

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

STAGING

AMERICAN JOINT COMMITTEE ON CANCER.T = TUMOR SIZE

T1 <2 CM DIAMETER

T2 2-4 CM DIAMETER

T3 >4 CM DIAMETER

T4 >4 CM WITH INVASION OF ADJACENT STRUCTURES

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

STAGING

N = NODAL BASINS: N0 NO POSITIVE NODES

N1 SINGLE NODE <3 CM DIAMETER

N2 3-6 CM DIAMETER

N3 >6 CM DIAMETER

M = METASTATIC DISEASE M0 NO METASTASIS

M1 METASTASIS

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

STAGING

STAGE I T1N0M0

STAGE II T2N0M0

STAGE III T3N0M0, T1 or T2 or T3, N1 or M0

STAGE IV T4N0 or N1, M0

ANY T, N2 or N3, M0

ANY T, ANY N, M1

Supraglottic cancer

Less frequent than glottic cancer Majority of lesions are seen on epiglottis,

false cords, aryepiglottic folds Spread: vallecula, base of the tongue,

pyriform fossa and even penetrate the thyroid

Symptoms: often silent, may present with throat pain, dysphagia and referred pain-ear, mass in the neck

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

LARYNX - SUPRAGLOTTIC

STAGE I & II: RADIOTHERAPY (PRESERVES VOICE) OR HEMILARYNGECTOMY

LYMPHATIC SPREAD AS HIGH AS 50% LARYNGEAL SUSPENSION REQUIRED TO

PREVENT ASPIRATION AFTER HEMILARYNGECTOMY

STAGE III & IV: LARYNGECTOMY FIVE YEAR SURVIVAL 37-57%

Supraglottic

Glottic cancer

Most common- 65% Spread: anteriorly- anterior commisure posteriorly- vocal process and arytenoid process Upward- ventricle and false cord Downward- Subglottic regionSymptoms: Hoarseness of voice, stridor

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

LARYNX - GLOTTIC

TREATMENT: RADIOTHERAPY OR SURGERY (HEMILARYNGECTOMY)

LYMPH NODE METASTASIS 2% (LOW) FIVE YEAR SURVIVAL IN THE EARLY STAGES 90% STAGE III & IV: TOTAL LARYNGECTOMY

Glottic

Subglottic cancer

Lesions rare Spread: Anterior wall, to the

opposite side or downwards to the trachea

May invade cricothyroid membrane, thyroid gland and muscles of neck

Symptoms: Stridor

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

LARYNX - SUBGLOTTIC

RARE

RADIOTHERAPY OR SURGERY

Subglottic

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

Examination: done to find extra laryngeal spread of disease and nodal metastasis

Investigation

Laryngoscopy: indirect, direct or micro

Radiography CT Staining and biopsy

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

Rehabilitation

By the following methods: A) Written language B) Oesophageal speech

Thank you