Carcinoma Larynx
Overview
Laryngeal cancer accounts for 25% of head and neck cancers and 1% of all cancers. It primarily affects men aged 60–70 (4:1 male-to-female ratio) and rarely occurs before 40. The disease impacts voice, swallowing, and quality of life, making early detection critical.
Laryngeal Anatomy
The larynx has three subsites, each affecting cancer behaviour and treatment:
| Subsite | Location | Structures Involved |
|---|---|---|
| Supraglottis | Above the vocal cords | Epiglottis, aryepiglottic folds, false cords |
| Glottis | At the vocal cords | True vocal cords, commissures |
| Subglottis | Below the vocal cords | Subglottis to cricoid cartilage |
Risk Factors
Multiple factors increase laryngeal cancer risk:
- Smoking: Carcinogens (e.g., nitrosamines, polycyclic hydrocarbons) damage DNA.
- Alcohol: Amplifies smoking’s effect (15x risk).
- HPV: Strains 16/18 cause DNA mutations.
- GERD: Chronic acid irritates the laryngeal mucosa.
- Occupational exposure: Asbestos, chromium, lead fumes.
- Prior radiation: Head/neck radiation increases risk.
Histological Types. Histology guides treatment and prognosis:
- Squamous Cell Carcinoma (SCC): 85–95% of cases; exophytic or endophytic; shows keratin pearls.
- Verrucous Carcinoma: Well-differentiated SCC; low metastasis, good prognosis.
- Rare Types: Fibrosarcoma, chondrosarcoma, adenocarcinoma, oat cell, spindle cell, salivary gland carcinoma.
Spread Patterns of Laryngeal Cancer. Cancer spread varies by subsite:
| Subsite | Spread Pattern | Lymph Node Involvement | Key Notes |
|---|---|---|---|
| Supraglottis | Aggressive; invades pre-epiglottic space, tongue, pyriform sinus | Early, jugular nodes, often bilateral | Hyoid rarely involved |
| Glottis | Slow; anterior commissure, arytenoids, subglottis | Rare; levels II–VI if advanced | Early hoarseness aids detection |
| Subglottis | Circumferential: thyroid, trachea, oesophagus | Delphian, paratracheal, mediastinal nodes | Rare; stridor early clue |
| Transglottic | Crosses the ventricle; affects all subsites | High nodal risk | Requires aggressive treatment |
Clinical Symptoms of Laryngeal Cancer. Symptoms depend on the subsite:
| Subsite | Early Symptoms | Advanced Symptoms | Red Flags |
|---|---|---|---|
| Supraglottis | Globus sensation, hemoptysis | Hot potato voice, otalgia, dysphagia, neck mass | Late presentation, nodal metastasis |
| Glottis | Hoarseness, breathiness | Stridor, aspiration, referred ear pain | Hoarseness >3 weeks |
| Subglottis | Vague discomfort, globus | Stridor, dyspnea, thyroid involvement | Unexplained vocal cord paralysis |
- Key Red Flag: Hoarseness >3 weeks in high-risk patients (e.g., smokers).
Diagnosis
- Clinical History: Note hoarseness (>3 weeks), dysphagia, stridor.
- Neck Exam: Check laryngeal tenderness, crepitus (lost in post-cricoid spread), and lymph nodes.
- Laryngoscopy:
- Indirect: Basic OPD view of lesion, vocal cord mobility.
- Flexible/Rigid: High-resolution assessment of tumour extent.
- Direct: Gold standard for biopsy under anaesthesia.
- Imaging:
- CT: Assesses tumour extent, cartilage erosion.
- MRI: Detects soft-tissue spread.
- PET-CT: Checks recurrence, distant metastasis.
- Microlaryngoscopy: Precise for early glottic tumours.
- Pulmonary Function Tests: Evaluate for surgery feasibility.
Treatment Options for Laryngeal Cancer. Treatment depends on the cancer stage:
| Stage | Treatment | Key Features |
|---|---|---|
| Premalignant/CIS | CO2 Laser Stripping | Outpatient, close follow-up |
| T1a Glottic | TLM, RT | TLM: Daycare, quick recovery; RT: Good voice, long schedule |
| T1b Glottic | RT, TLM | RT preferred for voice |
| T2 | RT, TLM, TORS | RT: 25–30% recurrence; Surgery: 7–15% recurrence |
| T3 | Chemoradiotherapy, OPL, TLM, TORS | Chemoradiotherapy preserves larynx |
| T4a | Total Laryngectomy, RT | Voice prosthesis; neck dissections |
- Nodal Disease: Modified neck dissections for T3/T4a supraglottic cancers (levels II–IV).
- RT Complications: Mucositis, xerostomia, radionecrosis, hypothyroidism, oedema, fibrosis; managed with supportive care.
Post-Laryngectomy Rehabilitation
Laryngectomy causes voice, swallowing, and smell challenges. Rehabilitation restores function:
- Preoperative Prep: Speech therapy, counselling, meeting laryngectomized patients.
- Pulmonary: Heat and moisture exchangers (HMEs) humidify air, reducing dryness.
- Swallowing: Preserve pharyngeal mucosa for a wide neopharynx; therapy strengthens muscles.
- Smell: Nasal airflow-inducing manoeuvre (NAIM) restores smell via jaw movement.
- Voice:
- Oesophageal Speech: Natural, hands-free; 5–25% success due to training needs.
- Electrolarynx: Immediate, robotic voice; suits older patients.
- Tracheoesophageal Puncture (TEP): Natural speech via prosthesis; risks leakage, Candida.
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Reference Textbooks.
- Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
- Cummings, Otolaryngology-Head and Neck Surgery.
- Stell and Maran’s, Textbook of Head and Neck Surgery and Oncology.
- Ballenger’s, Otorhinolaryngology Head And Neck Surgery
- Susan Standring, Gray’s Anatomy.
- Frank H. Netter, Atlas of Human Anatomy.
- B.D. Chaurasiya, Human Anatomy.
- P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
- Hazarika P, Textbook of Ear Nose Throat And Head Neck Surgery Clinical Practical.
- Mohan Bansal, Textbook of Diseases of Ear, Nose and Throat Head and Neck Surgery.
- Hans Behrbohm, Textbook of Ear, Nose, and Throat Diseases With Head and Neck Surgery.
- Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
- Arnold, U. Ganzer, Textbook of Otorhinolaryngology, Head and Neck Surgery.
- Ganong’s Review of Medical Physiology.
- Guyton & Hall Textbook of Medical Physiology.
Author:
Dr. Rahul Bagla
MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
Fellow Rhinoplasty & Facial Plastic Surgery.
Renowned Teaching Faculty
Mail: msrahulbagla@gmail.com
India
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- Please read. Juvenile Angiofibroma. https://www.entlecture.com/juvenile-angiofibroma/
- Please read. Tumours of Hypopharynx . https://www.entlecture.com/tumours-of-the-hypopharynx/
- Please read. Anatomy of Oesophagus. https://www.entlecture.com/anatomy-of-oesophagus/
Keywords:Discover the causes, symptoms, histological types, and spread of larynx (throat) cancer. Learn how early signs help improve survival and treatment options. Laryngeal cancer, Vocal cord cancer, Throat cancer symptoms, Glottic carcinoma, Subglottic tumour, Supraglottic tumour, Early signs of throat cancer, Risk factors for laryngeal cancer, Vocal cord tumour symptoms