Laryngeal Cancer

Intro & Risk Factors - Voice Box Villainy

• Malignancy of larynx (voice box); commonest head & neck cancer in Indian males.
• Key Risk Factors:
  • Tobacco (smoking, chewing): Main culprit (↑ 80-95% risk)
  • Alcohol: Synergistic with tobacco
  • HPV infection (types 16, 18)
  • Occupational exposure (e.g., asbestos, nickel, wood dust)
  • Chronic irritation (GERD, laryngitis)
  • Age >55 years, male sex, poor diet

⭐ Squamous Cell Carcinoma (SCC) is the predominant histological type, comprising >90% of laryngeal cancers globally and in India.

Patho & Staging - Grading the Threat

• Pathology:
  • Predominantly Squamous Cell Carcinoma (SCC) >90%.
  • Histologic Grade: Well, Moderately, Poorly differentiated (impacts prognosis).
  • Common Variant: Verrucous carcinoma (good prognosis).
• Anatomical Subsites (Prognostic Impact):
  • Glottis (~60-65%): True cords. Best prognosis; early symptoms, few lymphatics.
  • Supraglottis (~30-35%): Above cords. Rich lymphatics, often advanced.
  • Subglottis (<5%): Below cords. Poorest prognosis; early spread.
• Staging (AJCC TNM 8th Ed.):
  • T: Primary tumor extent (e.g., T1-limited, T4-invasive).
  • N: Regional lymph node involvement (N0-none, N1-N3 increasing spread).
  • M: Distant metastasis (M0-none, M1-present).

⭐ Supraglottic cancers often present with neck mass (nodal mets) due to rich lymphatics. oka

Symptoms & Diagnosis - Unmasking the Enemy

• Key Symptoms:
  • Persistent Hoarseness (>3 wks): Most common, esp. glottic.
  • Dysphagia/Odynophagia: Supraglottic tumors.
  • Stridor/Dyspnea: Late, airway compromise (subglottic/advanced).
  • Neck Mass: Lymph node metastasis.
  • Referred Otalgia (Arnold's nerve), Hemoptysis, Weight Loss.
• Diagnostic Pathway:
  • Thorough History & Clinical Examination.
  • Office Laryngoscopy (Indirect/Flexible Fiberoptic).
  • Gold Standard: Direct Laryngoscopy under GA + Biopsy for histopathology.
  • Imaging for Staging (TNM):
    • CECT (Neck & Chest): Tumor extent, nodes, distant mets.
    • MRI: Soft tissue, cartilage invasion, perineural spread.
    • PET-CT: Detecting occult mets, recurrence.

⭐ Any patient with hoarseness persisting for more than 3 weeks requires urgent laryngoscopy to rule out malignancy.

Treatment Approaches - The Battle Plan

• Early Glottic (T1-T2, N0):
  • T1a: Endoscopic resection (laser) OR RT. (Excellent voice/cure).
  • T1b-T2: RT OR Conservation Laryngeal Surgery (CLS).
• Early Supraglottic (T1-T2, N0):
  • RT (covers N0 neck) OR Supraglottic Laryngectomy.
• Advanced (Resectable: T3-T4a, N0-N3):
  • Organ Preservation: Concurrent Chemoradiotherapy (CCRT) standard.
  • Alternative: Induction CT then RT.
  • Surgery: Total Laryngectomy (TL) + Neck Dissection + Adjuvant RT/CCRT (if high-risk).
• Unresectable/Metastatic (T4b/M1):
  • Palliative CT, RT, Immunotherapy, Supportive Care.

⭐ For T1a glottic cancer, transoral laser microsurgery (TLM) and radiotherapy offer similar high cure rates (~95%) and voice preservation.

Prognosis & Key Pearls - Future Outlook

• 5-year survival: Early (T1/T2) >80%; Advanced (T3/T4) ~40-60%.
• Voice preservation is a key goal, often achievable with early-stage treatments (e.g., TLM, RT).
• Potential complications: Dysphagia, aspiration, stomal recurrence (post-laryngectomy).
• Lifelong follow-up is crucial for detecting recurrence, second primaries, and managing quality of life.

⭐ Most laryngeal cancers are squamous cell carcinomas, strongly associated with smoking and alcohol consumption; HPV is an emerging risk factor, especially for supraglottic cancers.

• Future: Immunotherapy, targeted therapies show promise for advanced/recurrent disease.

High‑Yield Points - ⚡ Biggest Takeaways

• Squamous Cell Carcinoma is the dominant histology.
• Glottis is the most common site, causing early persistent hoarseness.
• Smoking and alcohol are primary risk factors; HPV is also implicated.
• Hoarseness > 3 weeks mandates laryngoscopy and biopsy.
• Supraglottic cancers present later with dysphagia, otalgia, or neck nodes.
• Early glottic lesions (T1a) often cured by radiotherapy or endoscopic resection.
• Leukoplakia is a key premalignant condition.