Squamous cell carcinoma of the larynx
Squamous cell carcinoma of the larynx is the most common primary malignant tumor that affects the laryngeal framework. Typically it is categorized by the laryngeal subsite affected, which affects presentation, treatment and prognosis.
Epidemiology
Males are more affected than females, and usually, the older age group (>50 years) are more susceptible.
Risk factors
- smoking
- alcohol
- Greek/Turkish coffee
- asbestos exposure (mixed evidence)
Pathology
Squamous cell carcinoma (SCC) accounts for 98% of laryngeal tumors.
Classification
The tumor is classified according to its relation to the glottis, which affects the treatment options:
- supraglottic carcinoma (20-30%)
- glottic carcinoma (50-60%)
- subglottic carcinoma (5%)
- transglottic carcinoma: involving two or more of these spaces
Supraglottic carcinoma
SCC arises from the epiglottis, aryepiglottic fold, false vocal fold, as well as the deep pre-epiglottic and paraglottic space. It metastasizes early to cervical lymph nodes.
Glottic carcinoma
SCC arises from the true vocal fold. It manifests early due to hoarseness of voice and rarely metastasizes due to the poor lymphatic drainage of the glottis.
Subglottic carcinoma
SCC arises from anywhere below the true vocal fold to the inferior edge of the cricoid cartilage. It produces minimal symptoms, which is responsible for its late diagnosis, which coupled with early lymph node metastasis, means a poor prognosis.
Staging
See: laryngeal squamous cell carcinoma staging
Radiographic features
CT and MRI can both be used to assess and stage laryngeal SCC.
PET-CT can be used to assess for post-resection recurrence.
Supraglottic carcinoma
CT
Supraglottic soft tissue mass causing asymmetry of the laryngeal sides and cartilage sclerosis. The mass displays moderate enhancement. Enlarged lymph node >1.5 cm in short axis. CT can assess tumor extension.
MRI
- T1: low signal
- T2: high signal
- STIR: high signal
- T1 C+ (Gd): homogeneous/heterogeneous enhancement
- obliteration of paraglottic fat may be seen
Glottic carcinoma
CT
Enhancing exophytic or infiltrative true vocal fold mass. CT is useful to assess tumor for extension to anterior commissure (>1 mm thickness), posterior commissure, supra- or subglottis.
MRI
- T1: low signal
- T2: high signal
- T1 C+ (Gd): homogeneous enhancement
Subglottic carcinoma
CT
- enhancing soft tissue at the level of the cricoid cartilage
MRI
- T1: low signal
- T2: high signal
- T1 C+ (Gd): heterogeneous enhancement
Treatment and prognosis
Small tumors may be treated with laser therapy or radiotherapy. Larger tumors may require combination radiotherapy and total laryngectomy.
Voice-sparing supraglottic laryngectomy for supraglottic lesions with no cord fixation is also possible.
Siehe auch:
Assoziationen und Differentialdiagnosen zu Larynxkarzinom:
