Management Of Laryngeal Cancer2003

Presented by AMR ELGENDY Medical student E.N.T Department

What is laryngeal cancer • It is a disease in which malignant cancer cells form in the tissues of larynx • It may be in one of the following 3 sites: 1. Supraglottic (35%) 2. Glottic (60%) 3. Subglottic (5%)

Inicdence • It is one of the most common malignancies in head and neck • More common in males than females • most common in smokers • Estimated new cases and deaths from laryngeal cancer in the U.S.A in 2007: New cases : 11,300 Deaths : 3.660

Gross And Microscopic Picture

Spread 1-Direct To adjacent areas oflarynx To extralaryngeal structures e.g pharynx or trachea

2-Lymphatic Supraglottic → via UDCL.NDS Glottic → never or rarely Subglottic →via LDCL.NDS

3-Blood : to L L B B

Staging of laryngeal cancer • It is one of the most important factors affecting the treatment option • There are 2 staging parameters : 1) TNM staging system 2) Clinical staging (AJCC)

CLINICAL STAGING • Stage I : (tumour confined to its place) T1,N0,MO

•

Stage II : (tumour involves adjacent subsites) T2,N0,M0

• Stage III : ( tumour involves adjacent sites) T3,N0,M0

OR T1-3,N1,MO

• Stage IV : (extention of tumour to the whole larynx and surrounding tissues) T4,N0-1M0 →A T1-4,N2,MO →A T1-4,N3,M0 →B T1-4,N0-3,M0 → C

Diagnosis • Clinical picture • Examination by laryngeal mirror or endoscopy • Investigation by: 1. 2. 3. 4.

C.T SCAN MRI Barium swallow Biopsy by endoscope

Laryngeal mirrors

Rigid laryngoscope

Treatment option overview Main lines of treatmnet

Other lines still under clinical trials

Factors Affect Prognosis (Chance Of Recovery) And Treatment Options Prognosis (chance of recovery) depends on the following: • The stage of the disease. • The location and size of the tumor. • The grade of the tumor. • The patient's age, gender, and general health, including whether the patient is anemic. Treatment options depend on the following: • The stage of the disease. • The location and size of the tumor. • Keeping the patient's ability to talk, eat, and breathe as normal as possible. • Whether the cancer has come back (recurred). Smoking tobacco and drinking alcohol decrease the effectiveness of treatment for laryngeal cancer. Patients with laryngeal cancer who continue to smoke and drink are less likely to be cured and more likely to develop a second tumor. After treatment for laryngeal cancer, frequent and careful follow-up is important.

Treatment options according to clinical staging

Stage I

StageII

Stage III

Stage IV

Reccurent laryngeal cancer • Radiation therapy with high dose • If failed do partial laryngectomy • If reccurence → repeat surgery and radiation • If recurrence → total laryngectomy with postoperative radiation therapy • If failed you can try a palliative chemotherapy

laryngectomy