Head & Neck Oncology: Laryngeal Carcinoma
High-Yield Revision Notes for Board Review & PG Entrance Examinations
Laryngeal Carcinoma is primarily a Squamous Cell Carcinoma (SCC). Prognosis and clinical presentation depend heavily on the subsite of origin (Supraglottic, Glottic, or Subglottic).
1. Subsite Characteristics
| Subsite | Presentation | Nodal Metastasis |
|---|---|---|
| Supraglottic | Dysphagia, throat pain, “hot potato” voice (late). | Early & common (rich lymphatics). |
| Glottic | Early hoarseness (best prognosis). | Rare (poor lymphatic drainage). |
| Subglottic | Late (dyspnea, stridor). | Late (pre-tracheal/paratracheal). |
2. Staging & Spread
- Routes of Spread: Direct invasion into the paraglottic space is common. Transglottic tumors cross the ventricle to involve multiple levels.
- Diagnostic Gold Standard: Laryngoscopy (Direct) with biopsy and CT/MRI of the neck for extent.
3. High-Yield Board Exam Facts
- Most Common Site: The Glottis is the most frequent site of laryngeal cancer.
- TNM Factor: Vocal cord fixation automatically upstages a T1 or T2 tumor to a T3 lesion.
- Treatment: Early stage (T1-T2) can be managed with either endoscopic laser surgery or radiotherapy (with similar voice outcomes). Advanced stages require multimodal therapy (Total Laryngectomy + Radiotherapy).
- Synergy: Smoking and alcohol consumption have a synergistic carcinogenic effect on the laryngeal mucosa.