Chapter 44: Tumors of the Larynx

Laryngeal Cancer

• Second most common malignancy of upper aerodigestive tract (Table 44-1)

• Represents 1% to 5% of all malignancies

• 40% arise in the supraglottis, 59% in the glottis, and 1% in the subglottis

• Squamous cell carcinoma (SCC) represents 85% to 95% of laryngeal malignancies

• M:F ratio 4:1

• Risk factors

  1. Current smokers have 10 to 20-fold increased risk

     • 60% risk reduction after 10+ years of smoking cessation

  2. Alcohol

  3. Prior head and neck SCC

  4. Recurrent respiratory papillomatosis: 3% to 7% undergo malignant degeneration to SCC. Typically related to human papillomavirus (HPV) types 6 and 11.

  5. Relationship of HPV from types 16 and 18 is weak and under investigation

  6. Environmental factors reported in literature such as exposure to wood dust, paint, asbestos, nickel, leather products, and diesel fumes

  7. Gastroesophageal reflux

• Functions of the larynx

  1. Three primary functions including phonation, respiration, and airway protection during swallowing.

  2. These functions affect clinical manifestations of laryngeal cancer.

• Clinical presentation: Glottic tumors present earlier as they are more symptomatic at a smaller size

  1. Hoarseness/dysphonia (most common symptom)

  2. Sore throat (second most common symptom)

  3. Referred otalgia

  4. Dyspnea/stridor

  5. Dysphagia/aspiration (late manifestations typically in larger supraglottic tumors)

  6. Hemoptysis

  7. Weight loss

  8. Globus sensation

Clinical Evaluation

• History

  1. Pertinent risk factors

  2. Duration of symptoms

  3. Comorbidities

  4. History of prior cancers

  5. Dysphagia, malnutrition, dehydration, weight loss

  6. Dyspnea, stridor

• Physical examination

  1. Comprehensive head/neck examination

  2. Voice characteristics

  3. Neck examination for lymphadenopathy

  4. Dental evaluation

  5. Flexible laryngoscopy

  6. Videostroboscopy

• Diagnostic tests/studies

  1. Pathologic diagnosis

     • Endoscopy with biopsy to obtain tissue diagnosis, assess tumor extent, assess for conservation laryngeal surgery

     • Fine-needle aspiration (FNA) of palpable neck node

  2. Imaging

     • Computed tomography (CT) or magnetic resonance imaging (MRI) of neck

       • – Extent of disease

       • – Spread of tumor to pre-epiglottic, paraglottic, posterior cricoid areas

       • – MRI more sensitive for cartilage invasion

     • CT chest

       • – Exclude pulmonary metastasis

       • – Isolated pulmonary nodule more likely to be second primary than metastatic laryngeal cancer

       • – Consider pretreatment PET/CT for advanced disease as it alters ...