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Laryngeal cancer

Laryngeal cancer. Introduction :. 1% of new cancer diagnoses laryngeal cancer accounts for about one-fourth of head and neck cancer diagnosed annually. male-to-female ratio for larynx cancer is 4:1 lower socioeconomic groups. Supraglottic :.

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Laryngeal cancer

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  1. Laryngeal cancer

  2. Introduction : • 1% of new cancer diagnoses • laryngeal cancer accounts for about one-fourth of head and neck cancer diagnosed annually. • male-to-female ratio for larynx cancer is 4:1 • lower socioeconomic groups .

  3. Supraglottic : • The supraglottis has rich bilateral lymphatics Thus the strong tendency for supraglottic tumors to spread via lymphatics.

  4. Glottis • There is a paucity of lymphatics and, compared with supraglottic primary neoplasms malignant glottic tumors have less a tendency for bilateral regional lymphatic spread and remain confined to the glottis for longer periods of time.

  5. RISK FACTORS : • Tobacco smoking, alcohol. • HPV 16 / 18 • GERD implicated • Occupational factors • Radiation exposure • Genetic factors • Premalignant lesions

  6. Histological types • Squamous cell carcinomas: • 95% of all malignant laryngeal tumors

  7. Presentation Supraglottic tumors • asymptomatic until a relatively large tumor bulk is present . Nodal metastasis is often the initial complaint. Glottic tumors • tend to present early, with hoarseness as their chief complaint. Subglottic tumors rare and may present with stridor or hemoptysis .

  8. Supraglottic cancer

  9. Supraglottic cancer

  10. Epiglottic tumor

  11. Glotticsquamous cell carcinoma of the larynx. The tumor involves the anterior half of the left vocal cord.

  12. Glottic Tumor

  13. Glottic Tumor

  14. Subglottic cancer

  15. symptoms • Hoarsness • Dyspnea . • Dysphagia. • Ear pain. • Hemoptysis • Throat pain • Airway compromise • Aspiration • Neck mass

  16. Physical examination • complete head and neck examination should be performed. • The quality of the voice is noted. A breathy voice may indicate a vocal cord paralysis and a muffled voice, a supraglottic lesion. • Palpation : • cervical lymphadenopathy • broadening of the laryngeal prominence • Restricted laryngeal crepitus may be a sign of post cricoid or retropharyngeal invasion ( late stage )

  17. Laryngoscopy: - mirror examination - fiberoptic endoscope: Malignant laryngeal lesions can appear to be fungating, friable, nodular, or ulcerative, or simply as changes in mucosal color

  18. PANENDOSCOPY • Triple endoscopy and includes direct laryngoscopy, esophagoscopy, and bronchoscopy. • Assess the extent of the laryngeal tumor • Assess the respiratory tract and upper digestive tract for synchronous primary tumors. • To investigate cervical lymph node mets of unknown origin. • DIRECT LARYNGOSCOPY : Biopsies of suspected malignant sites with cup forceps.

  19. Imaging • CT Neck • MRI Neck • PET scan: • Identifying occult nodal metastases, • Distinguishing the recurrence of malignant growth from radionecrosis and other sequelae of prior treatment. • Identifying the location of any unknown primary cancer.

  20. Treatment • Early : surgery or radiotherapy • Advanced : surgery + radiotherapy

  21. Prognosis • Early laryngeal cancer has a very good prognosis (greater than 95%) 5 year survival • Involvement of lymph nodes in the region is associated with a poorer prognosis.

  22. Pharyngeal Cancer

  23. Nasopharynx • The pharyngeal recess (fossa of Rosenmüller) – most common site of NP tumour.

  24. The palatine tonsils are most common site of OP tumour

  25. On either side of the laryngeal orifice is a recess, termed the sinus pyriformis, which is bounded medially by the aryepiglottic fold, laterally by the thyroid cartilage and hyothyroid membrane. • sinus pyriformis is the most common site of hypopharyngeal CA.

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