Laryngeal and Pharyngeal Cancer

Question 1

what is it?

Answer 1

squamous cell carcinoma is the most common type

Question 2

who gets it?

Answer 2

male patient
>55 years
long cigarette and alcohol exposure
HPV related OP, SCC is increasing dramatically - non-smoker, higher socio-economic class, multiple partners typically

Question 3

how does it present?

Answer 3

typically late presentation worsening prognosis
Dysphona > 3 weeks warrants and urgent larynoscopy referral
Dysphagia - particularly if progressive
odynophagia
unilateral otalgia - if no other cause consider the referred pain
neck lump
can be obstructive of airway - stridor

Question 4

how do supra-glottic tumours spread?

Answer 4

drain to superior deep cervical nodes

Question 5

how do glottic tumours spread?

Answer 5

present on the cords
95% stay on the cords
minimal lymphatic drainage
presents with voice changes/ airway obstruction

Question 6

how do sub-glottic tumours spread?

Answer 6

spread to paratracheal nodes

present with voice changes/airway obstruction

Question 7

how is it diagnosed?

Answer 7

panendoscopy and biopsy
direct laryngoscopy, tracheoscopy and oesophagoscopy
these are performed under general anaesthesia
US, FNA, CT, MRI and PET
CT - great for looking at lymph nodes and larynx
MRI - great for looking at nasopharynx and tongue base

Question 8

what are the early stages of laryngeal cancer?

Answer 8

T1 & T2
transoral laser surgery
radiotherapy

Question 9

what are the advanced stages of laryngeal cancer?

Answer 9

T3 & T4
partial or total laryngectomy
chemo and radiotherapy

Question 10

how can laryngeal cancer be managed?

Answer 10

can do laryngectomy - it is often curative with good 5 year survival rate