Carcinoma of larynx

Faculty of Medicine
YARSI University
Jakarta
dr. Sofyan Suri SH, Sp.THT

Normal Larynx

Normal vs. Cancerous

Normal

Cancer (beginning
stage)

Squamous
Ca of larynx

Normal larynx

Aetiology
Classification and staging
Supraglottic, glottic and subglottic
cancer
Diagnosis
Treatment
Vocal rehabilitation

Aetiology

Classification and staging

TNM classification and staging

Classification by AJCC

TNM classification and staging

Helps to determine :
a) The extent
b) Treatment modalities
c) Prognosis

AJCC classification

SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK

LARYNX

MOST COMMON NONCUTANEOUS SITE OF SCC IN

THE HEAD AND NECK
SUPRAGLOTTIC: EMBRYOLOGICALLY DERIVED FROM
BUCCOPHARYNX
GLOTTIC AND SUBGLOTTIC: DERIVED FROM
TRACHEOBRONCIAL TREE
TNM CLASSIFICATION DEPENDS UPON VOCAL CORD
INVOLVEMENT AND TUMOR EXTENSION

SQUAMOUS CELL CARCINOMA OF

THE HEAD AND NECK
STAGING

AMERICAN JOINT COMMITTEE ON CANCER.

T = TUMOR SIZE

T1

<2 CM DIAMETER

T2

2-4 CM DIAMETER

T3

>4 CM DIAMETER

T4

>4 CM WITH INVASION OF

ADJACENT STRUCTURES

SQUAMOUS CELL CARCINOMA OF

THE HEAD AND NECK
STAGING

N = NODAL BASINS:
N
NO POSITIVE NODES
0

N1

SINGLE NODE <3 CM DIAMETER

N2

3-6 CM DIAMETER

N3

>6 CM DIAMETER

M = METASTATIC DISEASE
M
NO METASTASIS
0

M1

METASTASIS

SQUAMOUS CELL CARCINOMA OF

THE HEAD AND NECK
STAGING

STAGE I

T1N0M0

STAGE II

T2N0M0

STAGE III

T3N0M0, T1 or T2 or T3, N1 or M0

STAGE IV

T4N0 or N1, M0
ANY T, N2 or N3, M0
ANY T, ANY N, M1

Supraglottic cancer

Less frequent than glottic cancer

Majority of lesions are seen on epiglottis,
false cords, aryepiglottic folds
Spread: vallecula, base of the tongue,
pyriform fossa and even penetrate the
thyroid
Symptoms: often silent, may present with
throat pain, dysphagia and referred painear, mass in the neck

SQUAMOUS CELL CARCINOMA OF

THE HEAD AND NECK
LARYNX - SUPRAGLOTTIC

STAGE I & II: RADIOTHERAPY (PRESERVES

VOICE) OR HEMILARYNGECTOMY
LYMPHATIC SPREAD AS HIGH AS 50%
LARYNGEAL SUSPENSION REQUIRED TO
PREVENT ASPIRATION AFTER
HEMILARYNGECTOMY
STAGE III & IV: LARYNGECTOMY
FIVE YEAR SURVIVAL 37-57%

Supraglottic

Glottic cancer
Most common- 65%
Spread: anteriorly- anterior commisure
posteriorly- vocal process and
arytenoid process
Upward- ventricle and false cord
Downward- Subglottic region
Symptoms: Hoarseness of voice, stridor

SQUAMOUS CELL CARCINOMA OF

THE HEAD AND NECK
LARYNX - GLOTTIC

TREATMENT: RADIOTHERAPY OR SURGERY

(HEMILARYNGECTOMY)
LYMPH NODE METASTASIS 2% (LOW)
FIVE YEAR SURVIVAL IN THE EARLY STAGES 90%
STAGE III & IV: TOTAL LARYNGECTOMY

Glottic

Subglottic cancer

Lesions rare
Spread: Anterior wall, to the
opposite side or downwards to the
trachea
May invade cricothyroid membrane,
thyroid gland and muscles of neck
Symptoms: Stridor

SQUAMOUS CELL CARCINOMA OF

THE HEAD AND NECK
LARYNX - SUBGLOTTIC

RARE

RADIOTHERAPY OR SURGERY

Subglottic

Diagnosis

History: any patient may present with:

..A sore throat that does not go away
..Dysphagia
..A change or hoarseness in voice
..Pain in the ear
..A lump in the neck

Examination: done to find extra laryngeal

spread of disease and nodal metastasis

Investigation

Laryngoscopy:
indirect, direct or
micro

Radiography
CT
Staining and biopsy

Treatment

Depends upon:
a) The site of lesion
b) The extent of spread
c) Metastasis

Treatment maybe:
a) Radiotherapy
b) Surgery: conservative laryngeal
surgery or total laryngectomy
c) Combined therapy

Rehabilitation

By the following methods:

A) Written language
B) Oesophageal speech

Thank you