Chapter 13 - CA Hypopharynx, Larynx, Esophagus

Question 1

Most common subsite laryngeal cancer, and treatment of CA at this site

Answer 1

glottis

surgery and radiation have similarly good outcomes, if early

Question 2

How much more likely is a smoker to get laryngeal cancer

Answer 2

20x

Question 3

Which laryngeal subsite has bilateral LN drainage

Answer 3

supraglottis (II, III)

Question 4

Unique spread of hypopharyngeal cancer

Answer 4

submucosal

worse prognosis than larynx

Question 5

Subsites of supraglottis

Answer 5

suprahyoid and infrahyoid epiglottis
aryepiglottic folds
arytenoids, ventricles, false vocal folds
Goes down to superior surface of TVF

Question 6

Define glottis region, LN spread

Answer 6

Superior surface of TVF down 1cm

Deep invasion needed for u/l LN drain from tumors here, since VCs have sparse lymphatics

Question 7

Inferior aspect of subglottis

Answer 7

Inferior border cricoid cart

Question 8

Percentages of where in larynx cancer occurs

Answer 8

60% glottis (95% from TVF)
35% supraglottis
2% subglottis
3% transglottic, multiple subsites

Question 9

Laryngeal cancer epidemiology

Answer 9

2nd most common h/n (OC/OP)
1/3 die from dz
men 3.8x more than women

Question 10

RF for laryngeal cancer

Answer 10

smoking and etoh (synergistic)
risk returns to baseline 20 years after cessation
LPR may be a RF (no causal relationship established yet)

Question 11

Types of CA found in larynx

Answer 11

95% SCC
Variants of SCC: verrucous (better prog), spindle cell (worse)
Other tumors: adenoid cystic, mucoepidermoid, sarcoma, neuroendocrine, metastatic, contiguous (thyroid)

Question 12

Presentations of supraglottic, glottic and subglottic

Answer 12

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)

Question 13

Workup Imaging

Answer 13

None if T1 glottic
If other: CT neck w/ con or MRI
PET if advanced for mets

Question 14

Paralyzed VC: how and significance

Answer 14

mass effect, cricoarytenoid joint, or RLN

T3

Question 15

Membranes that prevent larynx cancer spread

Answer 15

conus elasticus (cricovocal membrane)
quadrangular membrane (epigl to FVF)
both separated by ventricle

Question 16

Paraglottic space boundaries

Answer 16

Medial: conus and quadranguar memb
Lateral: thyrohyoid membrane, thyroid cart lamina
Post: medial mucosa pyriform sinus
If involved: T3

Question 17

Preglottic space

Answer 17

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

Question 18

Typical spread of supraglottic, glottic and subglottic CA

Answer 18

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)

Question 19

T Staging Supraglottis

Answer 19

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

Question 20

T Staging glottis

Answer 20

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

Question 21

Subglottis T Stage

Answer 21

1: subglottis
2: to VC
3: fixed cord
4a: cricoid or thyroid cartilage or outside larynx
4b: prevert, ICA encase, mediastinum

Question 22

Basics of laryngeal cancer treatment

Answer 22

Stage 1-2: Rads or Surg

3-4: multimodal

Question 23

Contraindications to conservation laryngeal surgery

Answer 23

more than 5mm subglottic extension
extend to postcricoid
BOT or piriform sinus involve
cartilage invasion
bilateral fixed cords
bilateral arytenoid involvement

Question 24

Subsistes of Hyopharynx and cancer considerations

Answer 24

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

Question 25

Speech after laryngectomy

Answer 25

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

Question 26

RF esophageal CA

Answer 26

SCC: smoke, alcohol, hookah, poor, low fruit/veg, hot tea

Adeno: smoke, Barrett esophagus (GERD), obesity as it worsens GERD. 70% US

Question 27

When to Tx neck with laryngeal CA

Answer 27

Glottis: supreglottic extension

Supra: T2

(Up to debate)

Question 28

Comparing surgery and rads for early glottic cancer

Answer 28

Surg: one time, save rads for recurrence

Rads. Better voice (if full thick cord involved), cost, length, if recur May not save larynx

Question 29

Survival Rates Larynx/Hypo

Answer 29

Supra: 59-59-53-34
Glott: 90-74-56-44
Sub: 65-56-47-32
Hypo: 53-39-36-24