43 Malignant Laryngeal Tumours • 1% of all malignancies in British men • 85% of all laryngeal malignancies • 3 to 4 male: 1 female • Age 55–65 peak • High incidence = Brazil, United States, India, France • Low incidence = Japan, Scandinavia • Lower social class • African-Caribbean origin • Aetiological factors: Smoking Dark spirit consumption Asbestos exposure Formaldehyde exposure Radiation (therapeutic for thyroid) Keratosis and leukoplakia • Keratosis—keratin formation by superficial layer only • Parakeratosis—nucleus retained abnormality in superficial layer of keratin-producing cells • Dyskeratosis—keratinization within prickle cell layer • Dysplasia—nuclear variation, mitosis, loss of normal epithelial layering Grade I—squamous cell hyperplasia with mild dysplasia and keratosis Grade II—keratosis and squamous cell dysplasia with occasional nuclear atypia Grade III—squamous cell hyperplasia • Ca in situ—malignant cells confined superficially to basement membrane • Ca in situ shows course abnormalities of differentiation and nuclear atypia in almost all areas of epithelium with basal cell proliferation and mitoses regards as premalignant • Classification T1—limited to 1 subsite of supraglottis; VF movement normal T2—>1 subsite of supraglottis/glottis/hypopharynx without fixation of larynx T3—limited to larynx with vocal folds (VF) fixation and/or invades: postcricoid/pre-epiglottic/tongue base tissues T4—invades through thyroid cartilage and/or invades into soft tissues of neck/thyroid/oesophagus • Suprahyoid and infrahyoid epiglottis Arytenoid Aryepiglottic folds False cords • Chance of occult nodal mets T1/T2: 16% T3/4 up to 62% • Classification T1—limited to VF (± ant./post. commissures) with normal mobility – A—one VF – B—both VFs T2—extends to supraglottis and/or subglottis and/or with impaired VF mobility T3—limited to larynx with VF fixation T4—invades through thyroid cartilage and/or extends to other tissues beyond the larynx • Causes of VF fixation Deep invasion with involvement of at least the thyroarytenoid muscle If posterior part of VF involved, fixation due to involvement of cricoarytenoid joint/cricoid cartilage/arytenoid Perineural invasion of recurrent laryngeal nerve • Incidence of lymph node metastases <10% T1/2 10–37% T3/4 • Classification T1—limited to subglottis T2—extends to VF(s) with normal or impaired mobility T3—limited to larynx with VF fixation T4—invades through thyroid/cricoid cartilage and/or extends to other tissues beyond larynx Fig. 43.1a, b a Carcinoma of the right vocal fold (T1N0M0). b Carcinoma of the left vocal fold comprising the anterior commissure (T3N2M0). • See Table 43.1 • Verrucous carcinoma Consists of unusually well-differentiated keratinizing squamous epithelium arranged in compressed invaginating folds Warty papillary surface Clefts between adjacent capillary folds can be traced to depths of the tumour Infiltration is on a broad base with pushing margins against a stroma containing a prominent inflammatory reaction Usual cytological and infiltrating growth pattern of squamous carcinoma is absent Non-aggressive; seldom metastasizes • Kaposi sarcoma All patients with malignancy should be discussed in a multidisciplinary meeting • Performance status • Patient preference • Previous treatment • Patient’s distance from treatment facility
43.1 Squamous Carcinoma (Fig. 43.1)
43.2 Squamous Intraepithelial Neoplasia
43.3 Supraglottic Carcinoma (40%)
43.4 Glottic Carcinoma (50%)
43.5 Subglottic Carcinoma (5%)
43.6 Overall Staging Grouping for Laryngeal Cancer
43.7 Unusual Tumours
43.8 Treatment of Laryngeal Carcinoma
43.8.1 Factors to Consider
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Malignant Laryngeal Tumours
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