Laryngeal Cancer

There are 3 subsites of the larynx; supraglottis, glottis, and subglottis.

Supraglottic cancers usually present with mild odynophagia, dysphagia, and referred otalgia. Epiglottis is the most common involved area.

Supraglottic tumors typically spread to base of tongue and pre-epiglottic space. 25%- 50% have nodal metastasis to cervical lymph nodes.

Glottic tumors

• Most common site of laryngeal cancer
• Typical symptoms include hoarseness and globus sensation
• Incidence of cervical metastasis is low

Subglottic tumors are rare, aggressive, and poorly differentiated.

Distant metastasis; most common hematogenous spread to lungs greater than liver greater than skeletal system.

Treatment of early laryngeal cancer

It is mainly treated with single modality- either radiation or surgery.

Surgery

Endoscopic resection with or without laser; local control rates are 90%-95% for early-stage (T1 and T2) lesions.

Radiation

Radiation therapy has advantages and disadvantages.

Advantages: useful in nonoperative candidates, avoid up-front tracheostomy in certain patients.

Disadvantages: mucositis, laryngeal edema, dysphagia, xerostomia, risk of chondronecrosis, and increased difficulty in detecting recurrence.

The therapy involves 6-week course of treatment, and local control rates are 90%-98% for early-stage (T1-T2) lesions.

Surgical options are changed according to the tumor involvement 8and also stage). Laser or robotic surgery can performed for early laryngeal cancer. For advanced tumors partial or total laryngectomies are choises. The neck sholud be incorporated into radiation filed or the patient should undergo neck dissection for N0 neck.

Laryngeal preservation surgery

In selected patients with T2-T4 tumors, supraglottic or supracricoid laryngectomy can be considered.

• Patient can speak after the surgery (swallowing and speech therapy needed)
• No need to permenant tracheostomy (usually)

Major complications of treatment

If treated with surgery: pharyngocutaneous fistula, stomal stenosis, dysphagia

If treated with chemoradiation: esophageal stenosis, nonfunctional larynx, chondritis

Follow-up

NCCN recommends 1 to 3 months fort he first year after treatment, every 2 to 4 months in the second year, every 4 to 6 months in the third, fourth, and fifth years, and every 6 to 12 months thereafter.