Laryngeal cancer causes types and classification and team involved in management of laryngeal cancer

1. LARYNGEAL CANCER
By- Zareen Ahad
BASLP 5th semester
Submitted to- Mr Naveen Soni

2. LARYNGEAL CANCER
Laryngeal Cancer is a disease in which malignant cells form
in the tissue of the larynx.
Laryngeal Cancer occurs when the cells in the lining of the
throat grow uncontrollably and form tumour that invades
normal tissues and spread to other part of the body.
Squamous cell carcinoma is the most common form of
Cancer of the larynx.

3. Etiology
• The incidence of laryngeal cancer is closely correlated with smoking,
an head and neck tumor occurs 6 times more often among cigarette
smokers than among non smokers.
• Death from laryngeal cancer is 20 times more likely for the heaviest
smokers than for non smokers.
• Although alcohol is less potent carcinogen than tobacco, alcohol
consumption is a risk factor for laryngeal tumors.
• The incidence of laryngeal cancer has stabilized at approximately
10,000 case reported in the United States per year. Thus except for
oral cavity cancer, it is the most frequent cancer arising in the
upper aero digestive tract.

4. EPIDEMIOLOGY
• A distinct male predominance is noted for cancer of the larynx,
but recent data show that the ratio of the affected males to females
is decreasing as the result of an increasing incidence among
women
• Women’s are more likely to develop supraglottic cancer than
glottis.
• Cancer of the larynx is a disease of the elderly, with the peak
incidence in the sixth and seventh decades.
SIZE
Estimated New Cases Estimateddeaths
Both Sexes Males Females Both Sexes Males Females
ALL 1,286,000 643,000 625,000 553,400 286,100 267,300
LARYNX 10,000 8,000 2,000 4,000 3,100 900

5. EPIDEMIOLOGY
• 2% of the total cancer burden and 0.3% of all cancer deaths
• The second most common head and neck cancer site after Oral
cavity
• The ratio of glottic to supraglottic carcinoma is approximately 3:1.
• INDIA : 2.5 % of all cancers.
• Strongly associated with tobacco smoking

6. CAUSES AND FACTORS
• Excessive alcohol consumption
• Smoking
• Exposure to organic amines and polycyclic acids
• Herpes simplex virus
• Chronic infections
• Irradiation
• Air pollution
• Leukoplakia or keratosis of vocalfolds.
• Dietary factors.
• Gastroesophageal reflux

7. SYMPTOMS
• A lump in the neck Sore throat
• Persistent cough Bad breath
• Respiratory obstruction Dysphagia
• Hoarseness and other voice change Stridor(noisy breathing)
• Fever Earache
• Pain in throat reffered to the ear
• Aspiration on swallowing
• Hemoptysis(coughing up blood)
• Dyspnea(Shortness of breath)

8. ANATOMY
• The larynx can be divided anatomically into
• Supraglottis - The upper part of the larynx above the vocal cords,
including the epiglottis.
• Glottis - The middle part of the larynx where the vocal cords are
located.
• Subglottis - The lower part of the larynx between the vocal cords
and the trachea (windpipe).

9. CLASSIFICATION OF LARYNGEAL CANCER
• 1- SUPRAGLOTTAL CANCER(40%)
(Consist of epiglottis, false vocal folds, Ventricles Arypeglottic folds
and Arytenoids)
• 2- GLOTTAL CANCER(59%)
(true vocal cords and anterior and posterior commissure)
• 3- SUBGLOTTAL CANCER(1℅)
(region between vocal folds and trachea)

10. STAGING OF LARYNGEAL CANCER
• Staging consists of three separate evaluation: (TMN system)
1. The first is of the tumour/cancer itself (“T”).
2. The second is the extent to which adjacent lymph nodes are
involved in the tumour/cancer’s spread (“N”).
3. The third is the presence or absence of any distant metastases
(“M).
• TX - Primary tumor cannot be assed
• T0- No evidence of primary tumor
• TIS- Carcinoma in situ

11. SUPRAGLOTTAL CANCER STAGING
• T1– Tumor limited to one subsite of supraglottis with normal
vocal cord mobility.
• T2 - Tumor invades mucosa of more than one subsite of
supraglottis or glottis or glottis or region outside the supraglottis
(e.g., mucosa of the base of tongue vallecula, medial wall pyriform
sinus) without fixation of the larynx.
• T3 - Tumor limited to the larynx with vocal cord fixation and/or
invades any of the followinng postcricoid area, pre-epiglottic
tissues.
• T4 - Tumor invades through the thyroid cartilage and/or extends
into soft tissues of the neck, thyroid and/or esophagus.

12. Supraglottic Squamous
cell carcinoma of
larynx

13. GLOTTAL CANCER STAGING
• T1- Tumor limited to the vocal cord(s) (may involve anterior or
posterior commisure) with normal mobility.
• T1a- Tumor limited to one vocal cord
• T1b Tumor involves both vocal cords.
• T2 Tumor extends to supraglottis and/or subglottis and/or occurs with
impaired vocal cord mobility.
• T3 -Tumor limited to the larynx with vocal cord ffixation
• T4- Tumor invades through the thyroid cartilage and/or to other
tissues beyond the larynx (e.g, trachea, soft tissues if neck, including the
thyroid and pharyn

14. CANCER OF LEFT
VOCAL FOLD

15. GLOTTIC SQUAMOUS
CELL CARCINOMA
Tumor involves
anterior half of the
left vocal volds

16. SUBGLOTTAL CANCER STAGING
• T1- Tumor limited to the subglottis
• T2- Tumor extended to vocal cord(s) with normal or impaired
mobility
• T3- Tumor limited to the larynx with vocal cord fixation.
• T4- Tumor invades through the cricoid or thyroid cartilage and/or
to other tissues beyond the larynx (e.g., trachea, soft tissues of
neck, including the thyroid and pharynx.

17. Squamous cell
carcinoma of
subglottal larynx
Tumor involves the
subglottal region,
the glottal and
supraglottal region.

18. REGIONAL LYMPH NODE INVASION
• NX- Regional lymph nodes cannot be assessed
• N0- No regional lymph node metastasis
• N1- Metastasis in a single ipsilateral lymph node, 3 cm or smaller
in greatest dimension
• N2 -Metastasis in a single ipsilateral lymph node, larger than 3 cm
but not larger than 6cm in greatest
• N2a -Metastasis in a single ipsilateral lymph node larger than 3
cm but not larger than 6 cm in greatest dimension.
• N3 - Metastasis in a lymph node larger than 6cm in greatest
dimension.

19. DISTANT METASTASIS
• MX- Distant metastasis cannot be assessed
• M0- No distant metastasis
• M1- Distant metastasis

20. RULES FOR CLASSIFICATION
• Clinical staging
• The larynx is assessed primarily by inspection, with the use
of indirect mirror and direct endoscopic examinations. Cross-
sectional imaging with a high-resolution/fine-cut CT through the
larynx. Radiologic nodal staging should do simultaneously to
supplement clinical examination.
• Pathologic staging
• The pathologic description of any specimen should
describe the size, number, and level of involved lymph nodes, as
well as whether extra capsular spread is present.

21. STAGE GROUPING
STAGE T N M
0 Tis NO M0
I T1 NO M0
II T2 NO M0
III T3 NO M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
IVA T4 NO M0
T4 N1 M0
IV B AnyT N2 M0
IVC AnyT N3 M0
AnyT AnyN M1

22. TEAM OF PROFESSIONALS
IN MANAGEMENT OF
PERSON
WITH LARYNGEAL CANCER

23. INTRODUCTION
• This team may include:
• Medical Oncologists,
• Radiation Oncologists,
• Surgeons, Otolaryngologists (ear, nose, and throat doctors)
• , Maxillofacial Prosthodontists(specialists who perform
restorative surgery to the head and neck areas), dentists,
• Physical Therapists, Speech Pathologists, Audiologists, And
Psychiatrists.
• Diagnostic Radiologists and Pathologists also are an integral part of
the treatment team because they help with diagnosis and staging

24. • Cancer care teams include a variety of other health care
professionals, such as:
• Physician Assistants,
• Nurse Practitioners,
• Oncology Nurses,
• Social Workers,
• Pharmacists,
• Counselors,
• Dietitians, and others.

25. 1. ENT SURGEON-An ear, nose and throat (ENT) surgeon –
a specialist in treating cancer of the larynx
• A Plastic And Reconstructive Surgeon – a surgeon
skilled in rebuilding tissue in the head and neck
• A Cancer Doctor (Oncologist) – a doctor who specialises
in cancer treatments, such as radiotherapy, chemotherapy,
targeted therapy and immunotherapy
• A Therapeutic Radiographer – who works closely with the
doctors to plan and give radiotherapy
• A Restorative Dentist –a specialist dentist who makes sure
your teeth look as normal as possible, and work as naturally as
they can.

26. • A Radiologist – a doctor who specialises in reading
scans and x-rays
• A Pathologist – a doctor who specialises in looking at
cells under a microscope and diagnosing the cell type
• A Specialist Nurse – a nurse who gives support and
information about the cancer or treatment
• A Speech And Language Therapist (SLT) – a therapist
who specialises in helping with communication and
swallowing problems
• A Dietitian – someone who gives advice about getting all the
nutrients your body needs.

27. CONCLUSION
• In cancer care, different types of doctors and other specialists
often work together to create a patient’s overall treatment plan,
which combines different types of treatments. This is called
a multidisciplinary team. An evaluation should be done by
each specialist before any treatment begins.