Carcinoma of the larynx Epidemiology Accounts for 1% of all new cancers diagnosed in the U.S. and 0.75% of all cancer deaths. Accounts for 30% in all head and neck cancers. More frequently happened in patients at 50~70 years of age. M:F ratio: 5~10:1 (foreign country)，6.75:1(shanghai).

Carcinoma of the larynx Etiology Cigarette Wine (combined smoking and alcohol abuse increases the risk by 50% over the additive rate ) air pollution Virus (HPV) precancerous lesions (Leukoplakia, Papilloma) sex hormones

Leukoplakia of the larynx

Carcinoma of the larynx Pathology Nearly 98% are squamous cell carcinoma. adenocarcinoma and undifferentiated carcinoma is rare.

Carcinoma of the larynx Clinical classification: Glottic (60%)：well differentiated, late metastasis Supraglottic (30%)：poor differntiated, early metastasis Subglottic (6%)：poor differentiated, early metastasis

Anatomic divisions of the larynx

Carcinoma of the larynx Spread of tumor Direct spread Supraglottic cancer→ epiglottis, pre-epiglottic space, vallecula, and tongue base. piriform sinus, lateral wall of hypopharynx. paraglottic space, ventricle or the VC.

Carcinoma of the larynx Spread of tumor Direct spread Glottic cancer→ anteriorly, contralateral VC. posteriorly, arytenoid cartilage superiorly, supraglottic area. inferiorly, paraglottic space and subglottic area.

Carcinoma of the larynx Spread of tumor Direct spread Subglottic cancer→superiorly, glottis. anteriorly and laterally, strap muscle and thyroid gland. posteriorly, esophagus.

Carcinoma of the larynx Spread of tumor Lymph nodes metastases Supraglottic cancer →have a propensity to spread to cervical lymph nodes bilaterally at the early stages. Generally, the risk of occult or actual metastases from T1, T2, T3 and T4 tumors is 20, 40, 60, and 80%.

Carcinoma of the larynx Spread of tumor Lymph nodes metastases Glottic cancer →CV is virtually devoid of lymphatics, involvement of cervical nodes at the early stages is not common. ＜8% of patients with T1 and T2 tumors will have nodal involvement.

Carcinoma of the larynx Spread of tumor Lymph nodes metastases Glottic cancer →Only at the later stages, prelaryngeal nodes, paratracheal nodes and other cervical nodes could be involved.

Carcinoma of the larynx Spread of tumor Lymph nodes metastases Subglottic cancer →tend to spread to paratracheal lymphatics and then to superior mediastinual nodes.

Carcinoma of the larynx Spread of tumor Distant metstases via blood Distant metastasis only occurs in the very later stage of laryngeal carcinoma .

Carcinoma of the larynx Clinical manifestations Supraglottic carcinoma： Might be asymptomatic Foreign body sensation Pain while swallowing Throat burns Enlargement of cervical lymph nodes

Carcinoma of the larynx Clinical manifestations Glottic carcinoma： Hoarsenenss is the early symptom Respiratory obstruction will happen in late stage

Carcinoma of the larynx Clinical manifestations Subglottic carcinoma： There are no definitive symptoms in the early stage. Dyspnea and lymph nodes metastasis is the late symptoms

Supraglottic carcinoma

Glottic carcinoma

Carcinoma of the larynx Physical examination Laryngoscopic examination can find a mass on one or both vocal cords fixation of the vocal cords is common mass in the neck

Carcinoma of the larynx

Carcinoma of the larynx Differential diagnosis Tuberculosis of the larynx ：chest X-ray film Papilloma of the larynx Syphilis of the larynx

Treatment The modality of treatment depends on: the exact site of the lesion early or advanced stage presence or absence of neck metastasis distant metastasis age and sometimes the patient’s wish

Treatment Early laryngeal carcinoma (T1/T2) is usually managed with single modality of treatment and responds well to radiation, transoral laser resection,or partial laryngeal surgery. Primary cure rates of 80 to 85% are expected.

Treatment The management of advanced laryngeal carcinoma is more controversial. The aim is to optimize disease-free and overall survival while preserving quality of life.

Treatment Generally, combined therapy is widely used, as it shows better survival rates than single-modality treatment. Surgery + radiotherapy or radiotherapy + surgery are two commonly used modalities.

Surgical treatment Laryngofissure with cordectomy Partial laryngectomy Laryngofissure with cordectomy Vertical partial laryngectomy Frontolateral partial laryngectomy Horizontal partial laryngectomy Horizontal vertical partial laryngectomy Supracricoid partial laryngectomy Near total laryngectomy(Pearson’s operation) Transoral laser resection

Surgical treatment Total laryngectomy Neck dissection Radical neck dissection Functional neck dissection Selective neck dissection

Surgical treatment Rehabilitation of speech after total laryngectomy Blom- Singer valve Esophageal speech Electrical larynx

Radiotherapy T1N0M0 tumors located at the mid-portion of the VC Contraindication for surgery because of poor general condition Pre-operative irradiation for some advanced tumors

Other treatment modality Chemotherapy Genetherapy