THROAT - Carcinoma Larynx

What is Carcinoma of the larynx?

Definition: Carcinoma of the larynx is one of the most important malignancy of head and neck.

Incidence:

  • Age: Usually Occurs after 4th decade but can be seen earlier as well
  • Sex: More common in males due to smoking and tobacco habits.
  • Incidence: High in India, Hongkong, Europe, low in Japan, Norway, Sweden

What are the most commoncauses and Predisposing factors of carcinoma of the larynx?

  • Smoking in any form is the commonest cause.
  • Tobacco chewing
  • Laryngeal papilloma
  • Leucoplakia

What is the classification of carcinoma of the larynx?

I. According to Site:

  • Supraglottic (20%) Above the Vocal cords
  • Glottic carcinoma (70%)Involving the vocal cords
  • Subglottis (5%)Below the vocal cords
  • Transglottic(5) Tumours crossing or involving the ventricle

II. TNM classification

Staging of the tumour is done or depending on the extent of the primary tumour (T) ,regional lymphatic involvement (N) and distant metastasis (M).

Staging:
Tis: Carcinoma in situ
T1: Tumour confined to site of origin.
T2: Tumour spread to adjacent laryngeal sites
T3: Tumour confirmed to larynx with fixation of hemilarynx
T4: Tumour with cartilage destruction beyond the larynx

Nodes:
N0: No evidence of lymphatic involvement
N1: Lymph node < 3 cm on ipsilateral side
N2: Lymph node > 3 cm on contralateral side
N3: Contralateral lymph node

Metastasis:
M0: No evidence of distant metastasis.
M1: Evidence of distant metastasis

What are the symptoms of carcinoma of the larynx?

  • Hoarseness of voice is the commonest symptom
  • Stridor(Noisy breathing), cough,blood in sputum
  • Neck swelling.
  • Difficulty in swallowingDysphagia (Pyriform fossa and post cricoid involvement)

What investigations are required for carcinoma of the larynx?

  • Indirect laryngoscopy
  • Direct laryngoscopy this can be done along with a biopsy of the tumour mass and visualisation of the extent.
  • Fibre-optic laryngoscopy
  • Microlaryngoscopy

What is the treatment of carcinoma of the larynx?

  • Surgical: Depending on the extent of the tumour involved the options are:
    • Partial laryngectomy (to preserve as much of the voice box as possible)
    • Total laryngectomy (complete voice box removal)
    • Laser cordectomy (for carcinoma in situ and mobile vocal cords)
  • Radiotherapy: 5000-8000 rads are divided over a period of 6-8 weeks
  • Chemotherapy: Laryngeal tumours are not very chemosensitive but chemotherapy can be given in surgically unfit patients.
  • Usually combination therapy of surgery and radiotherapy or chemotherapy is commonly advocated.It should be noted that the treatment of every indiviual case of cancer of the larynx varies on the extent of tumour, Type of tumour, age of patient etc.


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