Transcript Laryngeal obstruction

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
•
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