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LARYNGEAL

CANCER
Duong Thi My

Cancer larynx, Disease of ear, nose, throat, head and


neck surgery
I. EPIDEMIOLOGY AND HISTOPATHOLOGY
II. AETIOLOGY
III. ANATOMY - SUBDIVISION
IV. TNM CLASSIFICATION AND STAGING
V. DIAGNOSIS OF LARYNGEAL CANCER
VI. TREATMENT OF LARYNGEAL CANCER
I. EPIDEMIOLOGY AND HISTOPATHOLOGY
- 2,63% of all body cancer in India
- M : F = 10:1

- Age group: 40-70 years

- 90–95% : squamous cell carcinoma


II. AETIOLOGY

American Cancer Society: Cancer Facts and Figures 2008. Atlanta, Ga: American
Cancer Society, 2008
III. ANATOMY - SUBDIVISION
IV. TNM CLASSIFICATION AND STAGING

Fixed

Source: AJCC Cancer Staging Manual, 6th Ed (2002)


IV. TNM CLASSIFICATION AND STAGING

Source: Greene FL, Page DL, Fleming ID, et al. (editors). American Joint Committee
on Cancer Staging Manual, 6th edition, New York: Springer-Verlag, 2002
IV. TNM CLASSIFICATION AND STAGING
IV. TNM CLASSIFICATION AND STAGING
V. DIAGNOSIS OF LARYNGEAL CANCER
1. History.
“any patient in cancer age group having persistent or
gradually increasing hoarseness for 3 weeks must have
laryngeal examination to exclude cancer”
- Other symptoms: Throat pain, dysphagia, referred pain in
the ear, or mass of lymph nodes in the neck
- Late feature: Weight loss, stridor, respiratory obstruction,
halitosis

2. Indirect laryngoscopy
- Appearance of lesion
- Vocal cord mobility
- Extent of disease
V. DIAGNOSIS OF LARYNGEAL CANCER

3. Examination of neck
- Extralaryngeal spread of disease
- Nodal metastasis
4. Radiography: CT scan or MRI:
- Evaluate pre-epiglottic or paraglottic space
- Laryngeal cartilage erosion
- Cervical node metastasis
Certain
5. Direct laryngoscopy diagnostic
- The hidden areas of larynx test
- Extent of disease
6. Supravital staining and biopsy
VI. TREATMENT OF LARYNGEAL CANCER

Site and Presence or


Distant
extent of absence of
Metastases (M)
lesion (T) Nodes (N)

Treatment
Organ
preservation

Radiotherapy Surgery Combined Endoscopic


therapy CO laser excision
2

(early stage)

Conservation Total
laryngeal surgery laryngectomy Surgery with
pre- or
postoperative
radiotherapy
GLOTTIC CARCINOMA
 1. Carcinoma in situ:

Transoral endoscopic CO laser


2

stripping of vocal cord biopsy

invasive carcinoma carcinoma in situ

radiotherapy Regular follow-up.


Invasive carcinoma
T1

carcinoma with carcinoma with extension


carcinoma
extension to arytenoid
to anterior commissure
The
best
Radiotherapy Radiotherapy

Refused or not avalable absence

Frontolateral
Excision of cord partial
laryngectomy

Fails

total laryngectomy
- Mobility of vocal cord?
- Involvement of anterior commissure
and/or arytenoid? T2N0

Cord mobile Cord mobility impaired


or
Involvement of anterior
Radiotherapy commissure or arytenoid

Failure Vertical
hemilaryngectomy
Conservation Conservation
Failure laryngectomy laryngectomy
Frontolateral
Failure Failure laryngectomy

Total laryngectomy Total laryngectomy


± neck dissection ± neck dissection
If nodes are palpable

T3, T4 total laryngectomy + neck dissection


More advanced T4 : combined therapy: surgery + P.R

Or only Palliative treatment

Subglottic
cancer

T1,T2 T3,T4

Total
laryngectomy and
Radiotherapy P.R

P.R: postoperative radiotherapy


Age of
patient

Subglottic
cancer
Supraglottic cancer

T1 T2 T3 , T4

Lung
function
Radiation or
total laryngectomy
excised with CO2 laser good poor
with neck
dissection
supraglottic laryngectomy and P.R to neck
With or without
neck dissection radiotherapy
Radiotherapy
- Cord mobility: normal

- Invade cartilage or cervical nodes: no

Total laryngectomy:
- T lesions (i.e. with cord fixed)
3

- All T lesions
4

- Invasion of thyroid or cricoid cartilage


- Bilateral arytenoid cartilage involvement
- Lesions of posterior commissure
- Failure after radiotherapy or conservation surgery
- Transglottic cancers, i.e. tumours involving supraglottis
and glottis across the ventricle, causing fixation of the
vocal cord