supraglottic cancer

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Supraglottic Cancer Supraglottic Cancer

Mohammed Nabil J AlAliMohammed Nabil J AlAli5th year medical studentAt King Faisal University

Group B (210006209)

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Outlines

-AnaTomy-Histology and LNs-Epidemiology-Etiology-Pathophysilogy

-Sign and symptoms-Stagings-Investigations-Treatment


Anatomy


Histology And lymph Ns

Supraglottic Thyrohyoid membrane Deep Cervical LN


Epidemiology

Laryngeal cancer- the second most common type of head and neck cancer worldwide

- the 11th most common cancer in men worldwide but is much less common in women.

- Men have as much as 30 times the risk that of women .

- Older individuals are at a higher risk ; the highest number (age 60-74 years).


Epidemiology (cont. )

The percentage of laryngeal cancers that originate in the supraglottis varies from country

to country.

In the United States:approximately 30-40% of laryngeal cancers originate in the supraglottis, while most occur in the glottis.

In Spain and Finland :the supraglottis is the most frequent subsite .


Etiology (as risk factors)

Other factors associated with laryngeal SCC :Other factors associated with laryngeal SCC :- Dietary deficiencies .- radiation exposure .- human papillomavirus (HPV) .- gastroesophageal reflux .

Some studies have show that 97% of patients with laryngeal cancer smoked. When compared with men who did not smoke, men who smoked at least 1.5 packs of cigarettes per day for more than 10 years were found to have a 30-fold increased risk of developing laryngeal cancer.

- Tobacco and Alcohol use- Tobacco and Alcohol use


Pathophysilogy

The supraglottis is embryologically derived from the buccopharyngeal anlage in the region of the third and fourth branchial arches.

Despite the theoretical separation of the supraglottis from the rest of the larynx, no anatomical or histological barrier has been identified.

Furthermore, supraglottic tumors invading the paraglottic space have access to the glottis via the medial surface of the thyroid cartilage.

Lymphatic vascularity in the supraglottis is much denser than in the glottis and subglottis. This is important in the development of supraglottic cancer and leads to a significantly higher incidence of cervical lymph node metastases in tumors of this subsite.


AL Hassa


Symptoms

1.Hoarseness of voice: First symptom in glottic but late in subglottic and supraglottic

2.Discomfort in throat: First symptom in supraglottic carcinoma.

3.Pain, dysphagia, otalgia

4.Stridor

5.Neck swelling

6.Anorexia


Signs

Indirect laryngoscopy ulcerating reddish mass at different locations in the larynx.


Staging

T1- tumor limited to one subsite of the supraglottis with normal vocal cord mobility

T2- tumor invades one adjacent site of the supraglottis or glottis or one region outside of the supraglottis without fixation of the vocal cords

T3- tumor limited to the larynx with vocal cord fixation or invasion into the area behind the larynx or in front of the larynx

T4- tumor invades outside of the larynx (trachea, soft tissues of the neck, etc.)


Investigation

- Biopsy is required for diagnosis Performed in OR with patient under anesthesia .

- Direct laryngoscopyDirect laryngoscopy

- BronchoscopyBronchoscopy

- EsophagoscopyEsophagoscopy

- Chest X-rayChest X-ray

- CT or MRICT or MRI


Treatment

Specific treatment will be determined by the physician(s) based on: 1- patient’s age, overall health, and medical history

2- extent of the disease

3- expectations for the course of the disease

4- patient’s tolerance for specific medications, procedures or therapies

5- patient’s opinion or preference


Treatment Early stages (T1 and T2)

- Can be treated with radiotherapy or surgery alone, both offer the 85-95% cure rate.

- Surgery has a shorter treatment period, saves radiation for recurrence, but may have worse voice outcomes

- Radiotherapy is given for 6-7 weeks, avoids surgical risks but has own complications


Treatment Advanced stages

- Lesions often receive surgery with adjuvant radiation .

- Most T3 and T4 lesions require a total laryngectomy .

- Some small T3 and lesser sized tumors can be treated with partial laryngectomy .


Prognosis

Cancer larynx has good prognosis with 67% 5-year survival rate.

Glottic malignancy has better prognosis than supra-glottic malignancy supra-glottic malignancy due to

1. Early presentation and diagnosis .

2. Less lymphatic spread .


Any Question ?Any Question ?


Resources

Emedicine (medscape)http://emedicine.medscape.com/article/852908-overview

ent.md.kku.ac.thhttp://ent.md.kku.ac.th/site_data/mykku_ent/1/Resident/Topic%2053/Topic_laryngeal_cancer.pdf


Thank you

supraglottic cancer

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