Tumours of the larynx
Tumours of larynx ◼ Benign : Papilloma (85%) Chondroma ◼ Malignant : Squamous cell carcinoma (85%) Carcinoma in situ Verrucous carcinoma undifferenciated carcinoma adenocarcinoma adenoid cystic carcinoma sarcoma
SCC larynx Epidemiology ◼ Geographical variation ◼ ? The most common cancer of H & N ◼ 1% of all malignancies ◼ Male : female = 5 : 1 ◼ Seventh decade Risk factors ◼ Geographic Smoking ◼ Social class V Alcohol ◼ Urban Radiation
◼ Aetiology : Unknown above factors keratosis / leukoplakia ◼ Compartments of larynx 1. Supraglottis – ventricle, FVC arytenoid, epiglottis, aryepiglottic fold 2. Glottic –TVC, ant & post commissure 3. Subglottic -
Clinical features of SCC larynx ◼ Primary tumour :Glottic carcinoma is the commonest in larynx continuos progressive hoarseness > 3 weeks in >40y male dyspnoea, dysphagia, pain ◼ Secondary deposits : Neck swelling, chest symptoms (cough,irritation) ◼ General effects of the tumour : anorexia, cachexia, foetor
Examination of Ca Larynx ◼ Indirect laryngoscopy – site, mobility ◼ Fibreoptic laryngoscopy ◼ Neck – lymph nodes – upper deep cervical, mediastinal ◼ General exam – chest , abdomen
Investigations ◼ FBC Direct laryngoscopy ◼ Serum analysis extent,biopsy, neck ◼ Chest X-ray Panendoscopy ◼ CT/MRI Staging of tumour ◼ USG abdomen ◼ Bone scan
Staging Ca larynx ◼ Glottic T1a – one vocal cord T1b - both vocal cords T2- to supra/subglottis, or impaired mobility T3 - fixed vocal cord T4 - beyond larynx
Treatment ◼ Curative, palliative Curative : small tumours - RT -Preservation surgery large tumours - primary surgery - postop RT Mx of Neck nodes – depends on stage selective / modified / radical neck dissection
Palliation of Ca larynx ◼ TLC ◼ Pain relief ◼ Tracheostomy ◼ PEG (percutaneous endoscopic gastrostomy) ◼ RT/chemotherapy/surgery