Tumours of the larynx
Benign tumour ِA-
Papillomas
1. Single papilloma: seen in adult arise usually from the vocal cord as a sessile or pedunculated mass, May have recurrence after removal and have risk of change to malignancy.
2. Multiple papillomas are the usual type in children may be due to human papilloma virus; no risk of malignancy but recurrence is common, regression occur at puberty.
There is no histological difference between two types.
Clinical features:
Either silent or present with hoarseness of voice or stridor.
Malignant tumour
Mostly squamous cell carcinoma others may include adenocarcinoma,or connective tissue tumour.
Squamous cell carcinoma:
Grading; well differentiated ,moderately differentiated and poorly differentiated
Clinical types, ulcerative or proliferative
Types:
?Supraglottic carcinoma
Area of supraglottis comprises the larynx superior to the apex of ventricle .It includes the ventricle, vestibular folds.arytenoids,aryepiglottic folds and the epiglottis (laryngeal surface, tip and lingual surface).
It has rich lymphatic drainage and the tumour spread either locally to base of tongue, glottis and pharynx or to the upper deep cervical lymph nodes.
? Glottic carcinoma
This comprises the vocal cords and the posterior and anterior commissures.
Spread either locally to subglottis or supraglottis and rarely to lymph nodes (4%) because no lymph drainage in this area.
?Subglottic carcinoma
This extends from the inferior border of the glottis to the lower border of the cricoid cartilage.
Spread locally to vocal cords, trachea, and circumferential spread, or to the lower deep cervical LN.paratracheal and mediasinal LN.
Risk factors:
Male, smoker, alcoholic, 5th-6th decade of life and chronic laryngitis.
Clinical features:
?Hoarseness of voice
??Stridor
???Neck mass due to LN or the tumour mass
????Pain locally in the neck or referred otalgia
?????Dysphagia
??????Cough
???????General symptom like cachexia and anorexia
Investigations
?Radiological plain x-ray ,CT, MRI
??Haematological
???Biochemical
????Laryngoscopic examination and biopsy
Staging
TNM classification of sq.cell carcinoma
T primary tumour
N lymph nodes
M distant metastasis
Primary tumour
Supraglottic
T1 Tumour limited to one subsite of supraglottis like aryepiglottic fold or arytenoids
T2 Invasion of more than one subsite of supraglottis or glottis or adjacent region outside the supraglottis like mucosa of tongue base
T3 Limited to the larynx with fixed vocal cord or invades the postcricoid area, pre-epiglottic tissue, base of tongue
T4 Extends beyond the larynx
Glottis
T1a tumor limited to one VC
T1b Involves both VC
T2 Extend to supraglottis and /or subglottis, or impaired VC mobility
T3 Limited to the larynx with fixed VC
T4 Extends beyond the larynx
Subglottis
T1 Limited to subglottis
T2 Extend to VC with normal or impaired mobility
T3 VC fixation
T4 Extend beyond the larynx
Lymph nodes
N0 No LN
N1 Ipselateral single LN equal yo or less than 3cm
N2 LN 3-6cm unilateral or bilateral
N3 many LN more than 6cm
Metastases
M0 No distant metastasis
M1 Distant metastasis
Treatment
Palliative?to decrease the patient suffering but no cure like pain relief and tracheostomy
Curative?the aim is to cure the patient
?Radiotherapy
It preserves the function of the larynx
Or given when the patient refuse surgery
Can be given pre or post operative in advance cases
?Surgery
External approach as total and partial larygectomy
Endoscopic approach as microlaryngoscopy and laser surgery
?No Ca larynx has been cured by chemotherapy
المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .