43 Malignant Laryngeal Tumours
43.1 Squamous Carcinoma (Fig. 43.1)
• 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
43.2 Squamous Intraepithelial Neoplasia
• 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
43.3 Supraglottic Carcinoma (40%)
• 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%
43.4 Glottic Carcinoma (50%)
• 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
43.5 Subglottic Carcinoma (5%)
• 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
43.6 Overall Staging Grouping for Laryngeal Cancer
43.7 Unusual Tumours
• 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
43.8 Treatment of Laryngeal Carcinoma
43.8.1 Factors to Consider
All patients with malignancy should be discussed in a multidisciplinary meeting
• Performance status
• Patient preference
• Previous treatment
• Patient’s distance from treatment facility
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