Malignant Laryngeal Tumours

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:


figure Smoking


figure Dark spirit consumption


figure Asbestos exposure


figure Formaldehyde exposure


figure Radiation (therapeutic for thyroid)


figure 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


figure Grade I—squamous cell hyperplasia with mild dysplasia and keratosis


figure Grade II—keratosis and squamous cell dysplasia with occasional nuclear atypia


figure 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


figure T1—limited to 1 subsite of supraglottis; VF movement normal


figure T2—>1 subsite of supraglottis/glottis/hypopharynx without fixation of larynx


figure T3—limited to larynx with vocal folds (VF) fixation and/or invades: postcricoid/pre-epiglottic/tongue base tissues


figure T4—invades through thyroid cartilage and/or invades into soft tissues of neck/thyroid/oesophagus


• Suprahyoid and infrahyoid epiglottis


figure Arytenoid


figure Aryepiglottic folds


figure False cords


• Chance of occult nodal mets


figure T1/T2: 16%


figure T3/4 up to 62%


43.4 Glottic Carcinoma (50%)


• Classification


figure T1—limited to VF (± ant./post. commissures) with normal mobility


– A—one VF


– B—both VFs


figure T2—extends to supraglottis and/or subglottis and/or with impaired VF mobility


figure T3—limited to larynx with VF fixation


figure T4—invades through thyroid cartilage and/or extends to other tissues beyond the larynx


• Causes of VF fixation


figure Deep invasion with involvement of at least the thyroarytenoid muscle


figure If posterior part of VF involved, fixation due to involvement of cricoarytenoid joint/cricoid cartilage/arytenoid


figure Perineural invasion of recurrent laryngeal nerve


• Incidence of lymph node metastases


figure <10% T1/2


figure 10–37% T3/4


43.5 Subglottic Carcinoma (5%)


• Classification


figure T1—limited to subglottis


figure T2—extends to VF(s) with normal or impaired mobility


figure T3—limited to larynx with VF fixation


figure T4—invades through thyroid/cricoid cartilage and/or extends to other tissues beyond larynx



43.6 Overall Staging Grouping for Laryngeal Cancer


• See Table 43.1


43.7 Unusual Tumours


• Verrucous carcinoma


figure Consists of unusually well-differentiated keratinizing squamous epithelium arranged in compressed invaginating folds


figure Warty papillary surface


figure Clefts between adjacent capillary folds can be traced to depths of the tumour


figure Infiltration is on a broad base with pushing margins against a stroma containing a prominent inflammatory reaction


figure Usual cytological and infiltrating growth pattern of squamous carcinoma is absent


figure 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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Jul 4, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Malignant Laryngeal Tumours

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