Laryngeal cancer is cancer of the larynx or voice box in which malignant cells are found in the tissue of the larynx. The most common form of laryngeal cancer is squamous cell carcinoma (95%); rare forms include adenocarcinoma, sarcoma, and others.
Causes
Unknown
Risk factors
· Smoking
· Alcoholism
· Chronic inhalation of noxious fumes
· Familial tendency
· History of gastroesophageal reflux disease
Pathophysiology
Laryngeal cancer may be intrinsic or extrinsic. An intrinsic tumor is on the true vocal cord and doesn't tend to spread because underlying connective tissues lack lymph nodes. An extrinsic tumor is on some other part of the larynx and tends to spread early. Laryngeal cancer is further classified according to these locations:
· supraglottis (false vocal cords)
· glottis (true vocal cords)
· subglottis (downward extension from vocal cords [rare]).
Signs and symptoms
Intrinsic laryngeal cancer
· Hoarseness that persists longer than 3 weeks
Extrinsic cancer
· Lump in the throat
· Pain or burning in the throat when drinking citrus juice or hot liquid
Later clinical effects of metastases
· Dysphagia
· Dyspnea
· Cough
· Enlarged cervical lymph nodes
· Pain radiating to the ear
Diagnostic test results
· Xeroradiography, laryngeal tomography, computed tomography scan, and laryngography confirm the presence of a mass.
· Chest X-ray identifies metastasis.
· Laryngoscopy allows definitive staging by obtaining multiple biopsy specimens to establish a primary diagnosis, to determine the extent of disease, and to identify additional premalignant lesions or second primary lesions.
· Biopsy identifies cancer cells.
Treatment
Precancerous lesions
· Laser surgery
Early lesions
· Surgery or radiation
Advanced lesions
· Surgery; procedures vary with tumor size and can include cordectomy, partial or total laryngectomy, supraglottic laryngectomy, or total laryngectomy with laryngoplasty
· Laser surgery to help relieve obstruction caused by tumor growth
· Radiation and chemotherapy
Speech rehabilitation
· If speech preservation isn't possible, may include:
§ esophageal speech
§ prosthetic devices
§ experimental surgical techniques to construct a new voice box
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LARYNGEAL CANCER
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