Chapter 13 - CA Hypopharynx, Larynx, Esophagus Flashcards
Most common subsite laryngeal cancer, and treatment of CA at this site
glottis
surgery and radiation have similarly good outcomes, if early
How much more likely is a smoker to get laryngeal cancer
20x
Which laryngeal subsite has bilateral LN drainage
supraglottis (II, III)
Unique spread of hypopharyngeal cancer
submucosal
worse prognosis than larynx
Subsites of supraglottis
suprahyoid and infrahyoid epiglottis
aryepiglottic folds
arytenoids, ventricles, false vocal folds
Goes down to superior surface of TVF
Define glottis region, LN spread
Superior surface of TVF down 1cm
Deep invasion needed for u/l LN drain from tumors here, since VCs have sparse lymphatics
Inferior aspect of subglottis
Inferior border cricoid cart
Percentages of where in larynx cancer occurs
60% glottis (95% from TVF)
35% supraglottis
2% subglottis
3% transglottic, multiple subsites
Laryngeal cancer epidemiology
2nd most common h/n (OC/OP)
1/3 die from dz
men 3.8x more than women
RF for laryngeal cancer
smoking and etoh (synergistic)
risk returns to baseline 20 years after cessation
LPR may be a RF (no causal relationship established yet)
Types of CA found in larynx
95% SCC
Variants of SCC: verrucous (better prog), spindle cell (worse)
Other tumors: adenoid cystic, mucoepidermoid, sarcoma, neuroendocrine, metastatic, contiguous (thyroid)
Presentations of supraglottic, glottic and subglottic
Supra: dysphagia/odynophagia, poss otalgia (pharynx extension), hoarse (glottic/arytenoid involve), discovered later than glottic
Glottic: hoarse, airway obst/hemoptysis later
Subglottic: early airway obstruction (biphasic stridor)
Workup Imaging
None if T1 glottic
If other: CT neck w/ con or MRI
PET if advanced for mets
Paralyzed VC: how and significance
mass effect, cricoarytenoid joint, or RLN
T3
Membranes that prevent larynx cancer spread
conus elasticus (cricovocal membrane) quadrangular membrane (epigl to FVF) both separated by ventricle
Paraglottic space boundaries
Medial: conus and quadranguar memb
Lateral: thyrohyoid membrane, thyroid cart lamina
Post: medial mucosa pyriform sinus
If involved: T3
Preglottic space
Sup: Hyoepiglottic lig
Ant: thyrohyoid membrane/thyr cart
Post: epiglottis, thyroepiglottic membrane
Anterior commissure –> Broyle’s ligament –> thyroid cartilage –> lacunae of epiglottis –> pre-epiglottic space
Typical spread of supraglottic, glottic and subglottic CA
Supra: bilateral II, III
Glottic: no notable drainage, <10% go to nodes
Sub: through CTM to involve lateral paratracheal and cervical lymphatics, medial prelaryngeal (Delphian)
T Staging Supraglottis
1: one subsite
2: >1 subsite of supra or outside supra
3: fixed cord or postcricoid/preepiglottic/paraglottic invasion, erosion of thyroid cartilage lamina
4a: through thyroid cart or beyond larynx
4b: prevertebral, ICA encase, mediastinum
T Staging glottis
1a: 1 cord
1b: both cords
2: outside glottis or impaired VC mobility
3: fixed cord or inner layer of cartilage involved
4a: through thyroid cart or outside larynx
4b: prevertebral, mediastinum, ICA encase
Subglottis T Stage
1: subglottis
2: to VC
3: fixed cord
4a: cricoid or thyroid cartilage or outside larynx
4b: prevert, ICA encase, mediastinum
Basics of laryngeal cancer treatment
Stage 1-2: Rads or Surg
3-4: multimodal
Contraindications to conservation laryngeal surgery
more than 5mm subglottic extension extend to postcricoid BOT or piriform sinus involve cartilage invasion bilateral fixed cords bilateral arytenoid involvement
Subsistes of Hyopharynx and cancer considerations
Piriform- 65-75%, medial limit is larynx, arytenoid, cricoid, AE fold. 75% regional Mets. Extend to subglottis, thy cart, postcricoid, CA joint
Postcricoid- post arytenoid to esophagus introitus. Can invade RLN, cric
Post ph wall - Hyoid to CP muscle, may extend to PVS
Speech after laryngectomy
Electrolarynx- cheap, easier, uses patient vibrations to create voice. Need power, hard to understand on phone
Esophageal speech- hard. Use vibrations and oral air trap
TEP- expired air from stoma enters esoph, more natural voice, risk of aspiration/constrictor spasm, $$, maintenance
RF esophageal CA
SCC: smoke, alcohol, hookah, poor, low fruit/veg, hot tea
Adeno: smoke, Barrett esophagus (GERD), obesity as it worsens GERD. 70% US
When to Tx neck with laryngeal CA
Glottis: supreglottic extension
Supra: T2
(Up to debate)
Comparing surgery and rads for early glottic cancer
Surg: one time, save rads for recurrence
Rads. Better voice (if full thick cord involved), cost, length, if recur May not save larynx
Survival Rates Larynx/Hypo
Supra: 59-59-53-34
Glott: 90-74-56-44
Sub: 65-56-47-32
Hypo: 53-39-36-24
