1. 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).

2. 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

3. Leukoplakia of the larynx

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

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

6. Anatomic divisions of the larynx

7. 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.

8. 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.

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

10. 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%.

11. 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.

12. 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.

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

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

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

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

19. 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

20. Supraglottic carcinoma

21. Glottic carcinoma

22. 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

23. Carcinoma of the larynx

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

25. 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

26. 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.

27. 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.

28. 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.

29. 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

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

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

33. 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

34. Other treatment modality
Chemotherapy
Genetherapy