耳鼻咽喉頭頸外科學(xué)：Carcinoma of Larynx

CarcinomaofLarynxAnatomyAnatomySupraglottisGlottisSubglottisAnatomyoftheLarynxFunctionofthelarynxSoundproductionRegulatesamountofairenteringthelung.Actsasavalvetopreventfoodinthepharynxfromenteringthetrachea.LaryngoscopyLymphaticDrainage

supraglotticportionIntoupperdeepcervicalnodes

glotticportionPoordrainage

subglotticportionIntolowerdeepcervical

nodesandparatrachealnodesMostcommonheadandneckcancer12,250newcases/yr(USA),60,000newcases/yr(CHN)Male:Female=10:1Age:40－70year96-98%squamouscellcancerEpidemiologyTobaccosmokingAlcoholabuseHPVinfectionAirpollution……

AetiologyClinicalPresentation

HoarsenessorothervoicechangesAlumpintheneckAsorethroatPersistentcoughStridorBadbreathEarache★SupraglotticCancer

SignsandsymptomsSupraglotticCA=tendtopresentlaterUsuallypresentdifficultyswallowing/otalgia/throatpainMorelikelytopresentwithnodemetastasisSupraglotticCancermoreaggressive:Directextensionintopre-epiglotticspaceLymphnodemetastasisDirectextensionintolateralhypopharynxandtonguebaseGlotticcancer

SignsandsymptomsHoarseness=allowforearlydetectionofglotticcancerOthersymptoms:cough,difficultybreathing,aspirationGlottictumorsgrowslowerandtendtometastasizelate.Theytendtometastasizeaftertheyhaveinvadedadjacentstructureswithbetterdrainage.CancausevocalcordfixationSubglotticCancer

Signsandsymptoms:hoarseness,neckmass,difficultybreathing,aspirationsubglotticcancersareuncommonClinicalPresentationPhysicalExamCompleteheadandneckexamPalpationfornodesLaryngoscopyFiberopticlaryngoscopyexamNote:color,cordmobility,extent.ClinicalPresentationSupraglotticcancerGlotticcancerSubglotticcancerClinicalPresentationImagingCTorMRILaryngealcartilageerosionCervicalnode

metastasis

Ultrasoundusedtoidentifycervical

metastasis

.BiopsyandHistologyDirectlaryngoscopywithbiopsyHistologictypesSquamouscellcarcinoma>96%ofcasesDiagnosisRiskfactorsSignsandsymptomsImagingBiopsyDifferentialDiagnosisInflammatoryGranulomatousdisease(TB)PapillomatosisTuberculosis(TB)Papillomatosis

PolypsSupraglottisTis:CAin-situT1:limitedtosubsiteofsupraglotsw/normalcordmobilityT2:invademucosaof>1subsiteofsupraglottis,glottis,oroutsideofsupraglottisw/outfixationofthelarynxT3:limitedtolarynxw/vocalcordfixationand/orinvadespostcricoidarea,pre-epiglottictissues,paraglotticspace,and/orminorthyroidcartilageerosionT4a:invadesthyroidcartilageand/ortissuesbeyondlarynxT4b:invadesprevertebralspace,encasescarotidartery,GlottisTis:CAin-situT1:limitedtocord; T1a:onecord;T1b:twocordsT2:extendstosupraglottis,and/orsubglottis,and/orw/impairedcordmobilityT3:limitedtolarynxw/vocalcordfixationand/orinvadesparaglotticspace,and/orminorthyroidcartilageerosionT4a:invadesthyroidcartilageand/ortissuesbeyondlarynxT4b:invadesprevertebralspace,encasescarotidartery,orinvadesmediastinalstructuresSubglottisTis:CAin-situT1:limitedtosubglottisT2:extendstovocalcordwithnormalorimpairedmobilityT3:limitedtolarynxw/vocalcordfixationT4a:invadescricoidorthyroidcartilage,and/orinvadestissuesbeyondthelarynxT4b:invadesprevertebralspace,encasescarotidartery,orinvadesmediastinalstructuresTNMclassification

Source:AJCCCancerStagingManual,6thEd(2002)TNMclassification

NodesN0:noregionalnodemetsN1:singleipsilateralnode,≤3cmN2a:singleipsilateralnode,>3cm,≤6cmN2b:multipleipsilateralnodes,≤6cmN2c:bilateralorcontralateralnodes,≤6cmN3:node>6cmMetsMx:unknownM0:nodistantmetsM1:distantmetsSource:AJCCCancerStagingManual,6thEd(2002)SurgeryMicrolaryngealsurgeryPartiallaryngectomyHemilargyngectomySupracricoidlaryngectomyNear-totallaryngectomyTotallaryngectomyRadiotherapyChemotherapyCisplatin+5-fluorouracilTreatments–Options★Microlaryngealsurgery（CO2laser）Neck

DissectionModifiedorradicalneckdissectionsareindicatedinthepresenceofnodaldisease.NeckdissectionsmaybeperformedinpatientswithsupraorsubglotticT2tumorsevenintheabsenceofnodaldiseaseNeck

DissectionTreatmentAdjuvantradiationisstartedwithin6weeksofsurgeryandwithoncedailyprotocolslasts6-7weeksQue