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Carcinoma of the Larynx

Laryngeal Cancer

A carcinoma of the larynx (CL) can develop in any part of the larynx and gradually affect other and finally all the parts. Most larynx carcinomas originate from squamous cells located in the epithelium. Early stage tumors are typically found in the glottis and will later on spread into the supra- and subglottic larynx regions. The treatment should involve an optimal combination of surgery, radiation therapy, and chemotherapy. All patients should be strongly advised to quit smoking.

Presentation

Early stage carcinomas of the larynx usually manifest in persisting and slowly increasing voice hoarseness. The carcinoma gradually impairs laryngeal functions and can also cause inflammatory reactions in the surrounding tissue at a later stage. In the majority of cases, the carcinomas remain localized. However, they can also form metastases in regional as well as distant lymph nodes in up to 40% of patients [1]. Metastases most likely develop in the liver and the lungs. Both the site and the stage of the carcinoma determine the spectrum of possible symptoms. Dysphonia which will gradually develop into aphonia, dysphagia, dyspnea, aspiration, fatigue and general weakness, localized pain, otalgia, halitosis and blood showing in the patient's sputum as well as general cachexia, tissue expectoration and suspicious local tissue development in the neck in advanced carcinoma stages can be noted in the clinical presentation [2].

Carcinomas of the larynx are strongly connected to certain lifestyle risk factors like smoking and alcohol abuse as well as advanced age (above 60 years) [3]. It is more common in males. The probability to develop a carcinoma of the larynx is sixteen times higher in smokers than in non-smokers [4] with a significant detrimental memory effect in former smokers [5]. Restarting the smoking habit during or after carcinoma treatment diminishes healing chances and also increases the risk for the development of further carcinomas [6]. Notably, the probability of developing early-stage disease has declined in the past decades [7]. In the case of patients with a drug history, it is most likely that the patients have accumulated further drug-related ailments that turn out to be fatal than carcinomas of the larynx.

Entire Body System

Weight Loss

Weight loss. Unintentional weight loss may signal an underlying cancer.[everydayhealth.com]
Symptoms of these cancers may include: A sore throat that does not go away Constant coughing Pain when swallowing Trouble swallowing Ear pain Trouble breathing Weight loss A lump or mass in the neck (due to spread of the cancer to nearby lymph nodes)[cancer.org]
loss Fatigue If you are concerned about any changes you experience, please talk with a doctor and/or dentist, especially if they don’t go away or get worse.[cancer.net]
loss , or fatigue (extreme tiredness).[nhs.uk]
Signs of Laryngeal Cancer Cancer may cause: Hoarseness or voice changes Problems swallowing Feeling like you have a lump in your throat A bad cough or chest infection Feeling short of breath Bad breath Weight loss An earache that lasts for a long time[asha.org]

Malnutrition

Complications Dysphagia, malnutrition. Loss of voice. Tracheo-innominate artery fistula and pharyngocarotid artery fistula. Loss of taste - potentially aggravating inadequate nutrition.[patient.info]
Tumor growth by local extension in the larynx can cause a patient's airway to be compromised or the swallowing function to be interrupted (which leads to problems eating and subsequent malnutrition), as well as causing the loss of the protection of the[oncolink.org]

Euthyroid

[…] patients who underwent curative radiotherapy for T1/T2 laryngeal cancer between 1998 and 2002. 33 patients were identified (mean 66.85 years, range 48-93). 19 patients had T1 lesions (58%), 14 had T2 lesions (42%) and 27 were N0 (82%). 23 patients were euthyroid[ncbi.nlm.nih.gov]

Thyroid Nodule

CONCLUSION: To approach a thyroid nodule, direct invasion or metastatic tumors of other organs must be borne in mind. 2017 S. Karger AG, Basel.[ncbi.nlm.nih.gov]

Immune System

Cervical Lymphadenopathy

Subglottic cancer presents with dyspnea, stridor, or palpable cervical lymphadenopathy.[health.am]

Respiratoric

Hoarseness

It affected a 78-year-old male who presented initially with hoarseness and bloody sputum. The patient had suffered from continuing hoarseness and bloody sputum for three months before he consulted an otorhinolaryngologist one month ago.[ncbi.nlm.nih.gov]
A 35-year-old Saudi female presented to the Ear, Nose and Throat clinic complaining of hoarseness of voice. Examination revealed subglottic mass, which proved to be adenoid cystic carcinoma of the larynx with adenocarcinoma hybrid.[ncbi.nlm.nih.gov]
We report such a lesion in a 15 years old boy presenting with hoarseness and an exophytic growth in the glottis.[ncbi.nlm.nih.gov]
Hoarseness or voice changes Laryngeal cancers that form on the vocal cords (glottis) often cause hoarseness or a change in the voice. This can lead to them being found at a very early stage.[cancer.org]
A 64 year old male, heavy smoker and alcohol abuser, presented with a 6 month history of hoarseness. Laryngoscopy revealed a right transglottic lesion involving the epiglottis, aryepiglottic fold, ventricle and true vocal fold.[ncbi.nlm.nih.gov]

Cough

KEYWORDS: Adenoid cystic carcinoma; Fiberscopy; Larynx; Prolonged cough; Subglottic mass[ncbi.nlm.nih.gov]
Feeling like you need to cough. Constant irritation of the throat and feeling like you have to cough or clear your throat can be an early cancer symptom. Breathing problems.[everydayhealth.com]
Symptoms of these cancers may include: A sore throat that does not go away Constant coughing Pain when swallowing Trouble swallowing Ear pain Trouble breathing Weight loss A lump or mass in the neck (due to spread of the cancer to nearby lymph nodes)[cancer.org]
Some of the most common signs include: hoarse voice breathing difficulties excessive coughing cough with blood neck pain sore throat ear pain trouble swallowing food neck swelling neck lumps sudden weight loss These symptoms don’t always occur with cancer[healthline.com]
Chondrosarcoma (cancer of the cartilage) Adenocarcinoma Adenoid cystic carcinoma (form of salivary gland cancer) Metastases from other cancers Laryngeal Cancer Symptoms Laryngeal cancer symptoms include: Persistent hoarseness or change in voice A sore throat or cough[cancer.osu.edu]

Dyspnea

Dyspnea was the most common complaint. All patients underwent combined-modality treatment with surgical resection and external beam radiation. The range of follow-up time varied from 1 to 7 years (median 5 years).[ncbi.nlm.nih.gov]
Dysphonia which will gradually develop into aphonia, dysphagia, dyspnea, aspiration, fatigue and general weakness, localized pain, otalgia, halitosis and blood showing in the patient's sputum as well as general cachexia, tissue expectoration and suspicious[symptoma.com]
Because most spindle cell tumors are polypoid and pedunculated, and tend to cause obstructive symptoms such as hoarseness, dyspnea, and dysphagia, most tumors without metastasis are detected early and tend to have a very good 5-year prognosis.[ccij-online.org]
Subglottic cancer presents with dyspnea, stridor, or palpable cervical lymphadenopathy.[health.am]
Ask about dysphagia, persistent cough, hemoptysis, weight loss, dyspnea, or pain that radiates to the ear, which are late symptoms of laryngeal cancer.[medical-dictionary.thefreedictionary.com]

Stridor

Late symptoms include dysphagia, odynophagia, stridor, or cough. Subglottic cancer presents with dyspnea, stridor, or palpable cervical lymphadenopathy.[health.am]
Case Report A 70-year-old male presented to our department with a 1-year history of progressive hoarseness and stridor since last 1 week.[ccij-online.org]
A noisy type of breathing called stridor may occur if the opening between the vocal cords is narrowed by a laryngeal cancer. Difficulty swallowing.[everydayhealth.com]
Symptoms may include the following: [3] [4] Hoarseness or other voice changes A lump in the neck A sore throat or feeling that something is stuck in the throat Persistent cough Stridor - a high-pitched wheezing sound indicative of a narrowed or obstructed[en.wikipedia.org]
[…] and Signs of Larynx Cancer A person should seek early medical attention if he has a persistent hoarse voice or a persistent sore throat, a painless lump in the neck, feels pain on swallowing, has difficulty swallowing, or has noisy breathing known as stridor[nccs.com.sg]

Hemoptysis

Supraglottic cancers tend to present late with symptoms of dysphagia, odynophagia, hemoptysis, or referred otalgia. Stridor and hoarseness are late findings. Palpable cervical lymphadenopathy is a common presenting sign.[health.am]
Ask about dysphagia, persistent cough, hemoptysis, weight loss, dyspnea, or pain that radiates to the ear, which are late symptoms of laryngeal cancer.[medical-dictionary.thefreedictionary.com]
Majority occur in anterior 2/3 of vocal cords Symptoms - persistent hoarseness, later dyspnea, chronic cough, hemoptysis, stridor Staging T1 - limited to vocal cords, with normal mobility T1a - limited to one vocal cord T1b - involves both vocal cords[en.wikibooks.org]

Gastrointestinal

Odynophagia

Late symptoms include dysphagia, odynophagia, stridor, or cough. Subglottic cancer presents with dyspnea, stridor, or palpable cervical lymphadenopathy.[health.am]
There were no associated complaints of dysphagia, odynophagia, or weight loss. There was no history of tuberculosis, trauma, or any focal neurological deficit. He was a chronic smoker since last 40 years.[ccij-online.org]

Jaw & Teeth

Halitosis

Dysphonia which will gradually develop into aphonia, dysphagia, dyspnea, aspiration, fatigue and general weakness, localized pain, otalgia, halitosis and blood showing in the patient's sputum as well as general cachexia, tissue expectoration and suspicious[symptoma.com]
Diagnosis Signs and Symptoms Persistent hoarseness in an elderly or middle-aged cigarette smoker Dyspnea and stridor Ipsilateral otalgia Dysphagia Odynophagia Chronic cough Hemoptysis Weight loss owing to poor nutrition Halitosis owing to tumor necrosis[health.am]
Dyspnoea and stridor, pain, dysphagia, cough, swelling in the neck, haemoptysis, halitosis, reflective otalgia, tenderness of the larynx and weight loss can also occur during the course of disease.[atlasgeneticsoncology.org]

Ears

Otalgia

A 74 year old man who presented with otalgia underwent direct laryngoscopy with biopsy, which revealed an invasive poorly differentiated carcinoma.[ncbi.nlm.nih.gov]
Dysphonia which will gradually develop into aphonia, dysphagia, dyspnea, aspiration, fatigue and general weakness, localized pain, otalgia, halitosis and blood showing in the patient's sputum as well as general cachexia, tissue expectoration and suspicious[symptoma.com]
Supraglottic cancers tend to present late with symptoms of dysphagia, odynophagia, hemoptysis, or referred otalgia. Stridor and hoarseness are late findings. Palpable cervical lymphadenopathy is a common presenting sign.[health.am]
Patients with supraglottic cancer often present with dysphagia; other common symptoms include airway obstruction, otalgia, development of a neck mass, or a "hot potato" voice.[merckmanuals.com]
(Outside the field of otorhinolaryngology, many physicians do not realize that otalgia may be a sign of laryngeal cancer.[emedicine.medscape.com]

Referred Otalgia

Supraglottic cancers tend to present late with symptoms of dysphagia, odynophagia, hemoptysis, or referred otalgia. Stridor and hoarseness are late findings. Palpable cervical lymphadenopathy is a common presenting sign.[health.am]

Face, Head & Neck

Neck Mass

A 56-year-old, diabetic male presented with a 2.5-cm, left-sided neck mass. Fine needle aspiration showed a mixture of malignant squamous and spindle cells. A third population of osteoclastlike giant cells was also present.[ncbi.nlm.nih.gov]
This report describes a case of a 62-year-old male with giant cell carcinoma of the larynx that presented as a neck mass and hoarseness. Case report, review of the world literature, and an immunohistochemical examination.[ncbi.nlm.nih.gov]
Patients presented with throat pain, hoarseness, dysphagia, and neck mass, and all tumors originated in the supraglottis. Six of the eight patients (all males) had a history of cigarette smoking.[ncbi.nlm.nih.gov]
Patients with supraglottic cancer often present with dysphagia; other common symptoms include airway obstruction, otalgia, development of a neck mass, or a "hot potato" voice.[merckmanuals.com]
Fine-needle aspiration (FNA) of a neck mass.[patient.info]

Neck Swelling

Some of the most common signs include: hoarse voice breathing difficulties excessive coughing cough with blood neck pain sore throat ear pain trouble swallowing food neck swelling neck lumps sudden weight loss These symptoms don’t always occur with cancer[healthline.com]

Workup

Diagnosis must start with a thorough check of the patient's background and lifestyle. The development of a carcinoma of the larynx can also be related to an infection with human papillomavirus (HPV) [8]. A physical exam involving direct laryngoscopy is inevitable. It is highly advisable to perform a biopsy of a potential early-stage tumor. Depending on the location and the development stage of the carcinoma, further tests to be considered are computed tomography (CT) scans of the chest, head and neck, magnetic resonance imaging (MRI) as well as positron emission tomography (PET). The aim of these tests is to determine the degree of tumor invasion into surrounding tissues which will also define the odds of patient survival.

Late-stage tumors with a significant depth of invasion and metastatic spread are fatal [9]. Localized tumors have healing chances between 75% and 95% [10].

Microbiology

Helicobacter Pylori

BACKGROUND: Infection with Helicobacter pylori (H. pylori) plays a role in the development of gastric carcinoma. However, there is controversy as to whether H. pylori infection increases laryngeal or pharyngeal cancers.[ncbi.nlm.nih.gov]

Treatment

[…] to influence treatment response.[ncbi.nlm.nih.gov]
Selection of adequate treatment for synchronous tumours is difficult because of different spreading rates and metastatic patterns.[ncbi.nlm.nih.gov]
Abstract External beam radiotherapy is currently the commonest form of treatment for early laryngeal cancer (T1/2) and thyroid dysfunction is a well recognised complication of this treatment.[ncbi.nlm.nih.gov]
No grade IV reactions or treatment related deaths occurred.[ncbi.nlm.nih.gov]

Prognosis

We report an observation of this association and present the therapeutic problems as well as the effects on prognosis.[ncbi.nlm.nih.gov]
To review the management of NCL, including discussion of clinical behavior, treatment outcome, and prognosis.[ncbi.nlm.nih.gov]
The tumor is highly aggressive biologically, and the overall prognosis is poor despite intensive treatment. We describe a case of basaloid squamous cell carcinoma of the larynx that metastasized to the spine.[ncbi.nlm.nih.gov]
In this paper we discuss the pathological features and electron microscopy of adenoid cystic carcinoma in detail, including its differential diagnosis, prognosis and treatment.[ncbi.nlm.nih.gov]
A review of the literature reveals that prognosis of this aggressive malignant neoplasm is poor (mean 2-3 years free of disease) on account of local recurrences, early cervical lymph node metastasis and distant dissemination.[ncbi.nlm.nih.gov]

Etiology

Efforts to detect possible common etiologic agents including human papillomavirus and chronic arsenicism revealed no association between Bowen's disease and the internal malignancies.[ncbi.nlm.nih.gov]
We propose that the development of laryngeal carcinoma in this cohort of patients who lack typical risk factors supports the notion that GERD plays a role in the etiology of carcinoma of the larynx.[ncbi.nlm.nih.gov]
Tobacco, alcohol, asbestos, and nickel in the etiology of cancer of the larynx: a case-control study. Journal of the National Cancer Institute.[headandneckcancerguide.org]
Very rare in young patients, in general Predominant sex : Male female (5:1), however, increasing incidence in women who smoke Incidence 5 in 100,000 (12,500 new cases per year) Etiology Smoking Alcohol abuse Associated conditions 10% of patients may have[health.am]
Until the complex molecular interactions of all associated etiologic agents for any cancer can be understood, these interactions are best thought of as associations.[emedicine.medscape.com]

Epidemiology

Methods A head and neck cancer epidemiology database was queried for eligible subjects from 2003 to 2014. Data were extracted from the electronic medical record and research database, and survival analyses were performed.[ncbi.nlm.nih.gov]
Laryngeal cancer includes tumours of the supraglottis, glottis or subglottis. [ 1 ] Within the larynx, the glottis is most frequently affected. [ 2 ] Epidemiology [ 3 ] Cancer of the larynx is the second most common form of head and neck cancer.[patient.info]
General Prevention Indirect laryngoscopy for patients with persistent hoarseness lasting beyond 1-2 weeks Cessation of smoking and/or alcohol abuse Epidemiology Predominant age : Median age of occurrence in the sixth and seventh decades Less than 1% of[health.am]
Social aftercare Follow-up care is an important part of laryngeal cancer aftercare, especially after total or partial removal of the larynx, as this means severe deep cuts in social communication abilities. [16] Epidemiology [ edit ] Incidence is five[en.wikipedia.org]
Human papillomavirus and the epidemiology of head and neck cancer. In: Flint PW, Haughey BH, Lund V, et al, eds. Cummings Otolaryngology: Head and Neck Surgery . 6th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 75.[mountsinai.org]

Sex distribution

Age distribution

Pathophysiology

Patients in whom HDAC1 was overexpressed and with low sensitivity to radiotherapy had a poorer overall 5-year survival rate. [2] Pathophysiology The larynx is an essential organ that is responsible for the following vital functions: Maintaining an open[emedicine.medscape.com]

Prevention

How can I prevent laryngeal cancer? Since it is fairly uncommon for a non-smoker to be diagnosed with laryngeal cancer, smoking cessation is the best way to prevent laryngeal cancer.[oncolink.org]
Is there anything I can do to help prevent this? The PACT Program The Marjorie E. Korff PACT program at the Massachusetts General Hospital Cancer Center provides psycho-educational support for parents who are patients.[massgeneral.org]
Prevention By far, the most effective way to prevent laryngeal cancer is not to smoke. Smokers who quit smoking also significantly decrease their risk of developing the disease.[encyclopedia.com]
It includes the following aspects: Prevention of complications that may occur as a result of treatment. It can be pneumonia, lymphostasis, thromboembolic or infectious complications. Restoration of general health.[bookinghealth.com]
In 2010, approximately 36,540 Americans were diagnosed with this largely preventable type of cancer that affects the mouth and throat; 7,880 died of the disease.[news-medical.net]

References

Article

Spector JG, Sessions DG, Haughey BH, et al. Delayed regional metastases, distant metastases, and second primary malignancies in squamous cell carcinomas of the larynx and hypopharynx. Laryngoscope. 2001;111:1079-1087.
Kirchner JA, Som ML. Clinical and histological observations on supraglottic cancer. Ann Otol Rhinol Laryngol. 1971;80:638-645
Spitz MR. Epidemiology and risk factors for head and neck cancer. Semin Oncol. 1994;21(3): 281-288.
Markou K, Christoforidou A, Karasmanis I, et al. Laryngeal cancer: epidemiological data from Νorthern Greece and review of the literature. Hippokratia. 2013;17(4):313–318.
Bosetti C, Garavello W, Gallus S, et al. Effects of smoking cessation on the risk of laryngeal cancer: an overview of published studies. Oral Oncol. 2006;42(9):866-872.
Kikidis D, Vlastarakos PV, Manolopoulos L, Yiotakis I. Continuation of smoking after treatment of laryngeal cancer: an independent prognostic factor? ORL J Otorhinolaryngol Relat Spec. 2012;74(5):250-254.
Carvalho AL, Nishimoto IN, Califano JA, Kowalski LP. Trends in incidence and prognosis for head and neck cancer in the United States: A site-specific analysis of the SEER database. Int J Cancer. 2005;114:806-816.
Varnai AD, Bollmann M, Bankfalvi A, et al. The prevalence and distribution of human papillomavirus genotypes in oral epithelial hyperplasia: proposal of a concept. J Oral Pathol Med. 2009;38:181-187.
Yilmaz T, Hoşal S, Gedikoglu G, et al. Prognostic significance of depth of invasion in cancer of the larynx. Laryngoscope. 1998; 108(5):764-768.
Reddy SP, Mohideen N, Marra S, et al. Effect of tumor bulk on local control and survival of patients with T1 glottic cancer. Radiother Oncol. 1998;47(2):161-166.

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Last updated: 2019-07-11 20:41