Ca larynx

Question 1

aetiology

Answer 1

excessive alcohol, smoking, HPV

Question 2

epidemiology

Answer 2

2:1 [m:f]
incidence increases with age

Question 3

pathology types

Answer 3

SCC = 95% [3/4 in the glottic region, second most common is supraglottic]

others: verticous carcinoma, spindle cell carcinoma

Question 4

what are the types of spread

Answer 4

direct
lymphatic

Question 5

direct spread

Answer 5

along the affected cord to anterior comissure at the point the tumour is free to spread to the other cord

Question 6

lymphatic spread

Answer 6

common in supraglottic
less common in glottic

Question 7

presentation

Answer 7

early in glottic
stridor
ear-ache
dysponea
dysphagia
sore throat
hoarse voice
enlarged nodes

Question 8

what investigations take place

Answer 8

full medical history
clinical exam
laryngoscopy [direct or indirect]
biopsy
CT or MRI
dental assessment

Question 9

surgery types

Answer 9

cordectomy: removal of the cord
hemilaryngectomy: part of the larynx removed
laser surgery: for small lesions
trachestomy: T4

Question 10

RT

Answer 10

supine, with beam directional shell
restricts movement
small fields [minimum 5x4 = 20cm^2]
thyroid cartilage moves whilst swallowing must be in the field
TV should be centred on the VC, include the thyroid and cricoid cartilages
two lat parallel opposed
OAR= spinal cord
66Gy in 33
back edge is close to SC beam divergence needs to be considered
wedges for tissue compensation
wax strip down the centre, brings dose to skin surface
neck clearance = neck needs to be extended therefore two ant oblique fields may be needed

Question 11

IMRT/ VMAT PTV’s

Answer 11

PTV 1 = primary + small margin (66Gy)
PTV 2 = larger margin (66Gy)
PTV 3 = contains up to level V nodes (54Gy)

Question 12

describe the late stage treatment

Answer 12

larynx: pre-epiglottic space, lymph node levels at risk of harbouring met disease
area of max dose is larger
CTV 1= larynx, pre-epiglottic lymph nodes
CTV 2 = any areas/nodes which harbour any tumour
CTV 3 = lymph node levels II-IV
integrated boost might be incorporated

Question 13

describe T4 treatment

Answer 13

surgery -> RT
multimodality = surgery, RT (chemoradiation if fit)
invasion of the thyroid cartilage

Question 14

describe T3 treatment

Answer 14

chemoradiation
treatment depends on the tumour characteristics

Question 15

SE

Answer 15

worsening sore throat
dysphagia
dysponia
weightloss
oral mucositis
physiological issues

Question 16

prognosis

Answer 16

T1 = 80-98
T2 = 60-90
T3 N0 = 60-74