Laryngeal Cancer

Laryngeal Cancer
Presentation by:Anh Q. Truong
University of Washington, SOM

Anatomy
Anatomy – subdivision
Incidence by Site
Supraglottic
Glottic
Subglottic
Epidemiology
Risk Factors
* Signs and symptoms
Clinical Presentation
* Physical Exam
o Complete head and neck exam
+ Palpation for nodes; restricted laryngeal crepitus.
o Quality of voice
+ Breathy voice = cord paralysis
+ Muffled voice = supraglottic lesion
o Laryngoscopy
+ Laryngeal mirror
+ Fiberoptic exam (lack depth perception)
+ Note: contour, color, vibration, cord mobility, lesions.
o Stroboscopic video laryngoscopy
+ Highlights subtle irregularities: vibration, periodicity, cord closure
Differential Diagnosis
* Infectious
* Inflammatory
* Granulomatous disease (TB, sarcoidosis)
* Papillomatosis
* Lymphoma
Imaging
* CT or MRI
* PET
* Ultrasound
Biopsy and Histology
* Glottis
* Subglottis
Staging
* Nodes
* Mets
Stage Grouping
Advanced stage
* Surgery
o Microlaryngeal surgery
o Hemilargyngectomy
o Supraglottic laryngectomy
o Near-total laryngectomy
o Total laryngectomy
* Photodynamic Therapy
* Radiation
* Chemothrapy
Treatments – Options
Treatment – Early Stage (I/II)
Dose Fractionation
Treatment – Advanced Stage (III/IV) – VA Study
Overall Survival
Treatment – Advanced Stage (III/IV) – RTOG 91-11 Study
Laryngeal Preservation
Concurrent chemoXRT
Anticipated Toxicities
Take Home Points
An Actual Picture of a Laryngeal Cancer

Laryngeal Cancer.ppt