Squamous cell carcinoma is the most common malignant tumor of the larynx, arising from stratified squamous epithelium. Risk factors include tobacco, alcohol, HPV infection, and other occupational exposures. Symptoms depend on the location but may include hoarseness, neck pain, difficulty breathing. Diagnostic workup involves laryngoscopy and imaging tests. Treatment options range from surgery, radiation, chemotherapy depending on the stage and location of the tumor. Prognosis depends on stage, with early stage disease having better outcomes.

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