tht tumor laring
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Carcinoma of larynx
dr. Sofyan Suri SH, Sp.THT
Faculty of MedicineYARSI University
Jakarta
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Normal Larynx
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Normal vs. Cancerous
Normal Cancer (beginning stage)
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Squamous Ca of larynx
Normal larynx
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Aetiology Classification and staging Supraglottic, glottic and subglottic
cancer Diagnosis Treatment Vocal rehabilitation
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Aetiology
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Classification and staging
TNM classification and staging Classification by AJCC
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TNM classification and staging
Helps to determine :a) The extentb) Treatment modalitiesc) Prognosis
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AJCC classification
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SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECKLARYNX
MOST COMMON NONCUTANEOUS SITE OF SCC IN THE HEAD AND NECK
SUPRAGLOTTIC: EMBRYOLOGICALLY DERIVED FROM BUCCOPHARYNX
GLOTTIC AND SUBGLOTTIC: DERIVED FROM TRACHEOBRONCIAL TREE
TNM CLASSIFICATION DEPENDS UPON VOCAL CORD INVOLVEMENT AND TUMOR EXTENSION
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SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
STAGING
AMERICAN JOINT COMMITTEE ON CANCER.T = TUMOR SIZE
T1 <2 CM DIAMETER
T2 2-4 CM DIAMETER
T3 >4 CM DIAMETER
T4 >4 CM WITH INVASION OF ADJACENT STRUCTURES
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SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
STAGING
N = NODAL BASINS: N0 NO POSITIVE NODES
N1 SINGLE NODE <3 CM DIAMETER
N2 3-6 CM DIAMETER
N3 >6 CM DIAMETER
M = METASTATIC DISEASE M0 NO METASTASIS
M1 METASTASIS
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SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
STAGING
STAGE I T1N0M0
STAGE II T2N0M0
STAGE III T3N0M0, T1 or T2 or T3, N1 or M0
STAGE IV T4N0 or N1, M0
ANY T, N2 or N3, M0
ANY T, ANY N, M1
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Supraglottic cancer
Less frequent than glottic cancer Majority of lesions are seen on epiglottis,
false cords, aryepiglottic folds Spread: vallecula, base of the tongue,
pyriform fossa and even penetrate the thyroid
Symptoms: often silent, may present with throat pain, dysphagia and referred pain-ear, mass in the neck
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SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
LARYNX - SUPRAGLOTTIC
STAGE I & II: RADIOTHERAPY (PRESERVES VOICE) OR HEMILARYNGECTOMY
LYMPHATIC SPREAD AS HIGH AS 50% LARYNGEAL SUSPENSION REQUIRED TO
PREVENT ASPIRATION AFTER HEMILARYNGECTOMY
STAGE III & IV: LARYNGECTOMY FIVE YEAR SURVIVAL 37-57%
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Supraglottic
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Glottic cancer
Most common- 65% Spread: anteriorly- anterior commisure posteriorly- vocal process and arytenoid process Upward- ventricle and false cord Downward- Subglottic regionSymptoms: Hoarseness of voice, stridor
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SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
LARYNX - GLOTTIC
TREATMENT: RADIOTHERAPY OR SURGERY (HEMILARYNGECTOMY)
LYMPH NODE METASTASIS 2% (LOW) FIVE YEAR SURVIVAL IN THE EARLY STAGES 90% STAGE III & IV: TOTAL LARYNGECTOMY
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Glottic
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Subglottic cancer
Lesions rare Spread: Anterior wall, to the
opposite side or downwards to the trachea
May invade cricothyroid membrane, thyroid gland and muscles of neck
Symptoms: Stridor
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SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
LARYNX - SUBGLOTTIC
RARE
RADIOTHERAPY OR SURGERY
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Subglottic
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Diagnosis
History: any patient may present with: ..A sore throat that does not go away ..Dysphagia ..A change or hoarseness in voice ..Pain in the ear ..A lump in the neck
Examination: done to find extra laryngeal spread of disease and nodal metastasis
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Investigation
Laryngoscopy: indirect, direct or micro
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Radiography CT Staining and biopsy
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Treatment
Depends upon:a) The site of lesionb) The extent of spreadc) Metastasis
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Treatment maybe:a) Radiotherapyb) Surgery: conservative laryngeal surgery or total laryngectomyc) Combined therapy
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Rehabilitation
By the following methods: A) Written language B) Oesophageal speech
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Thank you