Head and neck tumors€¦ · • asymptomatic until a relatively large tumor bulk is present ....

Laryngeal cancer

• 1% of new cancer diagnoses

• laryngeal cancer accounts for about one-fourth of head and neck cancer diagnosed annually.

• male-to-female ratio for larynx cancer is 4:1

• lower socioeconomic groups .

• The supraglottis has rich bilateral lymphatics Thus the strong tendency for supraglottic tumors to spread via lymphatics.

Supraglottic :

• There is a paucity of lymphatics and, compared with supraglottic primary neoplasms malignant glottic tumors have less a tendency for bilateral regional lymphatic spread and remain confined to the glottis for longer periods of time.

• Tobacco smoking, alcohol.

• HPV 16 / 18

• GERD implicated

• Occupational factors

• Radiation exposure

• Genetic factors

• Premalignant lesions

• Squamous cell carcinomas:

95% of all malignant laryngeal tumors

Supraglottic tumors

• asymptomatic until a relatively large tumor bulk is present . Nodal metastasis is often the initial complaint.

Glottic tumors

• tend to present early, with hoarseness as their chief complaint.

Subglottic tumors

rare and may present with stridor or hemoptysis .

Supraglottic cancer

Supraglottic cancer

Epiglottic tumor

Glottic squamous cell carcinoma of the larynx. The tumor involves the anterior half of the left vocal cord.

Glottic Tumor

Glottic Tumor

Subglottic cancer

• Hoarsness • Dyspnea . • Dysphagia. • Ear pain. • Hemoptysis • Throat pain • Airway compromise • Aspiration • Neck mass

• complete head and neck examination should be performed.

• The quality of the voice is noted. A breathy voice may indicate a vocal cord paralysis and a muffled voice, a supraglottic lesion.

• Palpation : – cervical lymphadenopathy

– broadening of the laryngeal prominence

– Restricted laryngeal crepitus may be a sign of post cricoid or retropharyngeal invasion ( late stage )

• Laryngoscopy:

- mirror examination

- fiberoptic endoscope:

Malignant laryngeal lesions can appear to be fungating, friable, nodular, or ulcerative, or simply as changes in mucosal color

• Triple endoscopy and includes direct laryngoscopy, esophagoscopy, and bronchoscopy. – Assess the extent of the laryngeal tumor

– Assess the respiratory tract and upper digestive tract for synchronous primary tumors.

– To investigate cervical lymph node mets of unknown origin.

• DIRECT LARYNGOSCOPY :

Biopsies of suspected malignant sites

with cup forceps.

• CT Neck • MRI Neck • PET scan:

– Identifying occult nodal metastases,

– Distinguishing the recurrence of malignant growth from radionecrosis and other sequelae of prior treatment.

– Identifying the location of any unknown primary cancer.

Treatment

• Early : surgery or radiotherapy

• Advanced : surgery + radiotherapy

Prognosis

Early laryngeal cancer has a very good prognosis (greater than 95%) 5 year survival

Involvement of lymph nodes in the region is associated with a poorer prognosis.

Pharyngeal Cancer

Nasopharynx The pharyngeal

recess (fossa of Rosenmüller) – most common site of NP tumour.

• The palatine tonsils are most common site of OP tumour

On either side of the

laryngeal orifice is a

recess, termed the

sinus pyriformis, which

is bounded medially

by the aryepiglottic

fold, laterally by the

thyroid cartilage and

hyothyroid membrane.

sinus pyriformis is the

most common site of hypopharyngeal CA.