Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ 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 Current smokers have 10 to 20-fold increased risk 60% risk reduction after 10+ years of smoking cessation Alcohol Prior head and neck SCC Recurrent respiratory papillomatosis: 3% to 7% undergo malignant degeneration to SCC. Typically related to human papillomavirus (HPV) types 6 and 11. Relationship of HPV from types 16 and 18 is weak and under investigation Environmental factors reported in literature such as exposure to wood dust, paint, asbestos, nickel, leather products, and diesel fumes Gastroesophageal reflux Functions of the larynx Three primary functions including phonation, respiration, and airway protection during swallowing. These functions affect clinical manifestations of laryngeal cancer. Clinical presentation: Glottic tumors present earlier as they are more symptomatic at a smaller size Hoarseness/dysphonia (most common symptom) Sore throat (second most common symptom) Referred otalgia Dyspnea/stridor Dysphagia/aspiration (late manifestations typically in larger supraglottic tumors) Hemoptysis Weight loss Globus sensation ++Table Graphic Jump LocationTable 44-1Differential Diagnosis of Laryngeal MassView Table||Download (.pdf) Table 44-1 Differential Diagnosis of Laryngeal Mass Nonneoplastic Lesions Primary Laryngeal Malignancies Mucus retention cyst Epithelial Laryngocele Squamous cell carcinoma Vocal fold polyp Verrucous Vocal process granuloma Spindle cell Keratosis Adenoid Hyperplasia—squamous cell Basaloid Hyperplasia—pseudoepitheliomatous Clear cell Amyloidosis Adenosquamous Infectious—tuberculosis (TB), Candida Giant cell Inflammatory—Wegener, relapsing Lymphoepithelial Polychondritis Malignant salivary gland tumors Benign neoplasms Neuroendocrine tumors Papilloma Carcinoid Pleomorphic adenoma Small cell carcinoma Oncocytic papillary cystadenoma Malignant paraganglioma Lipoma Malignant soft tissue tumors/sarcomas Neurofibroma Malignant bone/cartilage tumors Leiomyoma Chondrosarcoma Paraganglioma Osteosarcoma Chondroma Lymphoma Giant cell tumor Extramedullary plasmacytoma Premalignant lesions Squamous cell dysplasia Carcinoma in situ Adapted with permission from Flint PW, Haughey BH, Lund VJ, et al: Cummings Otolaryngology Head and Neck Surgery. 5th ed. St. Louis, Mo: Mosby Elsevier; 2010. +++ Clinical Evaluation ++ History Pertinent risk factors Duration of symptoms Comorbidities History of prior cancers Dysphagia, malnutrition, dehydration, weight loss Dyspnea, stridor Physical examination Comprehensive head/neck examination Voice characteristics Neck examination for lymphadenopathy Dental evaluation Flexible laryngoscopy Videostroboscopy Diagnostic tests/studies 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 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 management in ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth