Predesposing factors :
Tobacoo
Alcohol
Laryngeal cancer is a disease in which malignant Radiation Anatomical incidence :
( cancer ) cells form in the tissues of the larynx Genetic Glottic : 60%
The most common type of laryngeal cancer is susceptibility Supraglottic 35%
GERD Subglottic 5%
squamous cell carcinoma
Most common malignancy in head and neck Precancerous Condition : Surgical pathology :
Age : mostly seen in the age group of 40-70 years Leukoplakia Ulcerative lesion common seen in Glottic and Subglottic
Papilloma ( adult ) Exophytic lesion seen in Supraglottic
But people in thirties may be affected Erythroplakia
Sex : male more than female . Laryngeal
dysplasia
🔹
🔹 Direct : to the adjacent area of larynx and extralarynx
Lymphatic :
Spraglottic : to the upper cervical LN
SPREAD Subglottic : to the lower cervical LN
🔹
Glottic : No lymphatic
Haematogenous : late spread
( lungs , liver , bone , brain )
Clinical Features
🔹 Progressive contiuous hoarseness of voice is the main
🔹
early symptom particulary in glottic cancer
Discomfort in the throat : early in supraglottic CA
🔹
( foreign body sensation )
🔹 Dyspnoea or stridor : early in subglottic CA
🔹 Dysphagia and irritable cough haemoptysis
🔹Local Pain
Referred pain to ear
Clinical picture
Signs
🔷
🔹 Neck examination :
Neck Mass : either LN or mass infiltrating laryngeal
🔹
framework
🔹 Broadening of the larynx
Tenderness of the larynx due to perichondritis and
🔷
infilrtration of inner perichondrium
🔹TheLarynx examination :
growth may be seen on indirect laryngoscopy or
fibreoptic laryngoscopy as raised nodular , papilliferous
or ulcerative lesion , with or without fixation of the cordsjh
🔹
1- Radiological examination :
CT scan of the neck : which shows extension of the
Investigation
🔹
lesion and involvement of cartilages
X-ray of the chest : rules out the presence of
secondaries and other associated pathology
🔷 2- Direct laryngoscopy:
Under GA to mapping and biopsy taken
Sites
🔹 Supraglottis :
Suprahyoid epiglottis and infrahyoid epiglottis
Aryepiglottic folds ( laryngeal aspect only )
Arytenoids
🔹
Ventricular bands ( false cords )
Glottis:
True vocal cords including anterior and posterior
Cancer of the Larynx 🔹
commissure
Subglottis :
Subglottic up to lower border of cricoid cartilage ( more
than 10 mm below free margin of true vocal cord )
🔹
Primary tumor ( T )
Classification and staging 🔹
🔹
Tx : primary tumour cannot be assesd
T0 : no evedence of primary
🔹 T is : carcinoma insitu
T1 : tumor limited to one side of larynx with normal
🔹
vocal fold mobility
T2 : tumor extending to more than one site with normal
🔹
fold mobility
🔹T3T4 :: tumor limited to larynx with vocal fold fixation
tumor extending beyond the larynx
TNM system classification
🔹T : indicate tumour and its extent e.g : T1 , T2 , T3 etc… 🔹
Lymph Node ( N )
🔹 N : indicates regional lymph node enlargement and its 🔹 N0 : no clinically positive nodes
N1 : single clinically positive ipsilateral node 3cm or less
🔹M : indicates distant metastasis e.g : M0 , M1
size e.g : N0 , N1, N2 , N3
🔹
in diameter
N2 : single clinically positive node more than 3cm but
by fatema okoff
🔹
less than 6cm
N3 : massive epislateral nodes ( > 6cm ) or bilateral or
contralateral nodes
🔹
Distance metastasis ( M )
🔹M0 : no evidence of distance metastasis
M1 : tumor with distance metastasis
Indications of Total Laryngectomy
Type T3 and T4
Transgluttic CA
Fixation of vocal cord
Involve both arytenoid
Failure of partial laryngectomy
Cordectomy
Curative treatment
🔹
Laryngeal CA is curable specially in stage T1 and T2
🔹
Types of laryngectomy
🔹Total laryngectomy
🔹
🔹
Radiotherapy
Surgery Partial laryngectomy:
Cordectomy
🔹 Combined ( Radiotherapy and Surgery )
Chemotherapy :
chemotherapy and radiotherapy
Vertical laryngectomy
Horizontal laryngectomy
chemotherapy and surgery Subtotal laryngectomy ( supracricoid)
Subtotal laryngectomy( Supracricoid
laryngectomy )
Treatment
🔹
Palliative treatment
🔹Medications
🔹Palliative surgery ( tracheostomy \ gastrostomy )
Palliative radiotherapy and chemotherapy
🔹good
Prognosis
Glottic :
prognosis due to early symptoms ( hoarseness )
🔹badSpraglottic
and no lymphatic metastasis
and subglottic :
prognosis due to lymphatic spread
Voice Rehabilitation
1- Esophageal Speech Technique
2- Electrolarynx Speech Technique
3- Tracheo-Esophageal Prosthesis (TEP) Speech
Tobacoo
Alcohol
Laryngeal cancer is a disease in which malignant Radiation Anatomical incidence :
( cancer ) cells form in the tissues of the larynx Genetic Glottic : 60%
The most common type of laryngeal cancer is susceptibility Supraglottic 35%
GERD Subglottic 5%
squamous cell carcinoma
Most common malignancy in head and neck Precancerous Condition : Surgical pathology :
Age : mostly seen in the age group of 40-70 years Leukoplakia Ulcerative lesion common seen in Glottic and Subglottic
Papilloma ( adult ) Exophytic lesion seen in Supraglottic
But people in thirties may be affected Erythroplakia
Sex : male more than female . Laryngeal
dysplasia
🔹
🔹 Direct : to the adjacent area of larynx and extralarynx
Lymphatic :
Spraglottic : to the upper cervical LN
SPREAD Subglottic : to the lower cervical LN
🔹
Glottic : No lymphatic
Haematogenous : late spread
( lungs , liver , bone , brain )
Clinical Features
🔹 Progressive contiuous hoarseness of voice is the main
🔹
early symptom particulary in glottic cancer
Discomfort in the throat : early in supraglottic CA
🔹
( foreign body sensation )
🔹 Dyspnoea or stridor : early in subglottic CA
🔹 Dysphagia and irritable cough haemoptysis
🔹Local Pain
Referred pain to ear
Clinical picture
Signs
🔷
🔹 Neck examination :
Neck Mass : either LN or mass infiltrating laryngeal
🔹
framework
🔹 Broadening of the larynx
Tenderness of the larynx due to perichondritis and
🔷
infilrtration of inner perichondrium
🔹TheLarynx examination :
growth may be seen on indirect laryngoscopy or
fibreoptic laryngoscopy as raised nodular , papilliferous
or ulcerative lesion , with or without fixation of the cordsjh
🔹
1- Radiological examination :
CT scan of the neck : which shows extension of the
Investigation
🔹
lesion and involvement of cartilages
X-ray of the chest : rules out the presence of
secondaries and other associated pathology
🔷 2- Direct laryngoscopy:
Under GA to mapping and biopsy taken
Sites
🔹 Supraglottis :
Suprahyoid epiglottis and infrahyoid epiglottis
Aryepiglottic folds ( laryngeal aspect only )
Arytenoids
🔹
Ventricular bands ( false cords )
Glottis:
True vocal cords including anterior and posterior
Cancer of the Larynx 🔹
commissure
Subglottis :
Subglottic up to lower border of cricoid cartilage ( more
than 10 mm below free margin of true vocal cord )
🔹
Primary tumor ( T )
Classification and staging 🔹
🔹
Tx : primary tumour cannot be assesd
T0 : no evedence of primary
🔹 T is : carcinoma insitu
T1 : tumor limited to one side of larynx with normal
🔹
vocal fold mobility
T2 : tumor extending to more than one site with normal
🔹
fold mobility
🔹T3T4 :: tumor limited to larynx with vocal fold fixation
tumor extending beyond the larynx
TNM system classification
🔹T : indicate tumour and its extent e.g : T1 , T2 , T3 etc… 🔹
Lymph Node ( N )
🔹 N : indicates regional lymph node enlargement and its 🔹 N0 : no clinically positive nodes
N1 : single clinically positive ipsilateral node 3cm or less
🔹M : indicates distant metastasis e.g : M0 , M1
size e.g : N0 , N1, N2 , N3
🔹
in diameter
N2 : single clinically positive node more than 3cm but
by fatema okoff
🔹
less than 6cm
N3 : massive epislateral nodes ( > 6cm ) or bilateral or
contralateral nodes
🔹
Distance metastasis ( M )
🔹M0 : no evidence of distance metastasis
M1 : tumor with distance metastasis
Indications of Total Laryngectomy
Type T3 and T4
Transgluttic CA
Fixation of vocal cord
Involve both arytenoid
Failure of partial laryngectomy
Cordectomy
Curative treatment
🔹
Laryngeal CA is curable specially in stage T1 and T2
🔹
Types of laryngectomy
🔹Total laryngectomy
🔹
🔹
Radiotherapy
Surgery Partial laryngectomy:
Cordectomy
🔹 Combined ( Radiotherapy and Surgery )
Chemotherapy :
chemotherapy and radiotherapy
Vertical laryngectomy
Horizontal laryngectomy
chemotherapy and surgery Subtotal laryngectomy ( supracricoid)
Subtotal laryngectomy( Supracricoid
laryngectomy )
Treatment
🔹
Palliative treatment
🔹Medications
🔹Palliative surgery ( tracheostomy \ gastrostomy )
Palliative radiotherapy and chemotherapy
🔹good
Prognosis
Glottic :
prognosis due to early symptoms ( hoarseness )
🔹badSpraglottic
and no lymphatic metastasis
and subglottic :
prognosis due to lymphatic spread
Voice Rehabilitation
1- Esophageal Speech Technique
2- Electrolarynx Speech Technique
3- Tracheo-Esophageal Prosthesis (TEP) Speech
