Management of Carcinoma larynx | Dr Saurabh Mohite | Oncosurgeon

Smoking is the strongest etiological agent in the pathogenesis of carcinoma of the larynx.

Larynx Anatomical subdivisions:
• Supra-glottis: Epiglottis, Ary-epiglottic folds, Arytenoids, False cords, Ventricles
• Glottis: True vocal cord with anterior & posterior commissures
• Subglottis:

Hypopharynx:
• Pyriform sinus
• Post-cricoid region
• Posterior pharyngeal wall.

Pathology

Nearly all laryngeal cancers arise from the surface epithelium and are squamous cell carcinomas. Minor salivary gland tumors are rare; even rarer are soft tissue sarcomas, lymphomas, small cell neuroendocrine carcinoma, and plasmacytomas. Hemangiomas, chondromas, and osteochondromas are reported, but their malignant counterparts are rare.

Lymphatic Spread :

Level II to level VI lymph nodes.

Clinical Picture: Presenting Symptoms

Vocal Cords

Carcinoma produces hoarseness at a very early stage. Pain, dysphagia, and airway obstruction may be observed with advanced cancers

Supraglottic Larynx

Hoarseness is not a prominent symptom until the lesion becomes extensive. Pain on swallowing is the most frequent initial symptom. Pain is referred to the ear by the vagus nerve and the auricular nerve of Arnold. A neck mass may be the first sign of a supraglottic cancer. Late symptoms include weight loss, foul breath, dysphagia, and aspiration.

Specific Investigations before definitive treatment:

Indirect laryngoscopy / Hopkins telescopy
Ba swallow
Direct laryngoscopy
Microlaryngocsopy for early cord lesions
CT scan / MRI mandatory before conservative laryngectomy / laryngeal
preservation therapy

Differential Diagnosis and Staging

The differential diagnosis includes papillomas, polyps, vocal nodules, fibromas, and granulomas. Papillomas generally occur in children and young adults and may persist into adulthood. Vocal polyps and nodules occur at the junction of the middle and anterior one third of the true vocal cords. There is usually a history of voice abuse followed by hoarseness. Vocal cord granulomas usually occur as a result of intubation and are located on or near the posterior commissure. Endoscopic removal is the definitive treatment. Tuberculosis is rare. Generally, the lesion is destructive and occurs at the posterior commissure; it may involve epiglottis and false cords. Pulmonary tuberculosis is usually present.

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