1. Medical Imaging In Laryngeal Carcinoma

2. Navigation Click the HOME button to return to table of contents.
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3. Table of contents Objectives Introduction Laryngeal Carcinoma
Risk Factors
Signs and Symptoms
Diagnosis Through Imaging
Fluoroscopy
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography
Staging
Stage I
Stage II
Stage III
Stage IV
Treatment
Conclusion
References

4. Objectives Discuss laryngeal carcinoma
Define risk factors associated with this cancer
State the signs and symptoms
Describe the modalities utilized to accurately diagnose laryngeal carcinoma
Review staging of malignancy
Provide treatment options based off severity of cancer
Conclude medical imaging on laryngeal carcinoma
Objectives

5. Introduction
The population of America are discovering faults in their personal habits contributing to laryngeal carcinoma, and with the ever-advancing medical imaging capabilities. We can use multiple modalities to help lead us to an accurate diagnosis and treatment plan for this cancer with fluoroscopy, CT, MRI, and PET scans based off presented signs and symptoms.

6. Laryngeal Carcinoma
Laryngeal carcinoma is easily understood as malignant cancer of the neck, more specifically the larynx. The larynx which is also commonly known as the “voice box” is shown in the image to the right. 1
IMAGE 1.1

7. Did You Know?
Approximately 9,500 people in the United States receive the diagnosis of cancer in the larynx.1

8. Risk factors
Individuals are at a higher risk for laryngeal carcinoma with the following factors:
Tobacco use (number one cause of laryngeal carcinoma)
Excessive alcohol consumption
Large quantities of processed food
Lack of fruit and vegetables
Exposure to asbestos
Family history3

9. Signs and Symptoms
Sign: any objective problem of a disease that can be recognized by the patient, physician or any medical personnel.
Symptom: any subjective problem of a disease that cannot be measured.
An individual with laryngeal carcinoma may experience:
Hoarse voice
Trouble swallowing food
Breathing difficulties
Neck swelling
Excessive coughing
Neck lumps
Hemoptysis (coughing up blood)
Sudden weight loss
Neck pain
Sore throat3

10. Did You Know?
The National Cancer Institute tells us that throat/head cancer makes up for about 3% of the cancer in the US. 1
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11. Diagnosis Through Imaging
CT SCANNER
The following modalities are utilized in the diagnosis process:
Fluoroscopy
Computed tomography
Magnetic resonance imaging
Positron emission tomography
Dual modality
PET SCANNER

12. Fluoroscopy
Fluoroscopy is a live imaging system that uses x-rays to visualize anatomical structures in real-time video images. This dynamic study is most often utilized in the early steps to diagnose laryngeal carcinoma.

13. Fluoroscopy
One major health risk that is associated with throat abnormalities are trouble swallowing and trouble getting food down, which can lead to aspiration.
Swallow studies are one of the better ways to diagnosis aspiration because it gives a live film feed of a patient swallowing different thicknesses and consistencies of liquids mixed. 3
This type of exam visualizes the possible carcinoma that could be present.
FLUOROSCOPY UNIT

14. Fluoroscopy Image HOME
A filling defect is shown with contrast in this fluoroscopic image. The expanding carcinoma creates a new space for contrast to get trapped.
IMAGE 2.3
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15. Did you know?
The early stages of laryngeal carcinoma are curable with an 80%-95% survival rate within the first 5 years. Advanced stages of throat cancer have a 5 year survival rate of 25%-50%.3
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16. Computed Tomography
CT SCANNER
CT uses thin beams of x-rays that rotate around the patients stationary body to produce cross sectional images of the targeted anatomy. 3

17. Computed Tomography PUNCH BIOPSY NEEDLE TRUCUT BIOPSY NEEDLE
CT’s for laryngeal carcinoma demonstrates size, location, shape and adjacent tissues.
Provides an axial set of images of the larynx which focuses on the anatomy instead of function.
A contrast CT of the neck will give the best evaluation of the carcinoma.
Two types of biopsies in CT include:
Punch: A small piece of round tissue about the size of a pencil eraser is punched out using a sharp circular instrument.
Trucut: Utilizes a needle that has a notched rod to obtain a specimen.2
TRUCUT BIOPSY NEEDLE

18. CT Image
Image 3 demonstrates a mass on the vocal cords which is shown with the white arrows. The black arrows display sclerosis of the thyroid lamina. 2
IMAGE 3.2
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19. Did You Know?
Cancers of the larynx constitute about 25% of all head and neck malignancies.2

20. Magnetic Resonance imaging
An MRI uses an intense magnet that aligns the human body’s hydrogen atoms along the magnetic field lines of the scanner. A radio wave, enhanced by coils is sent through the patient causing the protons to flip direction, releasing energy.

21. Magnetic Resonance Imaging
MRI will map out the larynx anatomically. It is performed to define the submucosal extent and deeper margins of the tumor.2
MRI gives a better visualization of soft tissue, such as the larynx, compared to CT.

22. MRI Image
This picture shows a sagittal T1W MR image through the larynx. A sagittal T1W MRI shows the epiglottis (thin arrow) and the pre-epiglottic fat space (thick arrow). 3
Images are also utilized to see if the carcinoma is growing or spreading.
IMAGE 4.2
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23. Positron Emission Tomography
This exam uses radioactive materials known as radioisotopes that are introduced into the body. These materials can be introduced by inhaling, swallowing or being injected.
While images are being obtained, the area of interest is where the radioactive material is absorbed. The concentrated region shows shape, size, and position of the carcinoma.
This scan uses a radioactive substance known as fluorodeoxyglucose (FDG).
This FDG is injected into the blood stream and the quickly growing cancer cells absorb the radioisotope.
Positron Emission Tomography

24. PET Image
This picture depicts the region of interest, which is where the radioisotope is most concentrated. This brightly colored area is where the laryngeal carcinoma resides.3
Image 5.2
IMAGE 5.2
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25. STAGING
Cancer staging is the method of defining how much cancer is in the body and where it is located.
Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body. 
Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required.4
*Laryngoscope which utilizes a small scope or series of mirrors that give a clear up-close video to examine the larynx.
*Laryngoscope which utilizes a small scope or series of mirrors that give a clear up-close video to examine the larynx.
IMAGE 6.4

26. N- Identifies how far the cancer has spread to the lymph nodes.
There are four stages (I-IV).
TNM is an acronym used as a staging system for laryngeal carcinoma. (Tumor, Node, and Metastases).
Staging
T- Sizes the primary tumor and identify adjacent tissues that have been invaded.
N- Identifies how far the cancer has spread to the lymph nodes.
M- Designates whether the cancer has metastasized into other lymph nodes or distant organ systems.4
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27. Stage I
Cancer is in one or both vocal cords, and the vocal cords can move normally.4

28. Stage II
Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally.4

29. Stage III
Cancer is in the larynx only, and the vocal cords cannot move and/or cancer is in tissues next to the larynx. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is three centimeters or smaller.4

30. Stage Iv Stage IV is divided into three stages:
Stage IVA- cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus.
Stage IVB- Cancer has spread to the space in front of the spinal column, surrounds the carotid artery, or has spread to parts of the chest.
Stage IVC- Cancer has spread to other parts of the body such as the lungs, liver or bone.4

31. Treatment
Depending on the stage of the cancer and your overall health, different treatment options may be used alone or in combination. In creating your treatment plan, the most important factors to consider are the site and the stage of the cancer.3
Surgery- In the early stages (I, II), patients can be treated successfully without totally removing their larynx (partial laryngectomy). In late stages, total removal of the larynx occurs.
Radiation Therapy- Affects healthy cells and the carcinoma. However the healthy cells will grow back, whereas the cancer cells will not.
Chemotherapy- Used to directly treat the carcinoma.
Targeted Therapy- Utilizes a combination of both radiation therapy and chemotherapy.

32. Conclusion
In conclusion, laryngeal carcinoma is very relevant in today’s society because of lifestyle choices. There are many risk factors that lead to the various signs and symptoms that coincide with laryngeal carcinoma. Multiple imaging modalities are used to diagnostically stage and treat this cancer. No two patients are the same, which is why having multiple modalities with varying capabilities plays a critical role in the diagnosis process. These modalities include: fluoroscopy, computed tomography, magnetic resonance imaging, and positron emission tomography. The tool of imaging aides medical professionals in providing an efficient and effective treatment plan.

33. CLICK HERE TO SEE THE ANSWER
What is the leading cause for Laryngeal Carcinoma?
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34. Smoking

35. What type of treatment uses both radiation therapy and chemotherapy?
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36. Targeted therapy

37. Which imaging modality gives a better visualization of soft tissue?
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38. MRI

39. references
Jager EA, Kasperts N, Caldas-Magalhaes J, et al. GTV delineation in supraglottic laryngeal carcinoma: interobserver agreement of CT versus CT-MR delineation. Radiation oncology (London, England). Published January 23, Accessed March 22, 2019.
Joshi VM, Wadhwa V, Mukherji SK. Imaging in laryngeal cancers. The Indian journal of radiology & imaging. Published Accessed March 22, 2019.
Tests for Laryngeal and Hypopharyngeal Cancers. American Cancer Society. diagnosis-staging/how-diagnosed.html. Accessed March 22, 2019.
Stages of Laryngeal Cancer. Cancer Support Community, So that No One Faces Cancer Alone. Accessed March 22, 2019.
Qi X, Yu D, Zhao X, et al. Clinical experiences of NBI laryngoscope in diagnosis of laryngeal lesions. International journal of clinical and experimental medicine. Published October 15, Accessed March 22, 2019.

40. Image references
North Wby 30 D. Overview of Laryngeal Cancer. Arizona Oncology - The US Oncology Network. cancer/laryngeal-cancer/. Accessed March 22, 2019.
Joshi VM, Wadhwa V, Mukherji SK. Imaging in laryngeal cancers. The Indian journal of radiology & imaging. Published Accessed March 22, 2019.
Laryngeal Cancer - Ear, Nose, and Throat Disorders. Merck Manuals Professional Edition. disorders/tumors-of-the-head-and-neck/laryngeal-cancer. Accessed March 22, 2019
Manager. Home. Diagnostic Imaging Pathways. nose-throat/staging-of-laryngeal-cancer#pathway. Published August 15, Accessed March 22, 2019