CARCINOMA OF LARYNX
* EPIDEMIOLOGY • 6th commonest cancer world wide.
* Cancer larynx constitutes 2.63% of all body cancers in India.
* Age group – 40 to 70 years. • More common in males.
* ETIOLOGY • Tobacco – Benzopyrene is a carcinogen. Less than 5% cancer occurs in non-smoker • Alcohol – synergistic with tobacco • Radiation • Genetic • Environmental exposure - Asbestos, mustard gas. • Tumors – solitary papilloma, leukoplakia, erythroplakia..
* HISTOPATHOLOGY • 90-95% are squamous cell carcinoma with various grades of differentiation • 5-10% lesion includes • Verrucous carcinomas • Spindle cell carcinomas • Malignant salivary gland tumors • Sarcomas
* SUPRAGLOTTIC CANCER • EPIGLOTTIS • VENTRICULAR BAND • ARYEPIGLOTTIC FOLD • VENTRICLE SITE SPREAD OF TUMOR LOCAL LYMPHATIC
* SYMPTOMS • Muffled voice - hot potato speech • Hoarseness of voice • Foreign body sensation • Dysphagia • Pain throat and referred otalgia(via vagus) • Neck swelling • Aspiration • Stridor
* GLOTTIC CANCER • Most commonly involved • Free edge and upper surface of vocal cord is the most frequent site
* YMPTOMS • Persistence Hoarseness – cardinal feature • Cough due to aspiration • Dyspnea • Stridor • Hemoptysis -rare
* SUBGLOTTIC CARCINOMA • Rare 1-5% • Invades cricothyriod membrane, thyroid gland and strap muscles of neck • Lymphatic metastasis • Prelaryngeal • Paratracheal • Lower jugular nodes • Symptoms • Stridor or laryngeal obstruction • Hoarseness -late feature
* DIAGNOSIS -
* 1HISTORY - any patient in cancer age group having persistent or gradually increasing hoarseness for 3 weeks must have laryngeal examination to exclude cancer.
* Indirect Laryngoscopy • Appearance of lesion • Vocal cord mobility • Extent of disease • Lesions of suprahyoid epiglottis are usually exophytic & infrahyoid epiglottis lesions are ulcerative. • Lesions of vocal cord may appear as raised nodule, ulcer or thickening. • Lesions of anterior commissure may appear as granulation tissue. • Lesions of subglottic region appear as a raised submucosal nodule.
* Video laryngoscopy.
* Examination of neck. 1. Extralaryngeal spread of disease 2. nodal metastasis.
* Radiography • X-RAY chest • Soft tissue lateral view • CT /MRI scan
* DIRECT LARYNGOSCOPY
* MICROLARYNGOSCOPY
* SUPRAVITAL STAIN AND BIOPSY
* TREATMENT -
* 1.Radiotherapy 2. Surgery a. Conservation laryngeal surgery. b. Total laryngectomy 3. Combined therapy. Surgery with pre- or postoperative radiotherapy 4. Endoscopic CO2 laser excision 5. Organ preservation
* TREATMENT PLAN • For the first and second stages • Radiation therapy and/or conservative surgery • For the third and fourth stages • Radical surgery • Total laryngectomy • Laryngopharyngectomy • Combined with unilateral radical neck dissection with or without contralateral modified neck dissection • Post operative radiotherapy
* RADIOTHERAPY CURATIVE – 6500 grays/30 fraction for 6 weeks. 90% cure rate, if vocal mobility is not impaired. SURGERY INDICATIONS • Fixed cords • Subglottic extension • Cartilage invasion • Nodal metastases.
* CONSERVATIVE SURGERY ADVANTAGES • Preserves voice • Avoids permanent tracheostome. INCLUSION UNDER CONSERVATIVE SURGERY • a. Excision of vocal cord after splitting the larynx -cordectomy via laryngofissure. • b. Excision of vocal cord and anterior commissure region -partial frontolateral laryngectomy. • c. Excision of supraglottis, i.e. epiglottis, aryepiglottic folds, false cords and ventricle -partial horizontal laryngectomy.
* TOTAL LARYNGECTOMY • The entire larynx including the hyoid bone, pre-epiglottic space, strap muscles and one or more rings of trachea are removed.
* Combined therapy. Surgical ablation may be combine with pre- or postoperative radiation to decrease the incidence of recurrence. • Endoscopic resection with CO2 laser T1 lesions of the supra- or infrahyoid epiglottis with or without neck nodes are treated with CO2 laser. Laser excision has the advantages of lower cost, lower duration of treatment and morbidity.
* PROGNOSIS 5 YEAR SURVIVAL STAGE I 95% STAGE II 85-90% STAGE III 70-80% STAGE IV 50-60%
* VOCAL REHABILITATION AFTER TOTAL LARYNGECTOMY
* ELECTROLARYNX Vibrating disc is held against the soft tissues of the neck and a low-pitched sound is produced in the hypopharynx which is further modulated into speech by tongue, lips, teeth and palate

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