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:
 N0 NO POSITIVE NODES
 N1 SINGLE NODE <3 CM DIAMETER
 N2 3-6 CM DIAMETER
 N3 >6 CM DIAMETER

 M = METASTATIC DISEASE
 M0 NO METASTASIS
 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 pain-
ear, 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