ear, nose, and throat disorders
Laryngeal Cancer
Introduction
Ninety percent of laryngeal cancer is squamous cell carcinoma. Smoking, excessive alcohol use, lower socioeconomic status, and being male and>60 years increase risk. Early diagnosis is common with vocal cord tumors because hoarseness develops early. However, supraglottic tumors (above the vocal cords) and subglottic tumors (below the vocal cords) often manifest at an advanced stage because they can remain asymptomatic for a longer time frame. Diagnosis is based on laryngoscopy and biopsy. Treatment of early-stage tumors is with surgery or radiation. Advanced-stage tumors are often treated with chemotherapy and radiation therapy. Surgery is used for salvage treatment or lesions with extralaryngeal extension or cartilage destruction. Reestablishment of speaking ability is needed if a total laryngectomy is done. (See also Overview of Head and Neck Tumors .) Squamous cell carcinoma is the most common cancer of the larynx. In the US, it is 4 times more common among men and is more common among people of lower socioeconomic status. Over 95% of patients smoke; 15 pack-years of smoking increase the risk 30-fold. The incidence of laryngeal cancer is about 12,000 new cases per year and is decreasing, particularly among men, most likely due to changes in smoking habits. Annual deaths are about 3750 ( General reference ). (See also Sixty percent of patients present with localized disease alone; 25% present with local disease and regional nodal metastatic disease; and 15% present with advanced disease, distant metastases, or both. Lymph node metastasis are more common in supraglottic and subglottic tumors than with glottic cancers due to the minimal lymphatic drainage of the glottis and because glottic tumors cause symptoms earlier. Distant metastases occur most frequently in the lungs and liver. Common sites of origin are the true vocal cords (glottis) and the supraglottic larynx. The least common site is the subglottic larynx, where only 1% of primary laryngeal cancers originate. Verrucous carcinoma, a rare variant of squamous cell carcinoma, usually arises in the glottic area and has a better survival rate than standard squamous cell carcinoma. 