《耳鼻喉科学 Otolaryngology》课程教学课件（PPT讲稿）pharynx and larynx_Tumour of the larynx

Tumours of the larynx

Tumours of the larynx

Tumours of larynxBenign :Papilloma(85%)ChondromaMalignant:Sguamous cell carcinoma(85%)Carcinomain situVerrucous carcinomaundifferenciated carcinomaadenocarcinomaadenoid cysticcarcinomasarcoma

Tumours of larynx ◼ Benign : Papilloma (85%) Chondroma ◼ Malignant : Squamous cell carcinoma (85%) Carcinoma in situ Verrucous carcinoma undifferenciated carcinoma adenocarcinoma adenoid cystic carcinoma sarcoma

SCClarynxEpidemiologyGeographical variation?Themostcommoncancerof H&N1%ofallmalignanciesMale:female=5:1SeventhdecadeRisk factorsSmokingGeographicAlcoholSocial classVRadiationUrban

SCC larynx Epidemiology ◼ Geographical variation ◼ ? The most common cancer of H & N ◼ 1% of all malignancies ◼ Male : female = 5 : 1 ◼ Seventh decade Risk factors ◼ Geographic Smoking ◼ Social class V Alcohol ◼ Urban Radiation

Aetiology:oUnknownHyoid bonn,AryopigtottieoreatetcorrufoidUoporabove factorspartThyroyoidmembrareTubercle otQuadrargufarepighotimkeratosis/membraneSacculeof larynxMiddieVesttbular foidleukoplakiapartThyraid cartlageLaryngeat wentricioCompartmentsVocal foaldoflarynxLowerThyroirytenaispartCricovocalmemtraneChicoidcartilage1.Supraglottisventricle,FVCarytenoidFig.36.9Coronalsection throughthe larynxand thecanlalend ofthetracheawtacineepiglottisaryepiglotticfoldlemricularVallecula2. Glottic -TVC, antHocolEpiglon& postcordcommissureCuniformPglaniccartilogeL3.SubglotticCorniculatePyriformconilogefossaInferarytenoidarea

◼ Aetiology : Unknown above factors keratosis / leukoplakia ◼ Compartments of larynx 1. Supraglottis – ventricle, FVC arytenoid, epiglottis, aryepiglottic fold 2. Glottic –TVC, ant & post commissure 3. Subglottic -

Clinicalfeatures of SCC larynxPrimary tumour:Glottic carcinoma is thecommonest inlarynxcontinuos progressive hoarseness >3weeksin>40ymaledyspnoea,dysphagia,painSecondary deposits:Neckswelling,chestsymptoms(cough,irritation)General effects of the tumour :anorexia,cachexia,foetor

Clinical features of SCC larynx ◼ Primary tumour :Glottic carcinoma is the commonest in larynx continuos progressive hoarseness > 3 weeks in >40y male dyspnoea, dysphagia, pain ◼ Secondary deposits : Neck swelling, chest symptoms (cough,irritation) ◼ General effects of the tumour : anorexia, cachexia, foetor

Examinationof CaLarynxIndirect laryngoscopy- site, mobilityFibreopticlaryngoscopyNeck-lymphnodesupper deepcervicalmediastinalGeneral exam - chestabdomen

Examination of Ca Larynx ◼ Indirect laryngoscopy – site, mobility ◼ Fibreoptic laryngoscopy ◼ Neck – lymph nodes – upper deep cervical, mediastinal ◼ General exam – chest , abdomen

InvestigationsFBCDirect laryngoscopySerumanalysisextent,biopsy,neckChestX-rayPanendoscopyICT/MRIStagingof tumourUSGabdomenBonescan

Investigations ◼ FBC Direct laryngoscopy ◼ Serum analysis extent,biopsy, neck ◼ Chest X-ray Panendoscopy ◼ CT/MRI Staging of tumour ◼ USG abdomen ◼ Bone scan

Staging Ca larynxGlotticTla - one vocal cordT1b- both vocal cordsT2---- tosupra/subglottis,orimpairedmobilityT3-fixed vocal cordT4-beyond larynx

Staging Ca larynx ◼ Glottic T1a – one vocal cord T1b - both vocal cords T2- to supra/subglottis, or impaired mobility T3 - fixed vocal cord T4 - beyond larynx

TreatmentCurative,palliativeCurative :smalltumours-RT-Preservation surgerylarge tumours-primary surgery-postop RTMx of Neck nodes - depends on stageselective/modified/ radical neckdissection

Treatment ◼ Curative, palliative Curative : small tumours - RT -Preservation surgery large tumours - primary surgery - postop RT Mx of Neck nodes – depends on stage selective / modified / radical neck dissection

Palliationof Ca larynx.TLCPain reliefTracheostomyPEG(percutaneousendoscopicgastrostomy)RT/chemotherapy/surgery

Palliation of Ca larynx ◼ TLC ◼ Pain relief ◼ Tracheostomy ◼ PEG (percutaneous endoscopic gastrostomy) ◼ RT/chemotherapy/surgery