Transcript
Carcinoma of larynx
dr. Sofyan Suri SH, Sp.THT
Faculty of MedicineYARSI University
Jakarta
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 extentb) Treatment modalitiesc) Prognosis
AJCC classification
SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECKLARYNX
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 regionSymptoms: 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 lesionb) The extent of spreadc) Metastasis
Treatment maybe:a) Radiotherapyb) Surgery: conservative laryngeal surgery or total laryngectomyc) Combined therapy
Rehabilitation
By the following methods: A) Written language B) Oesophageal speech
Thank you
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