Description
Laryngeal cancer is a significant head and neck malignancy that requires timely diagnosis and a structured treatment approach to achieve optimal outcomes. This session provides a practical overview of the clinical presentation, diagnostic pathways, and staging systems essential for accurate disease assessment. It will also cover current management strategies, including surgery, radiation therapy, and multidisciplinary care. Designed for clinicians, the webinar aims to enhance decision-making and support improved patient prognosis through evidence-based practices.
Summary Listen
- Laryngeal cancers, predominantly squamous cell carcinoma, are strongly linked to tobacco and alcohol use, typically affecting individuals aged 50-70. The larynx is divided into the glottis (vocal cords), supraglottis (above the cords), and subglottis (below the cords), each further subdivided into specific anatomical sites. Diagnosis begins with indirect laryngoscopy and fiber optic or rigid scope examination for clinical staging.
- Staging of supraglottic cancers involves T1 (tumor limited to one subsite), T2 (tumor invading multiple subsites), T3 (vocal cord fixation), and T4 (cartilage invasion). T4 is further divided into T4A (invasion through cartilage, but not pre-vertebral space, carotid artery or mediastinum) and T4B (invasion of the pre-vertebral space, carotid artery, or mediastinum), with T4B considered inoperable. Glottic cancer staging similarly involves T1 (limited to vocal cord), divided into T1A (one cord) and T1B (both cords), with progression through T2, T3, and T4 following invasion of the subglottis and cartilage. Subglottic tumors are staged T1 (limited to subglottis), T2 (extending to glottis), T3 (vocal cord fixation), and T4 (cartilage involvement).
- Accurate assessment requires careful mapping and documentation of the tumor location, along with imaging (CT or MRI) to determine the tumor's depth and sub-epithelial spread. CT scans have sensitivity of 87% and specificity of 94%, while MRI has sensitivity of 89% and specificity of 84%. Imaging assists in evaluating vocal cord mobility and cartilage invasion, especially at the anterior commissure.
- Treatment options for early vocal cord cancers (carcinoma in situ) include stripping via microlaryngoscopy or CO2 laser, laryngofissure, or radiation therapy. Surgical control rates are up to 92%, while radiation control rates are up to 98%. Combining modalities can achieve control rates of 90-100%. The European Laryngological Society describes different types of cordectomies (Type 1: subepithelial, Type 2: mucosa and vocal ligament, Type 3: transmuscular, Type 4: mucosa to perichondrium, Type 5: cartilage resection).
- Type 1 cordectomy involves removing just the epithelium for suspected pre-malignant regions or carcinoma in situ, ideally performed with CO2 laser after sub-epithelial injection of normal saline. Type 2 cordectomy removes the mucosa along with the vocal ligament for more advanced lesions. Transmuscular (Type 3) and extending up to the perichondrium (Type 4) are reserved for more advanced stages that have muscle or cartilage invasion. Vertical partial laryngectomies, including frontal and lateral hemilaryngectomies are possible.
- T2 cancers with normal mobility can be treated with open or microscopic surgery or radiotherapy, while impaired mobility cases have a lower local control rate. Supraglottic partial laryngectomy involves elevating flaps, skeletonizing the thyroid cartilage, and excising the tumor while preserving one functional arytenoid unit. In early subglottic cancers, radiation is an option, but surgery is difficult.
- Advanced stages require multimodality treatment: surgery followed by radiation. Chemotherapy may be added to radiation in T3 cases without cartilage erosion. Cases with large volume disease, airway compromise, and cartilage sclerosis often necessitate total laryngectomy. Rehabilitation post-laryngectomy can involve provox voice prosthesis, near-total laryngectomy.
- Hypopharyngeal cancers often present late and are characterized by submucosal spread, requiring wide surgical margins. These cancers can be treated with CO2 laser for early lesions or with total or partial laryngopharyngectomy, potentially requiring free flap reconstruction. Neck management is crucial, ranging from elective neck dissection in early glottic cancer to bilateral or radical neck dissection in more advanced cases. Follow-up involves regular endoscopic examinations and imaging to detect recurrence.
Sample Certificate
About the Speakers
Dr. Arsheed Hakeem
Senior Consultant Head and Neck Oncologist, Apollo Cancer Hospital and Apollo Cancer Institute, Hyderabad
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