4/14/2009 1 MALIGNANT TUMORS MALIGNANT TUMORS OF THE LARYNX OF THE LARYNX Prof Prof Hesham Hesham Abd Abd Al Al –Fattah Fattah OF THE LARYNX OF THE LARYNX Department of Otolaryngology H & N Surgery Department of Otolaryngology H & N Surgery University of Alexandria University of Alexandria LARYNGEAL MASSES TUMOUR-LIKE TUMOURS CONGENITAL ACQUIRED BENIGN MALIGNANT •SACCULAR CYST •LARYNGOCELE •TRAUMATIC •NODULES •POLYPS •INTUBATION GRANULOMA •INFLAMMATORY •PAPILLOMA •MJP & ADULT •HAEMANGIOMA •CHONDROMA •PRIMARY •INFLAMMATORY •ADV REFLUX LARYNGITIS •RIENKE’S OEDEMA >> D POLYP •VENTRICULAR PROLAPSE •REACTIVE •HYPERKERATOSIS •LEUKOPLAKIA •ERYTHROPLAKIA •SCC •VERRUCOUS •ADENOID CYS •LYMPHOEPI •SECONDARY •HYPOPHARYN •THYROID •METASTATIC 5.5.2008 5.5.2008 2 Prof Hesham Abd Al Prof Hesham Abd Al-Fattah Fattah
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5. Malignant Tumours of the Larynx (Prof. Hesham Fattah
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4/14/2009
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MALIGNANT TUMORSMALIGNANT TUMORSOF THE LARYNXOF THE LARYNX
Prof Prof HeshamHesham AbdAbd Al Al ––FattahFattah
OF THE LARYNXOF THE LARYNX
Department of Otolaryngology H & N SurgeryDepartment of Otolaryngology H & N SurgeryUniversity of AlexandriaUniversity of Alexandria
LARYNGEAL MASSES
TUMOUR-LIKE TUMOURS
CONGENITAL ACQUIRED BENIGN MALIGNANT
•SACCULAR CYST•LARYNGOCELE
•TRAUMATIC•NODULES•POLYPS•INTUBATION GRANULOMA
•INFLAMMATORY
•PAPILLOMA•MJP & ADULT
•HAEMANGIOMA•CHONDROMA
•PRIMARY•INFLAMMATORY•ADV REFLUX LARYNGITIS•RIENKE’S OEDEMA >> D POLYP•VENTRICULAR PROLAPSE
1212y M spasmodic coughy M spasmodic cough 4545y M on steroids for SLEy M on steroids for SLE5.5.20085.5.2008 1313Prof Hesham Abd AlProf Hesham Abd Al--FattahFattah
Predisposing FactorsPredisposing Factors
1.Hydrocarbons2.Tar & Benzopyrenes3.Pesticides4.Radiation5 Genetic ( ariable non consistent genes)5.Genetic (variable non consistent genes)
6.Chronic Inflammation7.Enzymes (acid-pepsin)
8.Viruses (papillomatosis)
•Non-Specific(common)•Specific
•T.B. (rare)•Syphilis ( does not exist)
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LateralMedialArcuate Line
Glottic
I. According to its Location
1 cm
SupraglotticGlotticSubglotticTransglottic sc
ulat
ure
•parallel to vascular arcades
Lateral Arcuate line
Changes:
Tumour Location Cor
d Va
sarcades
•Sٍquamous to pseudo stratified epithelium
•Scarce dispersed to frequent lymphatics
• vocal ligament to vocalis muscle5.5.20085.5.2008 1515Prof Hesham Abd AlProf Hesham Abd Al--FattahFattah
II. According to its Pathology 1. N.E.A
Supraglottic are derived from the Supraglottic are derived from the 44thth
BranchialBranchial arch and Glottic & arch and Glottic & subglotticsubglotticfrom the from the 66thth explaining the different explaining the different bldbld
d l h ti l Td l h ti l T
i. Ulcerating(everted edges)
ii. Fungating ( exophytic)
, nerve and lymphatic supply. Tumors , nerve and lymphatic supply. Tumors respect this embryological and respect this embryological and anatomical barrieranatomical barrier
iii. Infiltrating ( submucosal5.5.20085.5.2008 1616Prof Hesham Abd AlProf Hesham Abd Al--FattahFattah
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II. According to its Pathology2.Microscopic Appearance
Original Broder’s•Grade I-IV,•0-100%•UndifferentiatedX5.5.20085.5.2008 1717Prof Hesham Abd AlProf Hesham Abd Al--FattahFattah
III. According To T.N.M ClassificationT-primary tumour:T1: tumour confined to one anatomical site in the regionT2: tumour involves more than one anatomical sitein the same region or adjacent region without cord fixationg j gT3: Cord fixation or pre-epiglottic/ Postcricoid/ Internal
Perichondrium invasionT4: Cartilage invasion or direct extralaryngeal spread
N-regional Lymph nodeN1: < 3 cm diameter lymph node enlargementN2: 3-6 cm diameter lymph node enlargementN3: >6 cm diameter lymph node enlargement
M-distant metastasesM0: No evidence of distant metastasesM1: Evidence of distant metastases
(AJC 1998/2005)5.5.20085.5.2008 1818Prof Hesham Abd AlProf Hesham Abd Al--FattahFattah
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StagesStage1: T1N0M0
III. According To T.N.M Classification
Stage2: T2N0M0Stage3: T3N0M0, T1,2,3 N1M0,Stage4: a. T4N0M0
b. Any T , N2 or more , M0b. Any T , N2 or more , M0c. Any T , Any N + M1
5.5.20085.5.2008 1919Prof Hesham Abd AlProf Hesham Abd Al--FattahFattah
a.a. Plain Neck & ChestPlain Neck & Chestb.b. Barium Swallow & MealBarium Swallow & Mealc.c. Ultrasound AbdomenUltrasound Abdomend.d.MultiMulti--slice CT scan Neck &Upper Chestslice CT scan Neck &Upper Cheste.e. Bone Scan (Whole Body Isotope study)Bone Scan (Whole Body Isotope study)5.5.20085.5.2008 2424Prof Hesham Abd AlProf Hesham Abd Al--FattahFattah
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ManagementManagementDiagnosis &Diagnosis & TreatmentTreatmentAim of Treatment1.Local Control2.Regional Control3.Distal Control4.Rehabilitatione ab tat o5.Palliation
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