4. Histology And lymph Ns
Supraglottic Thyrohyoid membrane
Deep Cervical LN
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5. Epidemiology
Laryngeal cancer
- the second most common type of head and neck cancer
worldwide
- the 11th most common cancer in men worldwide but is much
less common in women.
- Men have as much as 30 times the risk that of women .
- Older individuals are at a higher risk ; the highest number
(age 60-74 years).
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6. Epidemiology (cont. )
The percentage of laryngeal cancers that
originate in the supraglottis varies from country
to country.
In the United States:
approximately 30-40% of laryngeal cancers originate in the
supraglottis, while most occur in the glottis.
In Spain and Finland :
the supraglottis is the most frequent subsite .
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7. Etiology (as risk factors)
- Tobacco and Alcohol use
Some studies have show that 97% of patients with laryngeal cancer
smoked. When compared with men who did not smoke, men who smoked
at least 1.5 packs of cigarettes per day for more than 10 years were found
to have a 30-fold increased risk of developing laryngeal cancer.
Other factors associated with laryngeal SCC :
- Dietary deficiencies .
- radiation exposure .
- human papillomavirus (HPV) .
- gastroesophageal reflux .
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8. Pathophysilogy
The supraglottis is embryologically derived from the
buccopharyngeal anlage in the region of the third and
fourth branchial arches.
Despite the theoretical separation of the supraglottis from the rest of the
larynx, no anatomical or histological barrier has been identified.
Furthermore, supraglottic tumors invading the paraglottic space have
access to the glottis via the medial surface of the thyroid cartilage.
Lymphatic vascularity in the supraglottis is much
denser than in the glottis and subglottis. This is
important in the development of supraglottic cancer and
leads to a significantly higher incidence of cervical
lymph node metastases in tumors of this subsite.
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10. Symptoms
1. Hoarseness of voice:
First symptom in glottic but late in subglottic and
supraglottic
2. Discomfort in throat:
First symptom in supraglottic carcinoma.
3. Pain, dysphagia, otalgia
4. Stridor
5. Neck swelling
6. Anorexia
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12. Staging
T1- tumor limited to one subsite of the supraglottis with
normal vocal cord mobility
T2- tumor invades one adjacent site of the supraglottis or
glottis or one region outside of the supraglottis without
fixation of the vocal cords
T3- tumor limited to the larynx with vocal cord fixation or
invasion into the area behind the larynx or in front of the
larynx
T4- tumor invades outside of the larynx (trachea, soft tissues
of the neck, etc.)
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13. Investigation
- Biopsy is required for diagnosis
Performed in OR with patient under anesthesia .
- Direct laryngoscopy
- Bronchoscopy
- Esophagoscopy
- Chest X-ray
- CT or MRI
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14. Treatment
Specific treatment will be determined by the
physician(s) based on:
1- patient’s age, overall health, and medical history
2- extent of the disease
3- expectations for the course of the disease
4- patient’s tolerance for specific medications, procedures
or therapies
5- patient’s opinion or preference
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15. Treatment
Early stages (T1 and T2)
- Can be treated with radiotherapy or surgery
alone, both offer the 85-95% cure rate.
- Surgery has a shorter treatment period, saves
radiation for recurrence, but may have worse voice
outcomes
- Radiotherapy is given for 6-7 weeks, avoids
surgical risks but has own complications
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16. Treatment
Advanced stages
- Lesions often receive surgery with
adjuvant radiation .
- Most T3 and T4 lesions require a total
laryngectomy .
- Some small T3 and lesser sized tumors
can be treated with partial laryngectomy .
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17. Prognosis
Cancer larynx has good prognosis with 67% 5-year
survival rate.
Glottic malignancy has better prognosis than
supra-glottic malignancy due to
1. Early presentation and diagnosis .
2. Less lymphatic spread .
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Early presentation and diagnosis (Hoarseness of voice is a manifestation of vocal fold affection while the supraglottis is wide).
Less lymphatic spread (Vocal fold have little if any lymphatic drainage while the supraglottic region has abundant lymphatic drainage)
