This document provides information about cancer of the larynx, including its epidemiology, risk factors, clinical presentation, diagnosis, staging, and treatment options. Some key points:
- Laryngeal cancer most commonly affects men aged 60-70 and is strongly associated with smoking and heavy alcohol use.
- Common symptoms include hoarseness, neck mass, cough, and difficulty swallowing. Examination includes laryngoscopy and imaging like CT scans to assess tumor size and spread.
- Tumors are staged based on location (supraglottic, glottic, subglottic), size, involvement of surrounding structures, and presence of lymph node metastases.
- Treatment depends on stage but
Management of supraglottic and glottic larynx cancer has been revised lately. This presentation gives an overview of guidelines for management of laryngeal cancer. includes latest NCCN guidelines.
Management of supraglottic and glottic larynx cancer has been revised lately. This presentation gives an overview of guidelines for management of laryngeal cancer. includes latest NCCN guidelines.
laryngeal malignancies, laryngeal cancer
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
laryngeal malignancies, laryngeal cancer
Presentation prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal, for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Cavity obliteration is a procedure done at the end of Mastoidectomy to get a cavity-less mastoid cavity thus solving the problem of discharging post-operative cavity.
Carcinoma Larynx; Evidence based management
Staging - Surgery - Adjuvant therapy - Organ Preservation - Altered fractionation, chemotherapy - Radiotherapy (RT) techniques, Role of IMRT
presentation of cancer larynx lecture by Dr Ibrahim Habib Barakat ..E-mail: salamatuall@yahoo.com
Tel: 00966500072975
(Please vote for this lecture if you see it is good)
Brief Review of Surgical management of Early laryngeal cancer e.g glottic and supraglottic cancer.
This presentation describes latest literature evidence of conservative laryngeal surgery as well as radiotherapy in early glottic cancer
Slides prepared by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate MBBS students in the field of otorhinolaryngology. A clear and concise explanation of the basic concepts in the subject matter concerned. He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Slides prepared and compiled by highly experienced ENT teacher, Dr. Krishna Koirala from Nepal , for teaching undergraduate and postgraduate ENT students in the field of otorhinolaryngology.
A clear and concise explanation of the basic concepts in the subject matter concerned.
He is the Head of department with a sound knowledge in the field of ENT to teach both undergraduate and postgraduate ENT students
Nasopharyngeal carcinoma is a non lymphomatous squamous-cell carcinoma that occurs in the epithelial lining of the nasopharynx.
It frequently arises from the pharyngeal recess (fossa of Rosenmuller) posteromedial to the medial crura of the eustachian tube opening in the nasopharynx
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
6. Cancer of the larynx
By
Dr, IBRAHIM H. AHMED
M.D.
otorhinolaryngology
7. introduction
Incidence : 10,000 cases per year in U S A .
Most frequent upper aerodigestive tract cancer
The integration of chemotherapy and radiation
therapy has expanded organ preservation
options .
The patient’s perspective , with emphasis on
retention of speech , swallowing , & quality of
life has affected the decision making process.
8.
9.
10. Anatomy of larynx
area extending from :
tip of epiglottis to
lower border of cricoid cartilage .
divided into 3 anatomical subsites :
Supraglottis
glottis,
subglottis.
24. Histology of glottis
Vocal cord : stratified squamous epithelium
(edges) .
peudostratified ciliated
epithelium ( sup. & inf. Aspect )
Lamina propria : superficial ( Reink’s space )
intermediate & deep ( vocal lig.
* blood vessels & lymphatics are
almost absent in Reinke’s space.
* no mucous glands on free edge
of vocal cord .
25. Blood supply of the larynx
Arterial supply of larynx
•1- sup. Laryngeal a.
( branch of sup. Thyroid a. )
2- inf. Laryngeal a.
( branch of inf. Thyroid a. )
Venous drainage
1- Sup. Thyroid v .
, ends in I . J . V .
2- inf. Thyroid v .
, ends in innominate v .
26. Nerve supply of the larynx
Motor supply :
supplies all laryngeal musclesrecurrent laryngeal nerve
externalexcept cricothyroid muscle which supplied by
laryngeal n. ( branch of sup. Laryngeal nerve ) .
Sensory supply :
.internal laryngeal n. ( branch of sup. Laryngeal n )
supply mucous membrane above the vocal cords .
suppliesRecurrent laryngeal n.
mucous membrane below the vocal cords.
27.
28.
29.
30. Lymphatics of larynx
1- The vocal cords & upper part of the larynx
drain into the upper deep cervical lymph
nodes .
2- The lower part of the larynx drain into
the lower deep cervical lymph nodes &
prelaryngeal lymph nodes .
.
31.
32. Cancer of the larynx
epidemiology
•10,000 new cases per year
in U S A
etiology
Excessive tobacco use &
alcohol consumption .
33.
34. Epidemiology of cancer larynx
- 1% of all cancer related deaths in U S A .
- 10,000 new cases / year in U S A .
- 5 year survival is 65 % .
- Male to female ratio :
9,2 : 1 for glottic ca.
3-5 : 1 for supraglottic.
- Age : affect elderly . The peak incidence is 6th
& 7th decades .
< 1% in < 30 years of age .
- No rational predominance in U S A .
35. Risk factors
- tobacco .
- Synergistic effect with heavy alcohol intake in
Smokers .
- occupational exposure
Painter – metal working – plastic working –
diesel & gasoline fumes .wood dust & asbestos .
- G O R .
- Infectious agents especially papilloma virus .
39. Clinical presentation
Hoarseness
Hot potato voice
Hemoptysis
Weight loss & dysphagia
Referred otalgia
Palpable neck lump
Dysnea & stridure
Vocal cord involvement . Progressive &
unremitting .
supraglottic ca.
Large fungating or ulcerated lesion (epiglottic
lesion )
Malnutrition . (advanced lesion _pharyngeal
involvement )
Cartilage invasion .
Direct extension in soft tissue neck
1st presentation -subglottic or supraglottic ca
2nd presentation in glottic ca .
40.
41. Clinical evaluation
- complete history of the disease
- weight and weight loss
- performance status
- fiberoptic examination of H&N
mucosa
- neck examination
- drawing of any lesions
42. Complete examination of
the head and neck
Includes examination
• oral cavity,
• pharynx,
• indirect laryngoscopy.
• fiberoptic examination of the larynx and pharynx
- videostroboscopy
.
43. videostroposcopy
- proper assessment of glottic lesion :
1- Detailed vibrator behavior of vocal cord .
- amplitude of vibration
- mucosal wave
- non vibrating portion
2- Outpatient procedure .
3- Documentation .
4- Selection of patient for biopsy .
44. The examination
status of the dentition,
the status of the airway,
vocal cord mobility ,
laryngeal crepitus,
tumor extension
45. Palpation of the neck bilaterally,
Recording
1- the location (Group or Level II - IV),
- size,
- mobility,
- relationship of the node(s) to adjacent
structures.
2- widening of thyroid angle .
3- direct extention of the lesion .
4- Fixation of the larynx.
5- carotid pulsation .
46. Pattern of lymphatic spread
Supraglottic ca:
Primary glottic ca :
Subglottic ca :
Lymph node
Metastases 44%
L. N. metastases 5%
L. N. metastases 6%
47. Mobility of larynx
Vocal cord mobility .
Arytenoid mobility .
Hemilarynx mobility .
Laryngeal mobility over prevertebral
fascia (More’s sign )
48. The staging of the primary
and of the cervical lymph
nodes must be documented
49. Radiological examination of
cancer larynx
To reveal tumour invasion of laryngeal
cartilages & extra laryngeal tissues .
With clinical / endoscopic examination
result in proper staging accuracy .
50. Imaging Studies:
•Chest radiographs, PA and lateral
To rule out
(1) A synchronous pulmonary tumor,
(2) Acute or chronic pulmonary
disease
(3) Metastatic tumor.
51. imaging
.
Thickness , invasion ,
Lymph node metastasis .
Under estimate cartilage invasion .
More accurate than C T scan .
Soft tissue details & fat planes ,
Tissue edema & tumor extention .
Over estimate cartilage invasion .
Viability of a tumor .
Residual , recurrent tumor after
Radiotherapy & or chemotherapy .
Sensitive for detection of lymph node
metastasis.
C T scan
Spiral C T scan
M R I
P E T
52. a mass is seen eroding the thyroid
cartilage and spreading into the
soft tissue of the neck.
53. the thyroid cartilage is seen to be
eroded. The airway also appears
to be compromised.
54. The tumor appears to be eroding the
anterior commissure area of the thyroid
cartilage. The tumor appears large and
predominately on the right side of the
larynx. The airway also appears to be
compromised.
55. Laboratory Tests:
•C .B .C , B . T . , C . T . , serum calcium.
• Pulmonary function and arterial blood
gases in the patients with COPD or who
are candidates for surgery .
•Liver & kidney function tests (optional).
56.
57. ENDOSCOPIC EXAMINATION & BIOPSY UNDER
ANESTHESIA
Direct laryngoscope :
1 - confirmation .
2 - site , size , extent of the tumour .
3 - vocal cord mobility .
4 - arytenoid mobility .
5 - type of lesion .
6 - neck is felt .
7 - biopsy .
8 - drawing in axial & sagittal plane .
Pan endoscopy to exclude 2nd primary .
58.
59.
60. Pathology of cancer larynx
1- keratosis :
2- dysplasia :
Keratin layer in a normally non
keratinized epithelium .
Involves true vocal cords &
interarytenoid area .
Cellular atypia , loss of maturity ,
and loss of stratification in some
cases of keratosis .
1- mild .
2- moderate .
3- severe .
62. Pathology of cancer larynx
3- carcinoma in situ Atypical changes throughout the
epithelium without evidence
of surface maturation or
invasion trough the basement
membrane .
64. Verrucous carcinoma
A slow – growing , locally aggressive
tumor with an exophytic , fungating ,
warty , gray – white appearance and
well defined margins .
67. Consultations
•Radiation therapy
In anticipation of possible need for post-operative
radiation therapy or to use radiation therapy as a
definitive primary modality of treatment in early
stage tumors.
68. Consultations:
•Dental
To assess the status of the teeth and make
recommendations considering that radiation
therapy may be indicated. The evaluating dentist
should be versed in the effects of radiotherapy on
dentition. This evaluation should be done with
knowledge of the treatment portals planned for
the radiotherapy.
71. TMN / PRIMARY TUMOR ( T )
TX : Primary tumor cannot be assessed .
To : No evidence of primary tumor .
Tis : Carcinoma in situ .
Supraglottis .
Glottis .
Subglottis .
72. SUPRGLOTTIS ( T )
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 region outside the supraglottis ( e.g.,
mucosa of base of tongue , vallecula , medial wall of
pyriform sinus ) without fixation of the larynx .
T3 : Tumor limited to the larynx with vocal cord fixation
and/or invade any of the following : postcricoid area ,
pre-epiglottic tissues .
T4 : tumor invade through the thyroid cartilage and/or
extends into soft tissue of the neck , thyroid and/or
esophagus .
74. GLOTTIS
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 fixation .
T4 : Tumor invades through the thyroid cartilage and/or
to other tissues beyond the larynx ( e.g., trachea , soft
tissue of neck , including thyroid and pharynx .
76. Picture of
glottic squamous cell carcinoma of the
larynx. The tumor involves the anterior half of the left
vocal cord.
77. SUBGLOTTIS
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 invade 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 )
78. Picture of an extensive squamous cell carcinoma of
the larynx. The tumor involves the subglottic region,
the glottis and the supraglottic area.
79. TNM STAGING
No : no regional node metastasis .
Nx : regional nodes cannot be assessed .
N1 : single ipsilateral node,≤3cm
N2a : single ipsilateral nodes, > 3cm and ≤ 6cm
N2b : multiple ipsilateral nodes , ≤ 6cm
N2c : controlateral or bilateral nodes , ≤ 6cm
N3 : node > 6cm
80. ≤
TNM staging
Mx: Distant metastasis can’t be assessed
M0: No distant metastasis
M1: Distant metastasis
81.
82. Treatment of glottic ca.
1- carcinoma in situ .
2 - Stage 1 .
3 – stage II ..
Micro laryngeal surgery –
Radiotherapy .
Radiotherapy .
Partial surgery .
Trans oral co2 laser .
Radiotherapy .
Chemotherapy & radiotherapy .
Partial surgery .
Trans oral laser excision ..
85. Immediate post operative , after biopsy & surgical
removal of leukoplakia .This patient will be treated
with full course of radiotherapy .
86. Pre and post biopsy views of a patient
with two T1 SCC of true vocal cords .
The patient was treated with vocal
cord stripping and radiation therapy
87. Treatment of glottic ca
4 – stage III .
5 – stage IV .
1 – radiotherapy . or
chemo&radiotherapy .
2 - trans oral co2 laser excision
3 - surgery .
1- total laryngectomy +
Post operative radiotherapy .
88. Management of neck in glottic ca.
1- No .
2 – NI , NII .
3 – N III.
1 – radiotherapy .
2 – elective neck dissection .
1 – selective neck
dissection .
1 – modified or radicalneck
dissection + radiotherapy .
89.
90.
91.
92. Treatment of supraglottic ca.
1- TI .
2- TII .
1- radiotherapy .
2- open epiglottictomy .
3- co2 laser epiglottictomy
1- radiotherapy .
2- supraglottic laryngectomy .
3- trans oral co2 laser resection .
93.
94.
95. Treatment of supraglottic ca.
3- TIII .
4- TIV .
1- accelerated
radiotherapy .
2- co2 laser resection .
3- near total laryngectomy
4- cicohyoidopexy .
1- 1ry radiotherapy .
2- total laryngectomy &
post . op . radiotherapy
96. Management of neck in supraglottic ca.
1- No
2- N1 , N2 , N3 ,
Ipsilateral selective neck
dissection . IF +ve ----- contra
lateral selective neck dissection
level II , III , IV .
Radical neck dissection + post
operative radiotherapy .
97. Treatment of subglottic ca .
T1 .
T2 .
T3 .
Radiotherapy .
Radiotherapy or total laryngectomy.
Radiotherapy or total laryngectomy .
98. Management of neck in
subglottic ca.
Ipsilateral level VI dissection . If
lymph node +ve , post
operative radiotherapy .