Malignant Tumors Of Larynx

Question 1

Most important predictor of prognosis in laryngeal CA?

Answer 1

Nodal stage > Tumor stage // BOTH

Question 2

What are the natural barriers to tumor spread in the larynx?

Answer 2

Laryngeal cartilages
Hyoepiglottic ligament (protects tongue base)
Thyrohyoid membrane 
Quadrangular membrane 
Conus elasticus 
Cricothyroid membrane 
Anterior commissure

Question 3

What are natural pathways to spread in laryngeal tumors?

Answer 3

Pre epiglottic space

Paraglottic space

Question 4

Possible ways in which tumor becomes transglottic?

Answer 4

Spread directly thru:
Ventricle
Paraglottic space 
Anterior commissure 
Arytenoid

Question 5

Recurrence rate of premalignant lesion after surgery?

Answer 5

20% after initial excision

*RT has better control rates vs surgery for cases of dysplasia and CIS (con: cannot do repeat RT if with recurrence)

Question 6

the two primary risk factors for cancer of the larynx

Answer 6

Tobacco (glottis) and alcohol (supraglottic) use

Question 7

single greatest risk factor for head and neck SCC is

Answer 7

prior head and neck SCC

Annual risk:1-7% for 10 years
Cumulative risk:20%

Question 8

Difference between synchronous vs metachronous tumor

Answer 8

Synchronous: identified within 6 mo of index tumor
Metachronous: after 6 months

Question 9

An isolated pulmonary nodule in a laryngeal CA patient should be considered a second primary tumor than metastasis. True or false?

Answer 9

TRUE

Lung is a significant site of SPT among larynx CA patients

Question 10

The hallmark of SCC

Answer 10

Squamous differentiation

(+) keratin (+) intercellular bridges

Question 11

A lesion in which the entire thickness of the epithelium shows the cellular features of carcinoma without invasion of the underlying stroma

Answer 11

SCC in situ

Microinvasive:limited tumor invasion is confined to the area just deep to the basement membrane.

Question 12

What are the two mimics of laryngeal carcinoma?

Answer 12

1. Pseudoepitheliomatous hyperplasia (PEH): overgrowth of squamous epithelium due to irritation, GCT or trauma
2. Necrotizing sialometaplasia: infarction of salivary tissue

Question 13

Indications for thyroidectomy in T4 laryngeal SCC?

Answer 13

recommended for

• cases of palpable abnormality
• transglottic tumors
• subglottic tumors/ glottic tumors with greater than 1  cm of subglottic extension