Laryngeal Cancer 

 

 

Laryngeal Cancer

Within the group of head and neck malignancies, laryngeal cancer is the most common. Ninety percent of laryngeal cancers are squamous cell carcinomas originating from the epithelial lining of the laryngeal mucous membrane. The etiology of squamous cell carcinomas is mainly related to smoking and alcohol intake, particularly the combination of both.

A clear distinction needs to be made between glottic cancer (the true vocal cords), cancer of the supraglottic part of the larynx (false vocal cords, arytenoids, aryepiglottic folds and the epiglottis) and subglottic cancer. Cancer involving the glottis accounts for approximately 65% of the laryngeal cancers. Subglottic cancer is rare (5%). This distinction is made because of the differences in symptoms, tumor spreading patterns and therapy modalities of these different sites.

The most important symptom in this patient group with glottic cancer is persistent hoarseness. In a more advanced stage dysphagia and dyspnea occurs. Referred otalgia may be present but generally indicates deep supraglottic involvement. Cervical lymphadenopathy is more frequent in supraglottic cancers than in glottic lesions. The supraglottic area has a rich lymphatic drainage while the true vocal cords are devoid of lymphatic drainage. As a result cancer confined to the vocal cord rarely presents with lymph node involvement. Since hoarseness is a relative early symptom in glottic cancer, these tumors are generally smaller than supraglottic cancers at first detection.

The overall 5 year survival of glottic cancer is 85%. When looking at the different stage groups, the 5 years survival is for stage I: 95%, II: 85%, III: 60% and IV: 35%. The overall 5 year survival of supraglottic cancer is 55%. For stage I this is: 65%, II: 65%, 55% and 40%.

The risk of second primary tumors, especially if the patients continues smoking and drinking alcohol, has been reported as high as 25%.4 Furthermore, patients who smoke during radiation therapy appear to have lower response rates and shorter survival times than those who do not.5

Treatment Modalities of Laryngeal Cancer

As with any cancer, precise staging is of utmost importance as it dictates the treatment modalities. These treatment modalities differ to some extent for the sub-sites within the larynx and also for the institution involved. Depending on the stage the therapy will consist of radiation or surgery (including laser treatment) or a combination of the two. Chemotherapy, as of yet, has no place in curative treatment.

The larynx has three major functions: phonation, air passage and a sphincter function with which it protects the lower airways. Conservation laryngeal surgery has emphasized the importance of the larynx as an airway and sphincter. Loss of voice due to disease or treatment is a serious handicap, but an ineffective airway or inefficient sphincter may be fatal.6

It is impossible to determine a standard treatment for each tumor stage and sub-site because many factors play a role in the final decision which therapy is best. Anatomic considerations and the patient’s health and preference, are a few additional factors that can play a decisive role in therapy choice.

Total laryngectomy is mostly performed in the more advanced stages of disease and in radiation therapy failures. For glottic and supraglottic cancer this would be stages II and III, depending of course on location and spread. More conservative surgical procedures like supraglottic horizontal laryngectomy, vertical hemilaryngectomy and frontolateral hemilaryngectomy each have their specific indications.

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Copyright 1998 Medical Illustrations
Last modified: January 07, 1999

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