Laryngeal cancer 1% of new cancer diagnoses - PowerPoint Presentation

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Laryngeal cancer

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1% of new cancer diagnoses

laryngeal cancer accounts for about one-fourth of head and neck cancer diagnosed annually.

male-to-female ratio for larynx cancer is 4:1lower socioeconomic groups .

Introduction :

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The

supraglottis

has rich bilateral lymphatics Thus the strong tendency for supraglottic

tumors to spread via lymphatics.

Supraglottic

:

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Glottis

There is a paucity of lymphatics and, compared with supraglottic primary neoplasms malignant glottic tumors have less a tendency for bilateral regional lymphatic spread and remain confined to the glottis for longer periods of time.

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RISK FACTORS :

Tobacco smoking, alcohol.

HPV 16 / 18

GERD implicatedOccupational factorsRadiation exposureGenetic factors Premalignant lesions

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Squamous

cell carcinomas: 95% of all malignant laryngeal tumors

Histological types

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Supraglottic

tumors

asymptomatic until a relatively large tumor bulk is present . Nodal metastasis is often the initial complaint.

Glottic tumorstend to present early, with hoarseness as their chief complaint.Subglottic

tumors

rare and may present with

stridor

or

hemoptysis

.

Presentation

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Supraglottic

cancer

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Supraglottic cancer

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Epiglottic

tumor

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Glottic

squamous cell carcinoma of the larynx. The tumor involves the anterior half of the

left vocal cord.

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Glottic

Tumor

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Glottic

Tumor

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Subglottic cancer

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symptoms

Hoarsness

Dyspnea . Dysphagia.Ear pain.Hemoptysis

Throat pain

Airway compromise

Aspiration

Neck mass

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complete head and neck examination should be performed.

The quality of the voice is noted. A breathy voice may indicate a vocal cord paralysis and a muffled voice, a

supraglottic lesion. Palpation :cervical

lymphadenopathy broadening of the laryngeal prominence Restricted laryngeal

crepitus

may be a sign of post

cricoid

or retropharyngeal invasion ( late stage )

Physical examination

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Laryngoscopy

:

- mirror examination - fiberoptic

endoscope:Malignant laryngeal lesions can appear to be fungating, friable, nodular, or ulcerative, or simply as changes in mucosal color

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Triple endoscopy and includes direct

laryngoscopy

, esophagoscopy, and

bronchoscopy.Assess the extent of the laryngeal tumor Assess the respiratory tract and upper digestive tract for synchronous primary tumors.

To investigate cervical lymph node

mets

of unknown origin.

DIRECT LARYNGOSCOPY

:

Biopsies of suspected malignant sites

with cup forceps.

PANENDOSCOPY

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CT Neck

MRI Neck

PET scan:Identifying occult nodal metastases, Distinguishing the recurrence of malignant growth from radionecrosis and other sequelae of prior treatment.

Identifying the location of any unknown primary cancer.

Imaging

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Treatment

Early : surgery or radiotherapy

Advanced : surgery + radiotherapy

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Prognosis

 

Early laryngeal cancer has a very good prognosis (greater than 95%) 5 year survival Involvement of lymph nodes in the region is associated with a poorer prognosis.

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Pharyngeal Cancer

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Nasopharynx

The

pharyngeal recess (fossa of

Rosenmüller) – most common site of NP tumour.

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The palatine tonsils are

most common site of OP

tumour

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On either side of the laryngeal orifice is a recess, termed the

sinus pyriformis,

which is bounded medially by the aryepiglottic fold, laterally by the thyroid cartilage and

hyothyroid

membrane.

sinus pyriformis is the most common site of

hypopharyngeal

CA.