Concise notes on carcinoma larynx covering important points

2.  Squamous Cell Carcinoma is the most
common malignant tumour of larynx.
 Arise from stratified squamous epithelium or
respiratory epithelium that has undergone
squamous metaplasia.
 Incidence-glottis>supraglottis>subglottis
 Male to female incidence 3.8:1

3.  Tobacco and alcohol-smoking-more glottic
ca.,alcohol-more supraglottic ca.,
 Laryngopharyngeal reflux
 Diesel exhaust,asbestos,organic
solvents,sulfuric acid,mustard gas
 Human PapillomaVirus-HPV 16 most
commonly associated
 Genetic susceptibility

4.  Annual risk following index head and neck
SCC-1 to 7%
 Synchronous-within 6 months
 Metachronus-more than 6 months
 Most common site of synchronus and
metachronus SPT following laryngeal cancer
is lung
 Slaughter-field cancerization(malignant cells
in adjacent normal appearing tissue next to
primary site)

5.  Squamous differentiation-formation of keratin
and intracellular bridges.
 Well differentiated-keratin+intracellular
bridges+ nuclear pleomorphism+ nuclear
cytoplasmic ratio reduced atypical mitosis rare
 Moderately differentiated-less keratinisation
less intracellular bridges more atypical mitoses
more nuclear pleomorphism
 Poorly differentiated-minimal or no keratin or
intracellular bridges more atypical mitoses

6.  Expansive-well defined pushing margins
 Infiltrative-poorly defined margins with
tongues of tumour found in adjacent tissue
 SCC in situ-enire thickness of epithelium
shows cellular features of carcinoma without
invasion of underlying stroma
 Microinvasive SCC-limited tumour invasion
just deep to basement membrane
 IHC markers-cytokeratin Epithelial
MembraneAntigen

7.  Aggressive behaviour
 High risk of lymphatic metastasis
 Site of origin:Ventricle
 Mc Gavern Rules:
Crossing ventricle directly
Crossing anterior commissure
Spread through paraglottic space
Spread along arytenoid cartilage posterior to
ventricle

8.  Overgrowth of squamous epithelium
histologically resembling carcinoma.
 a/w chronic inflammation
 Epithelium does not show cytological
evidence of malignancy

9.  Infarction of salivary tissue in larynx
 After ischaemia or trauma to larynx
 Squamous metaplasia of ducts and acini of
seromucinous glands
 Resolve spontaneously

11.  Hoarseness
 Sore throat
 Localised neck pain due to cartilage
involvement
 Dyspnea Stridor

13.  Sore throat
 Odynophagia
 Neck mass
 Otalgia
 Weight loss
 Dyspnea
 Foul breath
 aspiration

15.  Late stage disease
 Exertional dyspnea
 stridor

17.  Supraglottic carcinoma mets to level 2,3,4 most
commonly bilateral
 For Supraglottic carcinoma N0,N1neck-B/L
selective neck dissection(level 2 to 4) & for
N2,N3-Comprehensive neck dissection(level 1to
5) indicated
 Glottic Carcinoma –neck node mets rare occur in
level 2,3,4,6 pretracheal prelaryngeal
paratracheal node
 Subglottic Carcinoma neck mets rare occur in
paratracheal node(level6)

18.  History and Examination including neck
 Indirect laryngoscopy
 Flexible fibreoptic laryngoscope-hidden areas
infrahyoid epiglottis anterior commissure
 Imaging
 Direct laryngoscopy and biopsy,
Esophagoscopy,Bronchoscopy
 CXR PA

19.  CT for ossified cartilage and calcification
 MRI for cartilage invasion and soft tissue
extension(pre epiglottic space-low signal on
T1 &high signal onT2)
 PET CT for residual or recurrent disease
distant metastasis,synchronus or
metachronus tumours
 CXR or CT Chest to rule out lung metastasis

28.  Perichondrium of cartilage
 Endolaryngeal ligaments and membranes
 Anterior Commissure tendon

29.  Confined to vocal cord
 Break into reinke space to involve entire extent
of vocal cord
 Involvement of vocalis/cricoarytenoid joint-
fixation of cord
 Anteriorly along Broyle ligament to contralateral
cord or thyroid cartilage anteriorly,cricothyroid
triangle to escape out of larynx
 Laterally spread to paraglottic space then to
supraglottis or subglottis
 Posteriorly to arytenoid cartilage and pyriform
fossa mucosa

30.  Superiorly to epiglottis base of tongue
 Inferiorly vocal fold
 Anteriorly pre epiglottic space thyroid
cartilage
 Posteriorly-aryepiglottic folds and pyriform
sinus

31.  Invade perichondrium of thyroid and cricoid
cartilage,through cricothyroid membrane
becomes extralaryngeal
 Superiorly to vocal folds causing its fixation
 Inferiorly to trachea esophagus.

36.  Chemoradiotherapy
 Pre epiglottic space not involved-Transoral
Endoscopic Co2 resection
 Preepiglottic space involved-SCPL-CHEP
 Latealised lesion-NearTotal Laryngectomy
 Total laryngectomy last resort.

39.  T3/T4a-Total Laryngectomy
 T4b-Palliative Radiotherapy

41.  T1,T2-RT if fails or recursTotal Laryngectomy
 T3,T4a-Total laryngectomy and postop
Radiotherapy
 T4b-Palliative RT

43.  Good candidate-low volumeT3,no or minimal
cartilage invasion,no base of tongue
invasion,swallowing speech function intact.
 Treatment-Concurrent chemoradiotherapy if
fails total laryngectomy

44.  Paratracheal node involvement
 Subglottic spread with tracheal invasion
 Thyroid gland spread
 Intraoperative tumour spill with implantation
of cells in the stoma
 Sisson stage 1,2-wide local resection of
stoma and mediastinal dissection
 Sisson stage 3,4-poor prognosis