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Laryngeal cancerLaryngeal cancerLIU Wei Wei, MDLIU Wei Wei, MD
Department of Head and Neck SurgerDepartment of Head and Neck Surgeryy
Email: [email protected]: [email protected]
AnatomyAnatomy
AnatomyAnatomy
AnatomyAnatomy
AnatomyAnatomy
AnatomyAnatomy
AnatomyAnatomy
AnatomyAnatomy
AnatomyAnatomy
HistologyHistology
Laryngeal EpitheliumLaryngeal Epithelium
Goblet Cells and Columnar Mucinous Cells
Squamous Epithelium
EpidemiologyEpidemiology
► Incidence rate increase recentlyIncidence rate increase recently►Region difference of laryngeal cancer inciRegion difference of laryngeal cancer inci
dencedence high in northeast of chinahigh in northeast of china►Presence more in 50-60sPresence more in 50-60s►Males>femalesMales>females►2020 ％ ％ of all head and neck cancersof all head and neck cancers
EtiologyEtiology
EtiologyEtiology
►Human Papilloma Virus 16 &18Human Papilloma Virus 16 &18►Chronic Gastric RefluxChronic Gastric Reflux►Occupational exposuresOccupational exposures►Prior history of head and neck irradiatioPrior history of head and neck irradiatio
nn
PathologyPathology
► 85-95% of laryngeal tumors are squamous cell c85-95% of laryngeal tumors are squamous cell carcinomaarcinoma
► Verrucous Carcinoma Verrucous Carcinoma ► Fibrosarcoma Fibrosarcoma ► Chondrosarcoma Chondrosarcoma ► Minor salivary carcinoma Minor salivary carcinoma ► Oat cell carcinomaOat cell carcinoma► AdenocarcinomaAdenocarcinoma► Giant cell and Spindle cell carcinomaGiant cell and Spindle cell carcinoma
In Situ Squamous Cell In Situ Squamous Cell CarcinomaCarcinoma
► Dysplastic process Dysplastic process involves the entire involves the entire thickness of the thickness of the epitheliumepithelium
► Loss of cellular maturation Loss of cellular maturation and polarityand polarity
► Increase of Increase of nuclear/cytoplaslic rationuclear/cytoplaslic ratio
► Normal and abnormal Normal and abnormal mitosesmitoses
► Keratosis and dyskeratosisKeratosis and dyskeratosis► Extension into adjacent Extension into adjacent
seromucinous glandsseromucinous glands
Microinvasive or Superficially Microinvasive or Superficially Invasive Squamous Cell CarcinomaInvasive Squamous Cell Carcinoma
► Nests of malignant cells Nests of malignant cells that have penetrated that have penetrated the basement the basement membrane and invaded membrane and invaded superficially into the superficially into the submucosasubmucosa
► Capable of Capable of metastasizingmetastasizing
► Development from Development from carcinoma in situ or carcinoma in situ or from epithelium with no from epithelium with no evidence of CISevidence of CIS
Invasive Squamous Cell CarcInvasive Squamous Cell Carcinomainoma
► 0.5% of all cancers in 0.5% of all cancers in womenwomen
► 95% of all laryngeal 95% of all laryngeal carcinomascarcinomas
► 2.5% of all cancers in 2.5% of all cancers in menmen
► Etiology: ETOH Etiology: ETOH (supraglottic), tobacco (supraglottic), tobacco (glottic), asbestos, nickel, (glottic), asbestos, nickel, wood, isopropyl alcohol, wood, isopropyl alcohol, radiationradiation
► DD: reactive epithelial DD: reactive epithelial changes, changes, pseudoepitheliomatous pseudoepitheliomatous hyperplasiahyperplasia
SymptomsSymptoms
► Sound hoarsenessSound hoarseness Most commonMost common Tiny lesion on vocal cord can cause sound cTiny lesion on vocal cord can cause sound c
hangehange
SymptomsSymptoms
►others:others: Swallowing difficultySwallowing difficulty Bloody sputumBloody sputum Sore throatSore throat otalgiaotalgia Breathing difficultyBreathing difficulty aspirationaspiration lymphadenopathylymphadenopathy
Clinical feature of different type Clinical feature of different type of Laryngeal cancerof Laryngeal cancer
►SupraglotticSupraglottic sound hoarseness not evident in early psound hoarseness not evident in early p
hasehase foreign body sensation present earlyforeign body sensation present early more common lymphadenopathymore common lymphadenopathy
► GlotticGlottic sound hoarseness present early, progressivesound hoarseness present early, progressive breathing difficulty presents more commonbreathing difficulty presents more common
► SubglotticSubglottic rare typerare type no evident symptoms in eary phaseno evident symptoms in eary phase easy to present breathing difficulty easy to present breathing difficulty
Clinical feature of different type Clinical feature of different type of Laryngeal cancerof Laryngeal cancer
supraglotticsupraglottic
glotticglottic
subglotticsubglottic
Clinical examinationClinical examination
►PEPE larynx shapelarynx shape cervical lymph nodescervical lymph nodes►Larynx and pharynx examinationLarynx and pharynx examination Indirect LaryngoscopyIndirect Laryngoscopy Flexible LaryngoscopyFlexible Laryngoscopy StroboscopyStroboscopy PanendoscopyPanendoscopy
Clinical examinationClinical examination
►Pathological biopsyPathological biopsy► ImagingImaging
plain X rayplain X ray
CTCT
MRIMRI
PETPET
VideoVideo
Laryngeal TBLaryngeal TB
病灶多位于杓状软骨间隙
表现为脓性分泌物覆盖的浅表溃疡
肺部大多有结核病灶存在
可有咳嗽、胸痛、午后潮热的症状
Vocal cord noduleVocal cord nodule
►Bilateral commonBilateral common►Located on anterior 1/3 of the cordLocated on anterior 1/3 of the cord►Any age can occureAny age can occure►Related to loudly speakingRelated to loudly speaking►Can present sound hoarsenessCan present sound hoarseness
Cord polypCord polyp
►epsilateralepsilateral►Located on anterior 1/3Located on anterior 1/3►Any age groupAny age group►Wide base, can have pedicleWide base, can have pedicle►Loud speaking, local infection and smokLoud speaking, local infection and smok
ing relateding related►Sound hoarsenessSound hoarseness
Laryngeal PapillomaLaryngeal Papilloma
► Benign, exophytic neoplastic growth Benign, exophytic neoplastic growth composed of branching fronds of composed of branching fronds of squamous epithelium with fibrovascular squamous epithelium with fibrovascular corescores
► The most common benign laryngeal The most common benign laryngeal neoplasmneoplasm
► No sex predilectionNo sex predilection► Changes in phonation, dyspnea, cough, Changes in phonation, dyspnea, cough,
dysphagia, stridordysphagia, stridor► HPV types 6 and 11HPV types 6 and 11
Laryngeal PapillomaLaryngeal Papilloma
►Juvenile type:Juvenile type: multiple lesions with extensive multiple lesions with extensive growth and rapid recurrence, may growth and rapid recurrence, may remit spontaneously or persist into remit spontaneously or persist into old ageold age
►Adult type:Adult type: more often single, recurs less often, more often single, recurs less often, less likely to spreadless likely to spread
► Exophytic, warty, friable, tan-white to red Exophytic, warty, friable, tan-white to red growthsgrowths
► Papillary fronds of multilayered benign squamous Papillary fronds of multilayered benign squamous epithelium containing fibrovascular coresepithelium containing fibrovascular cores
► Little or no keratin productionLittle or no keratin production
Laryngeal PapillomaLaryngeal Papilloma
► Absence of Absence of stromal invasionstromal invasion
► Certain degree Certain degree of cellular atypiaof cellular atypia
► Koilocytic Koilocytic changeschanges
KeratosisKeratosis
临床表现为声嘶、喉内不适
声带增厚，呈粉红色或白色斑块
病理上为不同程度的上皮增生和角质层
可伴有角化不全和乳头瘤样增生
Laryngeal LeukoplakiaLaryngeal Leukoplakia
Laryngeal AmyloidosisLaryngeal Amyloidosis
► Extracellular accumulation of fibrillar Extracellular accumulation of fibrillar proteinsproteins
► Systemic or localizedSystemic or localized► Primary or secondaryPrimary or secondary►Men > women, in the 5th and 6th Men > women, in the 5th and 6th
decades decades ► Polypoid mass (glottis and supraglottis) Polypoid mass (glottis and supraglottis)
or diffuse mucosal swelling (subglottis)or diffuse mucosal swelling (subglottis)►HoarsenessHoarseness
Laryngeal AmyloidosisLaryngeal Amyloidosis
► Extracellular, Extracellular, eosinophilic, eosinophilic, amorphous material amorphous material deposited randomly deposited randomly throughout throughout submucosa; submucosa; depositions around or depositions around or within the walls within the walls
► Disappearance of the Disappearance of the seromucous glands, seromucous glands,
► Mixed chronic Mixed chronic inflammatory infiltrateinflammatory infiltrate
Staging(supraglottic)Staging(supraglottic)T1T1 Tumor limited to one subsite of supraglottis with normal vocal cord mobTumor limited to one subsite of supraglottis with normal vocal cord mob
ility ility
T2T2 Tumor involves mucosa of more than one adjacent subsite of supraglottiTumor involves mucosa of more than one adjacent subsite of supraglottis or glottis, or region outside the supraglottis (e.g. mucosa of base of the s or glottis, or region outside the supraglottis (e.g. mucosa of base of the tongue, vallecula, medial wall of piriform sinus) without fixation tongue, vallecula, medial wall of piriform sinus) without fixation
T3T3 Tumor limited to larynx with vocal cord fixation and or invades any of thTumor limited to larynx with vocal cord fixation and or invades any of the following: postcricoid area, preepiglottic tissue, paraglottic space, ande following: postcricoid area, preepiglottic tissue, paraglottic space, and/or minor thyroid cartilage erosion (e.g. inner cortex) /or minor thyroid cartilage erosion (e.g. inner cortex)
T4aT4a Tumor invades through the thyroid cartilage and/or invades tissue Tumor invades through the thyroid cartilage and/or invades tissue beyond the larynx (e.g. trachea, soft tissues of neck including beyond the larynx (e.g. trachea, soft tissues of neck including deep extrinsic muscles of the tongue, strap muscles, thyroid, or deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus) esophagus)
T4bT4b Tumor invades prevertebral space, encases carotid artery, or invades mTumor invades prevertebral space, encases carotid artery, or invades mediastinal structures ediastinal structures
Staging(Glottic)Staging(Glottic)T1T1 Tumor limited to the vocal cord (s) (may involve anterior or posterior comTumor limited to the vocal cord (s) (may involve anterior or posterior com
missure) with normal mobilty missure) with normal mobilty T1aT1a Tumor limited to one vocal cord Tumor limited to one vocal cord
T1bT1b Tumor involves both vocal cords Tumor involves both vocal cords
T2T2 Tumor extends to supraglottis and/or subglottis, and/or with impaired vocTumor extends to supraglottis and/or subglottis, and/or with impaired vocal cord mobility al cord mobility
T3T3 Tumor limited to the larynx with vocal cord fixation and/or invades paraglTumor limited to the larynx with vocal cord fixation and/or invades paraglottic space, and/or minor thyroid cartilage erosion (e.g. inner cortex) ottic space, and/or minor thyroid cartilage erosion (e.g. inner cortex)
T4aT4a Tumor invades through the thyroid cartilage, and/or invades Tumor invades through the thyroid cartilage, and/or invades tissues beyond the larynx (e.g. trachea, soft tissues of the neck tissues beyond the larynx (e.g. trachea, soft tissues of the neck including deep extrinsic muscles of the tongue, strap muscles, including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus thyroid, or esophagus
T4bT4b Tumor invades prevertebral space, encases carotid artery, or invades mediTumor invades prevertebral space, encases carotid artery, or invades mediastinal structures astinal structures
Neck stagingNeck staging
N0N0 No cervical lymph nodes positive No cervical lymph nodes positive
N1N1 Single ipsilateral lymph node ≤ 3cm Single ipsilateral lymph node ≤ 3cm
N2aN2a Single ipsilateral node > 3cm and ≤6cm Single ipsilateral node > 3cm and ≤6cm
N2bN2b Multiple ipsilateral lymph nodes, each ≤ 6cMultiple ipsilateral lymph nodes, each ≤ 6cmm
N2cN2c Bilateral or contralateral lymph nodes, each Bilateral or contralateral lymph nodes, each ≤6cm ≤6cm
N3N3 Single or multiple lymph nodes > 6cm Single or multiple lymph nodes > 6cm
临床分期临床分期00 TisTis N0N0 M0M0
II T1T1 N0N0 M0M0
IIII T2T2 N0N0 M0M0
IIIIII T3T3 N0N0 M0M0
T1-3T1-3 N1N1 M0M0
IVAIVA T4aT4a N0-2N0-2 M0M0
T1-4aT1-4a N2N2 M0M0
IVBIVB T4bT4b Any NAny N M0M0
Any TAny T N3N3 M0M0
IVCIVC Any TAny T Any NAny N M1M1
TreatmentTreatment
►PrinciplePrinciple early lesion treated mainly by surgery and radiation, hearly lesion treated mainly by surgery and radiation, h
owever, advanced lesion treated by combined surgery wowever, advanced lesion treated by combined surgery with chemoradiation (combined therapy)ith chemoradiation (combined therapy)
T1/2 lesion: Rt or Surg.T1/2 lesion: Rt or Surg. For subglottic, total laryngectomy should be doneFor subglottic, total laryngectomy should be done Neck dissection for positive lymph nodesNeck dissection for positive lymph nodes Adenocarcinoma should be treated by surg.Adenocarcinoma should be treated by surg. For advanced lesion, laryngeal function preservation tFor advanced lesion, laryngeal function preservation t
herapy is another choiceherapy is another choice
SurgerySurgery
►Laser surgery under laryngoscopeLaser surgery under laryngoscope►Partial laryngectomyPartial laryngectomy►Total laryngectomyTotal laryngectomy►Neck dissectionNeck dissection
Laser surgeryLaser surgery
Laser surgeryLaser surgery
Vertical partial laryngectomyVertical partial laryngectomy
Supraglottic partial laryngectoSupraglottic partial laryngectomymy
Total laryngectomyTotal laryngectomy
Total laryngectomyTotal laryngectomy
Voice reconstructionVoice reconstruction
►Blom-singerBlom-singer
►Electrical larynxElectrical larynx
►Esophageal soundEsophageal sound
PrognosisPrognosis
5 year survival5 year survival
Stage IStage I >95%>95%
Stage IIStage II 85-90%85-90%
Stage IIIStage III 70-80%70-80%
Stage IVStage IV 50-60%50-60%
