Week 4: Supraglottis/Larynx Flashcards
Why do glottic cancers have a fairly low rate of regional mets?
The glottis does not have a rich supply of lymphatics.
Glottic cancers typically have to become large and/or very invasive before they develop cervical nodal mets, b/c they are well-contained by the ___ and ___, as well as this region having poor ___ supply.
Glottic cancers typically have to become large and/or very invasive before they develop cervical nodal mets, b/c they are well-contained by the
Conus Elasticus and Quadrangular Membrane
as well as this region having poor
Lymphatic supply.
Supraglottic T staging:
T1: primary tumor limited to ___ subsite(s)
Supraglottic T staging:
T1: primary tumor limited to 1 subsite
- Epiglottis (suprahyoid, free edge or infrahyoid, fixed edge)
- AE folds/arytenoids
- FVC
Supraglottic T staging:
T2: primary tumor invades mucosa of ___ adjacent subsite(s) of supraglottis or glottis or region outside the supraglottis
(e.g. ___, ___, ___)
Supraglottic T staging:
T2: primary tumor invades mucosa of >1 adjacent subsite of supraglottis or glottis or region outside the supraglottis
(e.g. mucosa of BOT, vallecula, medial wall of pyriform)
Supraglottic T staging:
T3: ___ or primary tumor invades:
Supraglottic T staging:
T3: VC fixation or primary tumor invades:
- PE fat
- PG fat
- inner cortex of thyroid cartilage
Supraglottic T staging:
T4a: primary tumor invades
Supraglottic T staging:
T4a: primary tumor invades:
- outer cortex thyroid cartilage
- BOT
Supraglottic T staging:
T4b: primary tumor invades;
Supraglottic T staging:
T4b: primary tumor invades:
- prevertebral space
- encases carotid a.
- invades mediastinum
A supraglottic laryngectomy is a partial laryngectomy which spares the ___, ___, ___, and ___.
A supraglottic laryngectomy is a partial laryngectomy which spares the
- TVF
- arytenoids
- BOT
- hyoid bone
Within the context of laryngeal malignancies, where is a “marginal” tumor located?
Aryepiglottic fold.
(“marginal” b/c could be considered as a laryngeal cancer or hypopharyngeal cancer in the pyriform sinus)
50-70% of patients w/hypopharyngeal cancer present w/nodal involvement at the time of dx due to the high rate of _____.
50-70% of patients w/hypopharyngeal cancer present w/nodal involvement at the time of dx due to the high rate of cervical mets.
___ cancer tend to have the WORST prognosis of all head and neck subsides.
Hypopharyngeal Cancers tend to have the WORST prognosis of all head and neck subsides.
-
Limited to:
- posterior pharyngeal wall
- medial or lateral wall of the pyriform sinus
73M tobacco user presents w/hoarseness/odynophagia worsening over 2 mos. FFL demonstrates an exophytic lesion of the L TVF extending to the FVC. The L TVF movement is decreased.
What are the Treatment options for this patient?
- Radiation
- Partial Laryngectomy
Treatment of early stage glottic cancer:
Tis -
Treatment of early stage glottic cancer:
Tis - Endoscopic surgery (preferred) vs. RT
Treatment of early stage glottic cancer.
-
Treatment of early stage glottic cancer.
T1a - single modality
- Surgery
- Radiation
Treatment of early stage glottic cancer.
-
Treatment of early stage glottic cancer.
T1b - single modality
- Surgery
- Radiation
Treatment of early stage glottic cancer.
-
Treatment of early stage glottic cancer.
T2:
- Surgery
- Radiation +/-Chemo
Treatment of late stage (T3) glottic cancer.
-
-
Treatment of late stage glottic cancer.
T3 - multimodality
- Surgery (total laryngectomy vs. open partial laryngectomy)
- post-op RT
- Definitive Chemoradiation
Treatment of late (T4) stage glottic cancer.
-
-
Treatment of late stage glottic cancer.
T4:
- Total laryngectomy
- post-op RT +/- chemo
- definitive chemoradiation (rarely)
Total Laryngectomy indications:
- advanced disease
- _____
- radiation necrosis not responsive to conservative management
- severe aspiration
Total Laryngectomy indications:
- advanced disease
- recurrent/residual cancer after failed chemorads or conservative surgery
- radiation necrosis not responsive to conservative management
- severe aspiration
Total Laryngectomy indications:
- advanced disease
- recurrent/residual cancer after failed chemorads or conservative surgery
- _____
- severe aspiration
Total Laryngectomy indications:
- advanced disease
- recurrent/residual cancer after failed chemorads or conservative surgery
- radiation necrosis not responsive to conservative management
- severe aspiration
Total Laryngectomy indications:
- advanced disease
- recurrent/residual cancer after failed chemorads or conservative surgery
- radiation necrosis not responsive to conservative management
- _____
Total Laryngectomy indications:
- advanced disease
- recurrent/residual cancer after failed chemorads or conservative surgery
- radiation necrosis not responsive to conservative management
- severe aspiration
Predominant type of epithelium found in the supraglottis?
pseudostratified columnar
with an abundance of mucus glands and lymphatic channels
Invasion of the ___ cartilage is a contraindication to supracricoid laryngectomy.
cricoid cartilage
Partial laryngectomy can be considered in patients with:
- adequate ___ function
- tumor limited to the AE fold
- involves the medial and anterior walls of the pyriform sinus
Partial laryngectomy can be considered in patients with:
- adequate pulmonary function
- tumor limited to the AE fold
- involves the medial and anterior walls of the pyriform sinus
Partial laryngectomy can be considered in patients with:
- adequate pulmonary function
- tumor limited to the __ fold
- involves the medial and anterior walls of the pyriform sinus
Partial laryngectomy can be considered in patients with:
- adequate pulmonary function
- tumor limited to the AE fold
- involves the medial and anterior walls of the pyriform sinus
Partial laryngectomy can be considered in patients with:
- adequate pulmonary function
- tumor limited to the AE fold
- involves the medial and anterior walls of the ___.
Partial laryngectomy can be considered in patients with:
- adequate pulmonary function
- tumor limited to the AE fold
- involves the medial and anterior walls of the pyriform sinus
Laryngeal chondrosarcoma is so rare (~1% of laryngeal neoplasms), treatment of choice is ___.
Surgery alone
Most common site of laryngeal chondrosarcoma?
Posterior cricoid
The __ and __ pharyngeal arches give rise to the supraglottis.
3rd and 4th
The __ branchial arch gives rise to the glottis.
6th
Pyriform sinus tumors involving the ___ and ___ are not candidates for laryngeal preservation, and thus must undergo total laryngopharyngectomy.
Pyriform sinus tumors involving the apex and larynx are not candidates for laryngeal preservation, and thus must undergo total laryngopharyngectomy.
Tumors of the ___ wall of the pyriform sinus generally also require TL, however, early lesions may be amenable to simple excision.
Tumors of the lareral wall of the pyriform sinus generally also require TL, however, early lesions may be amenable to simple excision.
Similar to other joints, RA can cause inflammation and fixation of the ___ joint.
Similar to other joints, RA can cause inflammation and fixation of the cricoarytenoid joint.
