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