Laryngeal

Question 1

Describe the 3 anatomic divisions of the larynx

Answer 1

Supraglottis
Epiglottis, aryepiglottic folds, arytenoids and false cords

Glottis
Vocal cords, ant and post commissars

Subglottis
From below the vocal cords to the bottom of the cricoid

Question 2

What is the commonest subtype of laryngeal cancer?

Answer 2

Glottic

Then supraglottis and then subglottis

Question 3

Which subtype has a propensity for bilateral LN involvement?

Answer 3

Supraglottic (50%)

Question 4

Describe the T stage for glottic tumours

Answer 4

T1 limited to vocal cords with normal mobility (may involve ant/post commissure)
T1a limited to 1 vocal cord
T1b. Involves both vocal cords

T2. Extends to supraglottis +- subglottis +- impaired vocal cord mobility

T3 limited to larynx with vocal cord fixation +- invasion of paraglottic space +- inner cortex of thyroid cartilage

T4a invades through outer cortex of thyroid cartilage, invades thyroid cartilage, invades tissues beyond larynx (eg trachea, deep muscles of tongue, strap muscles)
T4b invades mediastinum, prevertebral space or encases carotid artery

Question 5

Describe T stage for supraglottic tumours

Answer 5

T1 - 1 subsite

T2 - invades an adjacent area

T3 vocal cord fixation or thyroid cartilage invasion

T4a deep muscles/trachea
/thyroid

T4b prevertebral space, carotid involvement, mediastinal involvement

Question 6

Describe T stage for subglottis tumours

Answer 6

T1 limited to subglottis
T2 vocal cord involvement
T3 VC fixation or inner cortex of thyroid cartilage
T4a outer thyroid cartilage/deep muscles/tissues beyond larynx
T4b mediastinum/prevertebrals/carotid artery

Question 7

What should considered if airway compromise?

Answer 7

Tracheostomy

Question 8

What are the options for T1 disease?

Answer 8

Surgery (T1a) - TOLR (not if commisure involved). Neck dissection if supraglottic (not in glottic)

XRT - 50Gy/16# VMAT

Question 9

What treatment would you recommend for T2 disease?

Answer 9

XRT - 55Gy/20# and 45Gy elective nodes

Question 10

What treatment would you recommend for T3 disease?

Answer 10

CRT - 66Gy/30# & 54Gy elective

BL neck 2-4

Question 11

What treatment would you recommend for T4 disease?

Answer 11

Total laryngectomy and BL neck dissection (CI surgery - 360deg encasement of CA or prevertebral muscle involvement)

PORT - 60Gy/30# with 54Gy to elective regions

Chemoradiotherapy if <70y, positive margins or ENE