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Radiologic evaluation by CT or MRI is helpful in assessing tumor extent Imaging evaluates neck nodes, tumor volume, and cartilage sclerosis or destruction A chest CT scan is indicated if there are level VI enlarged nodes (around the trachea and the thyroid gland) or IV enlarged nodes (inferior to the cricoid cartilage along the internal jugular vein) or if a chest film is concerning for a second primary lesion or metastases Laboratory evaluation includes complete blood count and liver function tests Formal cardiopulmonary evaluation may be indicated, especially if partial laryngeal surgery is being considered A positron emission tomography (PET) scan or CT-PET scan may be indicated to assess for distant metastases when there appears to be advanced local or regional disease
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Diagnosis is made by biopsy at the time of laryngoscopy At that time, true cord mobility and arytenoid fixation, as well as surface tumor extent, can be evaluated Most otolaryngologists recommend flexible esophagoscopy and flexible bronchoscopy at that time to exclude synchronous primary tumor Although an FNA biopsy of an enlarged neck node may have already been done, it is generally acceptable to assume radiographically enlarged neck nodes (> 1 15 cm) or nodes with necrotic centers are neck metastases Open biopsies of nodal metastases should be discouraged because they may lead to higher rates of tumor treatment failure
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Staging is helpful in discussing laryngeal cancer, but a number of factors that are not included in the TNM staging are also important in deciding treatment recommendations
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Treatment of laryngeal carcinoma has four goals: cure, preservation of safe effective swallowing, preservation of useful voice, and avoidance of a permanent tracheostoma For early glottic and supraglottic cancers, radiation therapy is the standard of care since cure rates are
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Long-term follow-up is critical in head and neck cancer patients In addition to the 3 4% annual rate of second tumors and monitoring for recurrence, psychosocial aspects of treatment are common Dysphagia, impaired communication, and altered appearance, may result in patient difficulties adapting to the workplace and to social interactions In addition, smoking cessation and alcohol abatement are common challenges Nevertheless, about 65% of patients with larynx cancer are cured, most have useful speech, and many resume their prior livelihoods with adaptations
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Bernier J et al Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer N Eng J Med 2004 May 6;350(19):1945 52 [PMID: 15128894] Forastiere AA et al Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer N Engl J Med 2003 Nov 27;349(22):2091 8 [PMID: 14645636] Gallo A et al Supracricoid partial laryngectomy in the treatment of laryngeal cancer: univariate and multivariate analysis of prognostic factors Arch Otolaryngol Head Neck Surg 2005 Jul;131(7):620 5 [PMID: 16027286] Ganly I et al Results of surgical salvage after failure of definitive radiation therapy for early-stage squamous cell carcinoma of the glottic larynx Arch Otolaryngol Head Neck Surg 2006 Jan;132(1):59 66 [PMID: 16415431] Hoffman HT et al Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival Laryngoscope 2006 Sep;116(9 Pt 2 Suppl 111):1 13 [PMID: 16946667] Loughran S et al Quality of life and voice following endoscopic resection or radiotherapy for early glottic cancer Clin Otolaryngol 2005 Feb;30(1):42 7 [PMID: 15748189] Mendenhall WM et al Management of T1-T2 glottic carcinomas Cancer 2004 May 1;100(9):1786 92 [PMID: 15112257] Pfister DG et al American Society of Clinical Oncology clinical practice guideline for the use of larynx-preservation strategies in the treatment of laryngeal cancer J Clin Oncol 2006 Aug 1;24(22):3693 704 [PMID: 16832122] Sessions DG et al Supraglottic laryngeal cancer: analysis of treatment results Laryngoscope 2005 Aug;115(8):1402 10 [PMID: 16094113] Yamazaki H et al Radiotherapy for early glottic carcinoma (T1N0M0): results of prospective randomized study of radiation fraction size and overall treatment time Int J Radiat Oncol Biol Phys 2006 Jan 1;64(1):77 82 [PMID 16169681] Zeitels SM et al Voice and treatment outcome from phonosurgical management of early glottic cancer Ann Otol Rhinol Laryngol Suppl 2002 Dec;190:3 20 [PMID: 12498379]
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