Atlas of pathophysiology, 2 Edition

Part II - Disorders

Sensory Disorders

Laryngeal cancer

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

P.407

LARYNGEAL CANCER

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