Laryngeal carcinoma

Laryngeal carcinoma is a malignant tumor of the larynx that occurs most commonly in older men. Smoking and alcohol consumption are the most important risk factors. Based on the location of the tumor, laryngeal carcinomas may be classified as glottic (involving the vocal cords), supraglottic, or subglottic carcinomas. Glottic carcinoma, which is the most common form, presents early with hoarseness and is usually associated with a good prognosis. Supraglottic and subglottic carcinomas present late and are therefore associated with a poor prognosis. Direct laryngoscopy is required to visualize the tumor and assess vocal cord mobility. Imaging of the neck may be required to determine the extent of the tumor and check for spread to cervical lymph nodes. The method of treatment depends on the site and stage of the tumor. Early stages are treated by either radiotherapy or endoscopic laser resection with the goal of preserving the voice. Late stages require some form of laryngectomy. After laryngectomy patients must undergo vocal rehabilitation, which involves using vibrations in the pharynx to produce speech sounds.

• Sex: ♂ > ♀
• Age of onset: 40–70 years

References:^[1]

Epidemiological data refers to the US, unless otherwise specified.

• Smoking
• Alcohol use
• Exposure to asbestos
• Precancerous lesions: leukoplakia or laryngeal papillomatosis in adults (see “Precancerous lesions of the larynx”)
• Irradiation of the head and neck region
• Infection with human papillomavirus (HPV 16 and 18)
• Betel nut chewing
• Diets rich in salt-preserved meats (nitrosamines) and dietary fats

Laryngeal carcinomas are classified according to their location in relation to the glottis.

• Glottic carcinoma/vocal cord carcinoma (most common form: approximately 60% of cases)
• Supraglottic carcinoma (approximately 40% of cases)
• Subglottic carcinoma (approximately 1% of cases)

Laryngeal carcinomas are almost always squamous cell cancers (SCC)!

References:^[2]

• Hoarseness/change in voice
• Foreign body sensation
• Dyspnea
• Dysphagia
• Stridor (due to airway narrowing)
• Aspiration while eating or drinking

Unexplained hoarseness for longer than 3 weeks should always be investigated by laryngoscopy!

References:^[3]

• Direct laryngoscopy reveals irregular, nodular, or ulcerative lesions
  • Microlaryngoscopic examination and tissue biopsy: required to visualize very small tumors and to differentiate laryngeal cancer from benign laryngeal lesions (e.g., vocal nodules, vocal polyps)
  • Stroboscopic examination: assesses vocal cord mobility during phonation
• Imaging: CT, MRI, and/or ultrasound of the neck to assess tumor size and spread to surrounding tissue (e.g., lymph nodes)

• Vocal cord polyp
• Vocal cord nodule
• Vocal cord cyst
• Laryngeal papillomatosis
• Laryngeal amyloidosis
  • A localized form of amyloidosis that only involves the larynx.
  • Manifestations include hoarseness, globus sensation, hemoptysis, stridor, and dyspnea.
  • Laryngoscopy typically shows a firm, orange-yellow to gray epithelial nodule on a vocal cord.
• Laryngeal adenocarcinoma

The differential diagnoses listed here are not exhaustive.

• Early stages: radiotherapy or transoral endoscopic laser resection
• Advanced stages: (with lymph node; and/or distant organ metastasis): laryngectomy
• Voice rehabilitation after laryngectomy: The patient can be trained to produce speech from vibration in the pharynx by one of the following means:
  • Esophageal speech
  • Voice prosthesis
  • Electronic speaking aid

• Glottic carcinomas have the best prognosis (5-year survival rates of approximately 90%).
• The 5-year survival rate drops drastically when the supraglottis and/or subglottis are involved.