Carcinoma Of Larynx Flashcards
Most common variant of carcinoma of larynx ?
Squamous cell carcinoma
Which sex is commonly affected and the predisposing factors ?
Males are more commonly affected
Predisposing factors
Smoking (most common) , alcohol
Hpv infection
Irradiation to the neck
Most common site for carcinoma of larynx
GLOTTIS > supraglottis > subglottis
Least lymphatic metastasis and best prognosis is seen in which carcinoma of larynx?
Glottic carcinoma
Glottis is literally devoid of lymphatics and do not metastasise thus having a good prognosis
Maximum lymphatic metastasis and bilateral lymph node involvement is seen in ?
Supraglottic carcinoma
Which carcinoma of larynx present at the earliest and what is the presentation ?
Glottic carcinoma present the earliest and the presentation is HOARSENESS
Presentation of supraglottic carcinoma
Dysphagia
Lymph node enlargement
Inspiratory stridor
Presentation of subglottic carcinoma
Stridor
Pain in the ear can be seen which part’s carcinoma ?
Laryngeal carcinoma of any part
Pain will be referred to the ear via Arnold’s nerve
How to investigate a patient who comes with complaints of hoarseness of voice and is a smoker?
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
What is TNM classification?
T - tumour extent
N - neck node
M - metastasis
What is transglottic tumour?
Involves all the three sites of larynx (supraglottis , glottis , subglottis) or the tumour involves the paraglottic space
What is the stage of tumour when the vocal cords are not mobile ?
T3
Describe T3 stage
Vocal cord fixation + invasion to any of the following : pre-epiglottic region / para glottic region / post cricoid / minor thyroid invasion
What is T4a?
Tumour extends beyond the larynx and involves whole of the thyroid,thyroid gland , strap muscles,trachea,muscles of the tongue,oesophagus
What is T4b ?
Tumour involves the prevertebral space , mediastenum ,carotid artery
How is the tumour managed?
It is managed based on the stage
How is the T3 stage is managed ?
Concurrent chemo - radiotherapy
How is T4a is managed ?
Total laryngectomy + radiotherapy
T4b management
Palliative care
Management for T1 and T2
Radiotherapy or trans oral laser microsurgery (co2 laser)
How is the neck nodes are managed ?
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
What are the types of neck dissection ?
Radical dissection and modified radical neck dissection
What is radical neck dissection ?
Nodes from level 1 to level 5 are removed ; apart from these nodes certain other structures are also removed
What are the other structures removed in radical neck dissection ?
NERVE - Spinal accessory nerve
VEIN - Internal jugular vein
MUSCLE - Sternocleidomastoid , omohyoid
GLANDS - Parotid and submandibular
What is modified radical neck dissection ?
Here also node level 1 to 5 are removed but certain structures that are removed in radical neck dissection are preserved
Types of modified radical neck dissection
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
Lateral neck dissection / selective neck dissection is done when
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
Management for recurrence following radiotherapy
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
Types of open partial laryngectomy
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
What is verrucous / Ackerman tumour ?
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
How will a patient breath after total laryngectomy?
Permanent tracheostome will be created ; where trachea is pulled out and sutured to the skin to allow breathing
Olfactory rehabilitation is by ?
Polite yawning : yawning with mouth closed
