Recommended
More Related Content
What's hot
What's hot (20)
Similar to Laryngeal carcinoma by oshin manoharan
Similar to Laryngeal carcinoma by oshin manoharan (20)
Recently uploaded
Recently uploaded (20)
Laryngeal carcinoma by oshin manoharan
- 1. LARYNGEAL CARCINOMA DIAGNOSIS & TREATMENT OSHIN MANOHARAN S7 GMC PALAKKAD
- 2. DIAGNOSIS • HISTORY “Any patient in cancer age group having persistent or gradually increasing hoarseness for 3 weeks must have laryngeal examination to exclude cancer.”
- 3. INDIRECT LARYNGOSCOPY Appearance of lesion • Suprahyoid epiglottis : exophytic lesion • Infrahyoid epiglottis : ulcerative lesion • Vocal cord : raised nodule, ulcer or thickening • Anterior commissure : granulation • Subglottic region :raised sub mucosal nodule Vocal cord mobility • Impairment or fixation • deeper infiltration • Invasion of recurrent laryngeal nerve Extent of the disease
- 4. • Flexible fibreoptic or rigid laryngoscopy or video laryngoscopy • Examination of neck – Extralaryngeal spread – Nodal metastasis
- 5. RADIOGRAPHY X RAY chest • Coexistent lung disease • Pulmonary metastasis • Mediastinal nodes Soft tissue lateral view neck • Extent of lesion • Destruction of thyroid cartilage CT scan • Extent of tumor • Invasion to pre epiglottic and paraglottic space • Destruction of cartilage • Cervical node involvement MRI • Recurrent cancer after radiotherapy
- 6. Direct laryngoscopy • Visualise hidden areas of larynx • Infrahyoid epiglottis, anterior commissure, subglottis and ventricles • Extent of the disease Microlaryngoscopy • Small lesions of vocal cord • Taking biopsy without damaging the vocal cord
- 7. • Supravital staining and biopsy – Selection of site for biopsy in leukoplakic lesion – Carcinoma in situ and superficial carcinoma take up the stain – Leukoplakic lesion will not Toluidine blue is applied to laryngeal lesion Washed with saline Examined under microscope
- 9. Treatment depends upon • Site of lesion • Extent of lesion • Metastasis
- 10. RADIOTHERAPY • Curative radiotherapy – Neither impairment of vocal cord mobility nor invasion of cartilage or cervical nodes • Advantage – Voice is preserved • Not suitable when – Fixed cord – Subglottic extension – Cartilage invasion – Nodal metastasis CURE RATE Vocal cord mobility not impaired 90% Superficial exophytic lesion of tip of epiglottis and aryepiglottic folds 70-90%
- 11. SURGERY • CONSERVATION SURGERY – Conservation surgery include • Excision of vocal cord after splitting the larynx – Cordectomy via laryngofissure • Excision of vocal cord and anterior commissure region : – Partial frontolateral laryngectomy • Excision of supraglottis : partial horizontal laryngectomy – Advantages • Voice is preserved • No need of permanent tracheal opening
- 12. TOTAL LARYNGECTOMY • Pharyngeal wall repaired • Lower tracheal stump sutured to the skin for breathing • Laryngectomy + block dissection : nodal metastasis • Contraindicated – Distant metastasis Larynx Hyoid bone Pre epiglottic space Strap muscles Tracheal rings 1 or more
- 13. Indications • T3 lesion ( vocal cord fixed) • All T4 lesions • Invasion of thyroid and cricoid cartilage • B/L arytenoid cartilage involvement • Lesion of posterior commissure • Failure after radiotherapy or conservation therapy • Transglottic cancers Disadvantages • Voice not preserved • Permanent tracheostome
- 14. Combined therapy • Decreases incidence of recurrence • Helps to resect fixed nodes Endoscopic resection with CO2 laser • Ca of mobile membranous vocal cord • T1 lesion of supra or infrahyoid epiglottis with or without neck nodule • Advantages • Low cost • Lower duration of treatment • Low morbidity
- 16. Carcinoma in situ • Transoral endoscopic CO2 laser • Stripping of vocal cord under microscope • Tissue subjected to biopsy Biopsy Invasive carcinoma Radiotherapy Carcinoma insitu Regular follow up
- 17. Invasive carcinoma T1 carcinoma • Radiotherapy • Excision of cord by endoscopic CO2 laser or laryngofissure. T1 carcinoma with extension to anterior commissure • Radiotherapy • Frontolateral partial laryngectomy • Total laryngectomy T1 carcinoma with extension to arytenoids • Surgery is preferred
- 18. T2N0 CANCER Cord mobility Cord mobility impaired or Involvement of anterior Commissure or arytenoid Radiotherapy to the Primary including Radiation to upper Neck nodes Failure Conservation Laryngectomy Failure Total laryngectomy +/- neck dissection failure Conservation laryngectomy Failure Total laryngectomy +/- neck dissection ALGORITHM FOR TREATMENT OF T2N0 GLOTTIC CANCER
- 19. • Subglottic cancers – T1 and T2 : radiotherapy – T3 and T4 : total laryngectomy – Radiation portal should also include superior mediastinum
- 20. Supraglottic cancers • Status of cervical lymph node • Mobility of cord • Age • Lung function • Cartilage invasion • Subsites involved • Pre epiglottic space involvement Factors influencing treatment T1 LESION • Radiation • Excised with co2laser T2 LESION • Lung function good : supraglottic laryngectomy with or without nock dissection • Lung function poor : radiation to primary and nodes T3 AND T4 • Total laryngectomy with neck dissection • post operative radiation
- 21. Vocal rehabilitation after total larygectomy Methods of communication in laryngectomized patient • Written language • Aphonic lip speech • Oesophageal speech • Electrolarynx • Transoral pneumatic device • Trancheo oesophageal speech • Blom Singer prosthesis • Panje prosthesis
- 22. OESOPHAGEAL SPEECH • Swallow air • Hold it in upper oesophagus • Slowly eject it from upper oesophagus into the pharynx • 6-10 words before reswallowing air • Voice is rough loud understandable ARTIFICIAL LARYNX • Electrolarynx • Transistorized battery operated potable device • Vibrating disc held against soft tissue of neck • Low pitched sound produced in the hypopharynx modulated to speech by lips tongue teeth palate • Transoral pneumatic device • Vibration produced in rubber diaphragm • Carried by tube into the back of oral cavity • Sound and converted to speech by modulators • Use air from tracheostome
- 23. • Tracheo oesophageal speech – Air is carried away from trachea to oesophagus or hypopharynx by creation of a skin lined fistula or placement of anterior prosthesis – Vibrating column of air entering the pharynx is then modulated into speech – Disadvantage • Entry of food into trachea