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Laryngeal cancer (TNM Classification (T1 – tumor confined to the one…
Laryngeal cancer
TNM Classification
- T1 – tumor confined to the one region of the larynx; normal cord mobility
glottis: T1a - one vocal cord T1b - both cords
- T2 – tumor with extension to more thane one regions; normal or slightly impared cord mobility
- T3 – tumor confined to the larynx with fixation of one or both cords
- T4 – tumor extending beyond the larynx
treatment
- Method of treatment depends on:
primary localization (SupraG; G, SubG)
extension and depth of infiltration (T)
regional/distant metastases (N, M)
differentiation (G1-G3)
- Surgical treatment
partial laryngectomy - endoscopic, classic/external approach (preservation of the vocal function and normal airways)
total laryngectomy (loss of vocal function, airways and upper part of digestive tract are separated)
neck dissection (elective, therapeutic)
postoperative RT (if necessary)
- RT (+/- chemotherapy)
- Salvage laryngectomy (partial, total) in case of RT failure Paliative treatment (chemotherapy)
T1: Surgery or RT
T2: Surgery or RT
T3: Surgery +/- RT
T4: Surgery + RT
- alternative treatment:
T3/T4 agressive ChT+RT
„organ preservation strategies” in locally advanced carcinomas
- 5-year survival similar to S+RT
weak functional outcome of the larynx
(voice, tracheotomy)
-
pathology
- Squamous Cell Carcinoma (SCC)- 95%
Grades:
G1 well differentiated
G2 moderately differentiated G3 poorly differentiated
- Variants of SCC
Verrucous Carcinoma - variant of SCC G1, locally invasive, exophytic warty growth
Basaloid Squmous Cell Carcinoma - more agressive
-
risk factors
- Typical
tobacco smoking (pack-years)
alcohol abuse (heavy-drinking)
preneoplastic lesions
toxic exposure
- Atypical
GERD (gastroesophageal reflux disease)
HPV infections
genetic factors
Supraglottic cancer
- moderately and poorly differentiated
- infiltrative growht
- cervical lymph nodes metastases are common (rich lymphatic vascularity)
- symptoms of chronic pharyngitis
feeling that something is catching in the throat persistent
sore throat
dysphagia (difficullty swollowing)
odynophagia (painfull swollowing)
otalgy (ear pain)
fetor ex ore (bad breath)
hoarseness
haemoptysis (coughing up blood)
dyspnoe (breathing difficulties)
a lump/mass on the neck – the first sign in 40%
Subglottic cancer
- develops in the squamous metaplastic foci (poorly differentiated)
- cervical and mediastinal lymph nodes metastases are common (rich lymphatic vascularity, lymphatic drainage to the mediastinum
- Symptoms:
cough
hoarseness
haemoptysis (coughing up blood)
dyspnoe (breathing difficulties)
a lump/mass on the neck
-
epidemiology
- most common head&neck malignancy
- The second respiratory tract neoplasm (after lung cancer)
- Age40–60
- Morbidity
M>F
-
Glottic cancer
- develops from the squamous epithelium
- usually well differentiated
- cervical lymph nodes metastases are rare and occur late (scant lymphatic vascularity)
- Symptoms early: hoarseness late: dyspnoe
clinical diagnosis
- Patient history
- Physical (ENT) examination
indirect laryngoscopy
videolaryngoscopy laryngeal
endoscopy neck palpation
- Imaging
neck sonography/CT/MRI
chest x-ray/CT
laryngeal tomography (classic)
CT/MRI
-
-
results of the treatment
- 5-year survival rate - 66% (all stages)
supraglottis 60% (T1 T2 80%, T3 T4 30%)
glottis: 80% (T1 T2 90%, T3 T4 50-60%)
subglottis: 15%
- 5-year survival rate is decreased about 50% in patients with cervical lymph nodes metastases (N+)
and additionally depends on tumor differentiation (G1>>G2>>G3)
- Symptoms of laryngeal cancer depend on primary localization and local progresion of disease
- Hoarseness persisting for more than 2 week must be investigated by an ENT specialist
-