Diagnosis

Laryngeal cancer

Etiology

Etiology [ncu]

• Spontaneous

• Genetic

Pathophysiology [ncu]

1. Larynx is responsible for: maintaining an open air way, vocalizing, swallowing, protection of the lungs from chemical and thermal exposure and Valsalva maneuver

2. Chronic inflammation --> increased cellular turnover --> increased risk of mutation --> squamous cell carcinoma

3. Classification: supraglottic, glottic, and subglottic

Risk factors [ncu][mk1]

• Tobacco and alcohol (90% of overall mortality)

• HPV-infection

• Males

• Age

• Salt

• Radiation

• Laryngopharyngeal reflux

Epidemiology

Incidence per 100.000 [mk1][swr][bam][nb1][n6h][ofi]

Prevalence per 100.000 [mk1][swr][bam][nb1][n6h][ofi]

Approach

• Blood tests: Thyroid function, renal and hepatic function

• Laryngoscopy (persistent hoarse voice for > 2 weeks

• CT collum

• PET-CT

• MRI

• Biopsy

Treatment

Treatment depends on the stage of the disease and the location of the primary tumor (glottic, supraglottic or subglottic). [ncu]

1. Carcinoma in situ or early stage invasive glottic or supraglottic cancer:

   • Endoscopic surgical excision or radiation therapy

   • Transoral laser microsurgery

   • Transoral robotic surgery

2. Early stage laryngeal carcinomas (stage I-II):

   • Radiation or laryngeal preservation resection

   • Open partial laryngectomy

3. Advanced-stage laryngeal carcinomas (stage III-IV):

   • Total laryngectomy, reconstruction, and adjuvant postoperative chemoradiation therapy

   • Laryngeal preservation resection + chemotherapy and radiation

Differential diagnoses

Acute laryngitis, Benign vocal cord lesion, Branchial cleft cyst, Croup, Epiglottitis, Gastroesophageal reflux disease, Hemangioma, Human papillomavirus, Laryngopharyngeal reflux disease, Lymphadenopathy, Reinkes edema, Sarcoidosis, Sialadenitis, Subglottic stenosis, Syphilis, Thyroglossal duct cyst, Tuberculosis, Wegener's granulomatosis