Carcinoma Of Larynx

Question 1

Most common variant of carcinoma of larynx ?

Answer 1

Squamous cell carcinoma

Question 2

Which sex is commonly affected and the predisposing factors ?

Answer 2

Males are more commonly affected

Predisposing factors

Smoking (most common) , alcohol
Hpv infection
Irradiation to the neck

Question 3

Most common site for carcinoma of larynx

Answer 3

GLOTTIS > supraglottis > subglottis

Question 4

Least lymphatic metastasis and best prognosis is seen in which carcinoma of larynx?

Answer 4

Glottic carcinoma

Glottis is literally devoid of lymphatics and do not metastasise thus having a good prognosis

Question 5

Maximum lymphatic metastasis and bilateral lymph node involvement is seen in ?

Answer 5

Supraglottic carcinoma

Question 6

Which carcinoma of larynx present at the earliest and what is the presentation ?

Answer 6

Glottic carcinoma present the earliest and the presentation is HOARSENESS

Question 7

Presentation of supraglottic carcinoma

Answer 7

Dysphagia
Lymph node enlargement
Inspiratory stridor

Question 8

Presentation of subglottic carcinoma

Answer 8

Stridor

Question 9

Pain in the ear can be seen which part’s carcinoma ?

Answer 9

Laryngeal carcinoma of any part

Pain will be referred to the ear via Arnold’s nerve

Question 10

How to investigate a patient who comes with complaints of hoarseness of voice and is a smoker?

Answer 10

SUSPECT LARYNGEAL CARCINOMA

Investigations:

Laryngeal endoscope - reveals an irregular ulceroproliferative mass on vocal cords 

To confirm whether it is carcinoma , then take biopsy ; biopsy is taken under GA if vocal cords are involved , under LA if there’s supraglottic growth 

Examination of neck nodes 

Laryngeal crepitus - larynx is pushed posterior and is moved from side to side to feel for any crepitus ; normally crepitus is felt as cricoid rubs against the vertebra ; if not felt then is indicates that the tumour has grown post - cricoid 

CT - for bone involvement

MRI - for cartilage involvement

Question 11

What is TNM classification?

Answer 11

T - tumour extent

N - neck node

M - metastasis

Question 12

What is transglottic tumour?

Answer 12

Involves all the three sites of larynx (supraglottis , glottis , subglottis) or the tumour involves the paraglottic space

Question 13

What is the stage of tumour when the vocal cords are not mobile ?

Answer 13

T3

Question 14

Describe T3 stage

Answer 14

Vocal cord fixation + invasion to any of the following : pre-epiglottic region / para glottic region / post cricoid / minor thyroid invasion

Question 15

What is T4a?

Answer 15

Tumour extends beyond the larynx and involves whole of the thyroid,thyroid gland , strap muscles,trachea,muscles of the tongue,oesophagus

Question 16

What is T4b ?

Answer 16

Tumour involves the prevertebral space , mediastenum ,carotid artery

Question 17

How is the tumour managed?

Answer 17

It is managed based on the stage

Question 18

How is the T3 stage is managed ?

Answer 18

Concurrent chemo - radiotherapy

Question 19

How is T4a is managed ?

Answer 19

Total laryngectomy + radiotherapy

Question 20

T4b management

Answer 20

Palliative care

Question 21

Management for T1 and T2

Answer 21

Radiotherapy or trans oral laser microsurgery (co2 laser)

Question 22

How is the neck nodes are managed ?

Answer 22

Depends on the treatment of primary tumour

If the primary tumour is treated by surgery - nodes are treated by NECK DISSECTION

If primary tumour is treated by radiotherapy- nodes are treated by radiation

Question 23

What are the types of neck dissection ?

Answer 23

Radical dissection and modified radical neck dissection

Question 24

What is radical neck dissection ?

Answer 24

Nodes from level 1 to level 5 are removed ; apart from these nodes certain other structures are also removed

Question 25

What are the other structures removed in radical neck dissection ?

Answer 25

NERVE - Spinal accessory nerve

VEIN - Internal jugular vein

MUSCLE - Sternocleidomastoid , omohyoid

GLANDS - Parotid and submandibular

Question 26

What is modified radical neck dissection ?

Answer 26

Here also node level 1 to 5 are removed but certain structures that are removed in radical neck dissection are preserved

Question 27

Types of modified radical neck dissection

Answer 27

Type 1 - spinal accessory nerve is preserved

Type 2 - type 1 + internal jugular vein is preserved

Type 3 - type 1 + type 2 + sternocleidomastoid muscle is preserved = aka FUNCTIONAL NECK DISSECTION

Question 28

Lateral neck dissection / selective neck dissection is done when

Answer 28

When there’s supraglottic tumour and is not yet have metastasised N0

Here lymph node level 2 3 4 are removed as precaution to high possibility of occult metastasis

Question 29

Management for recurrence following radiotherapy

Answer 29

T1 , T2 - open partial laryngectomy

T3 , T4 - total laryngectomy

Radiotherapy is not done once again and TLM can’t be done as radiotherapy would have made the areas fibrosed and margins will not be clear to excise the tumour via TLM

Question 30

Types of open partial laryngectomy

Answer 30

HORIZONTAL / SUPRAGLOTTIC LARYNGECTOMY - in supraglottic carcinoma

VERTICAL / HEMI LARYNGECTOMY- in glottic carcinoma where one half of the thyroid cartilage + true vocal cords + false vocal cords are removed

Question 31

What is verrucous / Ackerman tumour ?

Answer 31

Variant of squamous cell carcinoma

Locally invasive

Doesn’t metastasise

Slow growing

Seen as a whitish mass/ growth in the oral cavity

MANAGEMENT : TLM / radiotherapy

Question 32

How will a patient breath after total laryngectomy?

Answer 32

Permanent tracheostome will be created ; where trachea is pulled out and sutured to the skin to allow breathing

Question 33

Olfactory rehabilitation is by ?

Answer 33

Polite yawning : yawning with mouth closed