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{{Laryngeal cancer}}
{{Laryngeal cancer}}
{{CMG}} {{AE}}{{Rim}}, {{Faizan}}
{{CMG}} {{AE}} {{OK}}, {{Rim}}, {{Faizan}}


==Overview==
==Overview==
If left untreated, laryngeal cancer produces few symptoms early in the course. Once the [[tumor]] has expanded from its site of origin, it may obstruct the airway. Common complications of laryngeal cancer include [[airway obstruction]], neck disfigurement, and speaking difficulties. The prognosis varies with the type and stage of laryngeal cancer. Stage 4 squamous cell carcinoma of larynx has the most unfavorable prognosis.
If left untreated, [[laryngeal cancer]] produces few [[symptoms]] early in the course. Once the [[tumor]] has expanded from its site of [[origin]], it may obstruct the [[airway]]. Common complications of [[laryngeal cancer]] include [[airway obstruction]], [[neck]] disfigurement, and [[voice]] [[abnormalities]]. The [[prognosis]] varies with the type and stage of [[laryngeal cancer]]. Stage 4 [[squamous cell carcinoma]] of [[larynx]] has the most unfavorable [[prognosis]]. The 3-year survival rate for [[supraglottic laryngeal cancer]] and T3 transglottic [[carcinoma]] are 91.7% and 73.2%, respectively.


==Natural history==
==Natural history==
The natural history of laryngeal cancer varies with the anatomic site of origin. Supraglottic tumors are usually more aggressive in direct extension into the preepiglottic space and lymph node metastasis. The higher incidence of lymphatic spread has to do with the embryologic origin of the region. The supraglottis is derived from midline buccapharyngeal primordium and brachial arches 3 and 4 which have rich bilateral lymphatics. This is in contrast to the glottis which forms from midline fusion of lateral tracheobronchial primordium and arches 4, 5, and 6; here there is a paucity of lymphatics hence glottic cancers have less regional lymphatic spread. In supraglottic carcinomas one third to one half will have lymph node involvement. These lymph channels drain into the internal jugular chain. Direct extension can also occur into the lateral hypopharynx, glossoepiglottic fold and the tongue base. Glottic carcinomas are usually well differentiated, grow slow, and tend to metastasize late in their course. Due to embryonic reasons mentioned earlier glottic tumors typically metastasize after they have directly invaded adjacent structures with better drainage. These tumors do have early extension toward the anterior third of the vocal cord and the anterior commissure with subsequent spread to the opposite cord or anteriorly invade the thyroid cartilage. This thyroid cartilage invasion may be noted clinically as broadening of the thyroid cartilage. Glottic cancer can also extend superiorly into the ventricular walls or inferiorly into the subglottic space. These tumors can also cause cord fixation, as mentioned previously, owing more often to direct extension than nerve involvement but may be due only to shear bulk of the tumor. True subglottic carcinomas are uncommon, but can more often be seen in extension from glottic carcinoma which is a sign of poor prognosis. The lymphatic drainage patterns from this area increases the incidence of having bilateral disease and can lead to extension into the mediastinum. Accordingly glottic tumors with subglottic extension require, in addition to a total laryngectomy with ipsilateral thyroidectomy, an extensive lymph node dissection including the superior mediastinal nodes. This rich nodal spread is also thought to play a role in the high stomal reoccurrence after a total laryngectomy.
The natural history of [[laryngeal carcinoma]] depends on the site:<ref name="pmid7610838">{{cite journal |vauthors=Ferlito A |title=The natural history of early vocal cord cancer |journal=Acta Otolaryngol. |volume=115 |issue=2 |pages=345–7 |date=March 1995 |pmid=7610838 |doi= |url=}}</ref>
*If left untreated, laryngeal cancer produces few symptoms early in the course.
*Once the [[tumor]] has expanded from its site of origin, it may obstruct the aerodigestive passages.


==Complications==
=== Supraglottic tumors <ref name="pmid29155864">{{cite journal |vauthors=Ding W, Liu T, Liang J, Hu T, Cui S, Zou G, Cai W, Yang A |title=Supraglottic squamous cell carcinomas have distinctive clinical features and prognosis based on subregion |journal=PLoS ONE |volume=12 |issue=11 |pages=e0188322 |date=2017 |pmid=29155864 |pmc=5695779 |doi=10.1371/journal.pone.0188322 |url=}}</ref><ref name="pmid1160463">{{cite journal |vauthors=Bocca E |title=Supraglottic cancer |journal=Laryngoscope |volume=85 |issue=8 |pages=1318–26 |date=August 1975 |pmid=1160463 |doi=10.1288/00005537-197508000-00007 |url=}}</ref> ===
Common complications of laryngeal cancer include:
* More aggressive
* Direct extension into the pre-epiglottic space, lateral [[hypopharynx]], [[Glossoepiglottic folds|glossoepiglottic fold]] and the [[tongue]] base and [[lymph nodes]]
 
=== Glottic tumors <ref name="pmid28461858">{{cite journal |vauthors=Zainuddin N, Mohd Kornain NK |title=Glottic cancer in a non-smoking patient with laryngopharyngeal reflux |journal=Malays Fam Physician |volume=11 |issue=2-3 |pages=35–37 |date=2016 |pmid=28461858 |pmc=5408877 |doi= |url=}}</ref><ref name="pmid12057082">{{cite journal |vauthors=Hinerman RW, Mendenhall WM, Amdur RJ, Villaret DB, Robbins KT |title=Early laryngeal cancer |journal=Curr Treat Options Oncol |volume=3 |issue=1 |pages=3–9 |date=February 2002 |pmid=12057082 |doi= |url=}}</ref> ===
* Well differentiated
* Less aggressive, they tend to grow slow
* [[Metastasize]] late in the [[disease]]
* Extend superiorly into the [[ventricular]] walls or inferiorly into the [[subglottic airway]]
 
=== Subglottic tumors  <ref name="pmid12057082">{{cite journal |vauthors=Hinerman RW, Mendenhall WM, Amdur RJ, Villaret DB, Robbins KT |title=Early laryngeal cancer |journal=Curr Treat Options Oncol |volume=3 |issue=1 |pages=3–9 |date=February 2002 |pmid=12057082 |doi= |url=}}</ref><ref name="pmid1177633">{{cite journal |vauthors=Sessions DG, Ogura JH, Fried MP |title=Carcinoma of the subglottic area |journal=Laryngoscope |volume=85 |issue=9 |pages=1417–23 |date=September 1975 |pmid=1177633 |doi=10.1288/00005537-197509000-00001 |url=}}</ref> ===
* Uncommon
* Extends into the [[mediastinum]]
 
==Complications==  
Common complications of laryngeal cancer include:<ref name="pmid27841116">{{cite journal |vauthors=Jones TM, De M, Foran B, Harrington K, Mortimore S |title=Laryngeal cancer: United Kingdom National Multidisciplinary guidelines |journal=J Laryngol Otol |volume=130 |issue=S2 |pages=S75–S82 |date=May 2016 |pmid=27841116 |pmc=4873912 |doi=10.1017/S0022215116000487 |url=}}</ref><ref name="pmid26569309">{{cite journal |vauthors=Issa MR, Samuels SE, Bellile E, Shalabi FL, Eisbruch A, Wolf G |title=Tumor Volumes and Prognosis in Laryngeal Cancer |journal=Cancers (Basel) |volume=7 |issue=4 |pages=2236–61 |date=November 2015 |pmid=26569309 |pmc=4695888 |doi=10.3390/cancers7040888 |url=}}</ref>
*[[Airway obstruction]]
*[[Airway obstruction]]
*Disfigurement of the neck or face
*Disfigurement of the [[neck]] or [[face]]
*Loss of voice and speaking difficulties
*Loss of [[voice]] and speaking difficulties
*[[Metastasis]]
*[[Metastasis]]
*A small percentage of patients (5%) will not be able to swallow and will need to be fed through a feeding tube
*A small percentage of patients (5%) will not be able to [[swallow]] and will need to be fed through a [[feeding tube]]
==Prognosis==
==Prognosis==
Laryngeal cancers can be cured in 90% of patients if detected early. If the cancer has spread to surrounding tissues or [[lymph nodes]] in the neck, 50 - 60% of patients can be cured. If the cancer has metastasized to parts of the body outside the head and neck, the cancer is not curable and treatment is aimed at prolonging and improving quality of life. After treatment, patients generally need therapy to help with speech and swallowing.
* The 3-year survival rate for [[supraglottic laryngeal cancer]] and T3 transglottic [[carcinoma]] is 91.7% and 73.2%, respectively<ref name="pmid14606603">{{cite journal |vauthors=Woo JS, Baek SK, Kwon SY, Jung KY, Lee J |title=T3 supraglottic cancer: treatment results and prognostic factors |journal=Acta Otolaryngol. |volume=123 |issue=8 |pages=980–6 |date=October 2003 |pmid=14606603 |doi= |url=}}</ref>
 
* [[Laryngeal cancer]] can be cured in 90% of patients if detected early.
===5-Year Survival===
* If the [[cancer]] has spread to surrounding [[tissues]] or [[lymph nodes]] in the [[neck]], 50 - 60% of [[patients]] can be cured.  
* Between 2004 and 2010, the 5-year relative survival of patients with laryngeal cancer was 62.6%.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* If the cancer has [[metastasized]] to parts of the body outside the [[head]] and [[neck]], the [[cancer]] is not curable and treatment is aimed at prolonging and improving [[quality of life]]. After treatment, patients generally need therapy to help with [[speech]] and [[swallowing]].<ref name="pmid20530316">{{cite journal |vauthors=Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML |title=Human papillomavirus and survival of patients with oropharyngeal cancer |journal=N. Engl. J. Med. |volume=363 |issue=1 |pages=24–35 |date=July 2010 |pmid=20530316 |pmc=2943767 |doi=10.1056/NEJMoa0912217 |url=}}</ref>
* When stratified by age, the 5-year relative survival of patients with laryngeal cancer was 61.5% and 58.2% for patients <65 and ≥ 65 years of age respectively.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
* The survival of patients with laryngeal cancer varies with the stage of the disease. Shown below is a table depicting the 5-year relative survival by the stage of laryngeal cancer:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
{| style="cellpadding=0; cellspacing= 0; width: 600px;"
|-
| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" |'''Stage'''|| style="padding: 0 5px; font-size: 100%; background: #4682B4; color: #FFFFFF; width: 10%" align="center" | '''5-year relative survival (%), (2004-2010)'''
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''All stages'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |60%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Localized'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |75.1%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Regional'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" | 43.4%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Distant'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |35.1%
|-
| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |'''Unstaged'''|| style="font-size: 100; padding: 0 5px; background: #B8B8B8" align="left" |55.7%
|}
 
* Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of laryngeal cancer by stage at diagnosis according to [[SEER]]. These graphs are adapted from [[SEER]]: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
[[Image:5 year survival in laryngeal cancer in USA.PNG|5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of laryngeal cancer by stage at diagnosis according to SEER]]


==References==
==References==

Latest revision as of 06:16, 18 March 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Rim Halaby, M.D. [3], Faizan Sheraz, M.D. [4]

Overview

If left untreated, laryngeal cancer produces few symptoms early in the course. Once the tumor has expanded from its site of origin, it may obstruct the airway. Common complications of laryngeal cancer include airway obstruction, neck disfigurement, and voice abnormalities. The prognosis varies with the type and stage of laryngeal cancer. Stage 4 squamous cell carcinoma of larynx has the most unfavorable prognosis. The 3-year survival rate for supraglottic laryngeal cancer and T3 transglottic carcinoma are 91.7% and 73.2%, respectively.

Natural history

The natural history of laryngeal carcinoma depends on the site:[1]

Supraglottic tumors [2][3]

Glottic tumors [4][5]

Subglottic tumors [5][6]

Complications

Common complications of laryngeal cancer include:[7][8]

Prognosis

References

  1. ↑ Ferlito A (March 1995). "The natural history of early vocal cord cancer". Acta Otolaryngol. 115 (2): 345–7. PMID 7610838.
  2. ↑ Ding W, Liu T, Liang J, Hu T, Cui S, Zou G, Cai W, Yang A (2017). "Supraglottic squamous cell carcinomas have distinctive clinical features and prognosis based on subregion". PLoS ONE. 12 (11): e0188322. doi:10.1371/journal.pone.0188322. PMC 5695779. PMID 29155864.
  3. ↑ Bocca E (August 1975). "Supraglottic cancer". Laryngoscope. 85 (8): 1318–26. doi:10.1288/00005537-197508000-00007. PMID 1160463.
  4. ↑ Zainuddin N, Mohd Kornain NK (2016). "Glottic cancer in a non-smoking patient with laryngopharyngeal reflux". Malays Fam Physician. 11 (2–3): 35–37. PMC 5408877. PMID 28461858.
  5. ↑ 5.0 5.1 Hinerman RW, Mendenhall WM, Amdur RJ, Villaret DB, Robbins KT (February 2002). "Early laryngeal cancer". Curr Treat Options Oncol. 3 (1): 3–9. PMID 12057082.
  6. ↑ Sessions DG, Ogura JH, Fried MP (September 1975). "Carcinoma of the subglottic area". Laryngoscope. 85 (9): 1417–23. doi:10.1288/00005537-197509000-00001. PMID 1177633.
  7. ↑ Jones TM, De M, Foran B, Harrington K, Mortimore S (May 2016). "Laryngeal cancer: United Kingdom National Multidisciplinary guidelines". J Laryngol Otol. 130 (S2): S75–S82. doi:10.1017/S0022215116000487. PMC 4873912. PMID 27841116.
  8. ↑ Issa MR, Samuels SE, Bellile E, Shalabi FL, Eisbruch A, Wolf G (November 2015). "Tumor Volumes and Prognosis in Laryngeal Cancer". Cancers (Basel). 7 (4): 2236–61. doi:10.3390/cancers7040888. PMC 4695888. PMID 26569309.
  9. ↑ Woo JS, Baek SK, Kwon SY, Jung KY, Lee J (October 2003). "T3 supraglottic cancer: treatment results and prognostic factors". Acta Otolaryngol. 123 (8): 980–6. PMID 14606603.
  10. ↑ Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML (July 2010). "Human papillomavirus and survival of patients with oropharyngeal cancer". N. Engl. J. Med. 363 (1): 24–35. doi:10.1056/NEJMoa0912217. PMC 2943767. PMID 20530316.


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