Cancer of The Larynx

Çağatay OYSU, M.D.

Professor of Otolaryngology
 Could an otolaryngologist
have prevented World War I ?

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• In 1886 the Crown Prince Frederick of
Germany developed hoarseness as he was
due to ascend the throne.

• Was evaluated by Sir Makenzie of London,

the inventor of the direct laryngoscope

• Frederick’s lesion was biopsied and

thought to be cancer

• He refused laryngectomy and later died in

1888

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• Frederick was succeeded by Kaiser Wilhelm II, who along with Otto von
Bismark militarized the German Empire and led them into WW I

• German surgeon Billroth who performed first successful laryngectomy 1883

may prevent the war.

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Incidence
THSK 2010-2014 Yılları Türkiye
Kanser İstatistikleri, 2017
• Male: 6-8/100.000
• Female: 0.4-0.5/100.000
• 5655 cases in 5 years
World
• Laryngeal cancer is relatively low
compared with that of carcinomas
of all sites, comprising about 2 % of
all cancers.
• 10,000 new cases of laryngeal
cancer and 4,000 deaths related to
laryngeal cancer were expected to
occur in the United States in the
year 2000.
• Most prevalent in the 6th and 7th
decades of life
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 Etiology

• Tobacco use is a major risk factor for the development of the larynx cancer

• French study showed a 13-fold increase in laryngeal cancer in smokers; 34-

fold increase in those consumning 1.5 L/day of wine.

• The two substances together have a synergistic effect on laryngeal tissues

• Beer and hard liquour are sugested to be more at fault than wine.

• Chemical carciongens: asbestos, nickel, mineral oils, glass-wool.

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 Symptoms
Early recognition of malignancies of the larynx is crucial for good out
come and preservation of the functions.

• Hoarseness persisting longer than 2- 4 weeks should be investigated.

• An enlarged lymph node or lump in the neck
• Airway obstruction, difficulty breathing, and noisy breathing
• Persistent sore throat or a feeling that something is caught in the throat
• Difficulty swallowing that does not go away
• Ear pain
• Chronic bad breath
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 Diagnosis: Laryngoscopy
Every patient with hoarseness should be examined by
laryngoscopy and if indicated, the larynx is biopsied.

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Diagnosis: videolaryngoscopy

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 Diagnosis: videolaryngoscopy
(endoscopic evaluation)

• Extend of cancer and staging of disease can be done in office by

endoscopy.

• Vocal cord mobility is best assessed preoperatively.

• Good neck exam looking for cervical lymphadenopathy and broadening

of the laryngeal prominence is required

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Videolaryngoscopy

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 Diagnosis: Direct laryngoscopy and endoscopy

• It is important to obtain biopsy specimens from obvious tumor and any

additonal suspicous areas.

• Operative microscobe allows better visualisations of the larynx.

• Endoscopy is also required to rule out the existence of a second

malignancy

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Direct Laryngoscopy (microlaryngoscopy)

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 Pathology

• %95 of laryngeal malignancies are squamous cell carcinoma (epidermal

carcinoma).

• Malignancy of larynx has often been considered synonymous with

squamous cell carcinoma

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Precursors of the Squamous Cell Carcinoma

A. In Situ SCC
B. Microinvasive SCC
C. Invasive SCC

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A. In Situ Carcinoma

 DEFINITION: Cellular dysplasia involving the entire thickness of the

mucosa without compromise of the basement membrane
Mostly involves true vocal cords
Hoarseness presenting complaint

 TREATMENT AND PROGNOSIS :

Conservative mucosal stripping or irradiation
Periodic laryngoscopic examinations
Treatment failures related to undetected invasive SCC

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Anatomy

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Supraglottic Cancer

 Accounts for 25–40 % of all laryngeal SCC

Supraglottic tumors more aggressive:
– Lymph node metastasis

– Direct extension into pre-epiglottic space

– Direct extension into lateral hypopharnyx, glossoepiglottic fold,

and tongue base

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Supraglottic Cancer

TREATMENT AND PROGNOSIS:

T1 and T2 : Conservation surgery:

supraglottic laryngectomy with neck
dissection. (alternatively: radiotherapy)

T3 and T4 : Surgery+ postoperative RT

Overall 5 year survival rate is

75 %

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SUPRAGLOTTIC LARYNGECTOMY

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Glottic Cancer

CLINICAL :
• Majority of laryngeal cancers (60–75 %)
• Hoarseness is presenting symptom (usually early diagnosis)
• Amenable to conservative surgery
• Glottic tumors grow slower and tend to metastasize late owing to a paucity
of lymphatic drainage
• They tend to metastasize after they have invaded adjacent structures with
better drainage
• Extend superiorly into ventricular walls or inferiorly into subglottic space
• Can cause vocal cord fixation

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 Glottic Cancer
• TREATMENT AND PROGNOSIS :
• T1 and T2: Conservative surgery or RT

• T3 and T4 : Conservative surgery or total laryngectomy+ NECK DISSECTION

• OR
• RT+CHEMO

• Overall 5 year survival rates:

• T1 > 90%
• T2: 85%
• T3: 55%
• T4: 40-30%

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Endoscopic Cordectomy

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Hemilaryngectomy

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Subglottic Cancer
 CLINICAL :
True subglottic tumors are uncommon (1 %)
Tend to remain clinically quiescent --presenting with
advanced disease
Presenting symptoms -- dyspnea, stridor and voice
changes
Increases chance of bilateral disease and mediastinal
extension
Total Laryngectomy is treatment of choice

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SUBGLOTTIC SCC
 TREATMENT AND PROGNOSIS:
T1 and T2 -- Conservative surgery or radiotherapy
In general present with advanced disease usually necessitates a total
laryngectomy

Overall 5 year survival rates -- < 40

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Take Home Messages-1

• Squamous cell carcinoma (SCC) accounts for 85% to 95% of

malignant laryngeal tumors.

• Tobacco and alcohol are the two most important risk factors for
the development of laryngeal SCC.

• Laryngeal SCC occurs in the glottis more frequently than in the

supraglottis. Subglottic SCC is rare.

• Laryngeal preservation may be achieved in properly selected

cases by the use of conservation laryngeal surgery (partial
laryngectomy), radiotherapy, or chemoradiotherapy. 46
Take Home Messages-2

• Advanced (stage III and IV) laryngeal SCC is generally

treated with combined-modality therapy.

• Endoscopic partial laryngectomy (transoral laser

microsurgery) has similar oncologic outcomes to open
partial laryngectomy with less functional morbidity.

• Total laryngectomy is the gold standard surgical procedure

for the treatment of advanced laryngeal SCC.

• The stage of disease is the most important factor

predictive of prognosis, with nodal stage more significant
than tumor stage.

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