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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Vocal cord cancer

Introduction

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Synonyms and keywords: Cancer of larynx, Malignant tumor of larynx, Laryngeal carcinoma, Squamous cell carcinoma of the larynx, SCC of the larynx, Voice box cancer

Overview

Overview

Overview

Laryngeal carcinoma was first discovered by Dr. Morgagni, a Byzantine physician. Theodore Bilroth reported a century ago, the first few examples of primary malignant tumors. The surgery for laryngeal cancer started in the 19th century and kept advancing through the 20th century. Laryngeal carcinoma may be classified into more than 14 subtypes based on the anatomical and histological characteristics of the tumor. Anatomical classification includes supraglottic, glottic and subglottic laryngeal cancer. There are no established causes for laryngeal cancer. However, chromium or nickel, asbestos, alcohol and smoking have been associated with laryngeal cancer. The prevalence of laryngeal cancer is approximately 19.5 per 100,000 individuals in the United States. The incidence of laryngeal cancer is approximately 3.3 per 100,000 individuals in the United States. According to the American Cancer Society, screening for laryngeal cancer is not recommended. If left untreated, laryngeal cancer produces few symptoms early in the course. Once the tumor has expanded from its site of origin, it may obstruct the airway. The hallmark of laryngeal cancer is hoarseness. A positive history of neck lump and hoarseness is suggestive of laryngeal cancer. Based on the location of the tumor, symptoms may differ but commonly includes hoarseness or other voice changes, lump in the neck, sore throat, and persistent cough. The medical therapy combined with radiation has largely replaced the surgical cure for laryngeal cancer. However, the treatment truly depends on the stage at the time of diagnosis. Multiple factors will be taken into account when considering treatment like laryngeal preservation, maintaining the airway, swallowing and speech. Induction includes three cycles of continuous infusion of cisplatin (100 mg/m2 on day 1) plus fluorouracil (1000 mg/m2/day ) followed by definitive radiation therapy in the induction phase and concurrent cinsists of Cisplatin (100 mg/m2 on days 1, 22, and 43) with radiation therapy. The feasibility of surgery depends on the stage of laryngeal cancer at the time of diagnosis. The goal of treatment is to completely remove the tumor, achieve tumor free margins and prevent the spread. The options of surgery can be transoral laser surgery, transoral robotic surgery, total laryngectomy, and total laryngectomy with partial pharyngectomy

Historical Perspective

Laryngeal carcinoma was first discovered by Dr. Morgagni, a Byzantine physician. Theodore Bilroth reported a century ago, the first few examples of primary malignant tumors. The surgery for laryngeal cancer started in the 19th century and kept advancing through the 20th century.

Classification

Laryngeal cancer arises from squamous cells, which are cells that are normally involved in protection of upper respiratory airway. Genes involved in the pathogenesis of laryngeal cancer include p16, NOTCH1, cyclin D1, and TP53. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are characteristic findings of laryngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are characteristic findings of laryngeal cancer

Pathophysiology

Laryngeal cancer arises from squamous cells, which are cells that are normally involved in protection of upper respiratory airways. Genes involved in the pathogenesis of laryngeal cancer include p16, NOTCH1, cyclin D1, and TP53. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are characteristic findings of laryngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are characteristic findings of laryngeal cancer.

Causes

There are no established causes for laryngeal cancer. However, chromium or nickel, asbestos, alcohol and smoking have been associated with laryngeal cancer

Differentiating Laryngeal cancer from other Diseases

Laryngeal carcinoma must be differentiated from laryngeal syphilis, lymphoma, and chronic laryngitis

Epidemiology and Demographics

The prevalence of laryngeal cancer is approximately 19.5 per 100,000 individuals in the United States. The incidence of laryngeal cancer is approximately 3.3 per 100,000 individuals in the United States.The estimated number of new cases in the United States in 2014 is 12,630 which corresponds to 0.8% of all new cancer cases. Laryngeal cancer is listed as a “rare disease” by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH), which means that laryngeal cancer affects less than 200,000 people in the US population. In the United Kingdom, 2,369 people were diagnosed with laryngeal cancer in 2011.

Risk Factors

Common risk factors in the development of laryngeal cancer are smoking tobacco, chewing tobacco, and heavy alcohol consumption

Screening

According to the American Cancer Society, screening for laryngeal cancer is not recommended

Natural History, Complications and Prognosis

If left untreated, laryngeal cancer produces few symptoms early in the course. Once the tumor has expanded from its site of origin, it may obstruct the airway. Common complications of laryngeal cancer include airway obstruction, neck disfigurement, and voice abnormalities. The prognosis varies with the type and stage of laryngeal cancer. Stage 4 squamous cell carcinoma of larynx has the most unfavorable prognosis. The 3-year survival rate for supraglottic laryngeal cancer and T3 transglottic carcinoma were 91.7% and 73.2%, respectively

Diagnosis

Staging

According to the TNM staging system, the stages of laryngeal cancer are based on the tumor size, lymph node involvement, and distant metastasis

History and Symptoms

The hallmark of laryngeal cancer is hoarseness. A positive history of neck lump and hoarseness is suggestive of laryngeal cancer. Based on the location of the tumor, symptoms may differ but commonly includes hoarseness or other voice changes, lump in the neck, sore throat, and persistent cough

Physical Examination

Patients with laryngeal carcinoma are usually well appearing. Physical examination of patients with laryngeal carcinoma is usually remarkable neck swelling, hearing loss, and stridor.

Laboratory findings

There are no diagnostic lab findings associated with laryngeal cancer.

Electrocardiogram

There are no ECG findings associated with laryngeal cancer.

Chest X-ray

Chest x-rays may be performed to detect metastasis of laryngeal cancer to the lungs.

Ultrasonography

Ultrasonography could be of value in the assessment of laryngeal carcinoma alongwith laryngoscopy with some calcifications of the thyroid cartilage. It helps to detect, localize and find out the invasion of laryngeal carcinoma.

CT scan

Head and neck CT scan may be helpful in the diagnosis of laryngeal cancer. Findings on CT scan suggestive of laryngeal cancer include solid soft tissue nodule, region of superficial thickening with increased enhancement, and obliteration of fat planes.

MRI

MRI may be helpful in the diagnosis of laryngeal cancer. Findings on MRI suggestive of laryngeal cancer include intermediate to low signal mass and soft tissue enhancement. MRI is better than CT for evaluation of neural metastasis, skull invasion, and intracranial invasion of head and neck cancer

Other Imaging Findings

Other imaging findings for laryngeal cancer inlcude Fluoro-D-glucose positron emission tomography PET which is taken up more by actively metabolic cells. In case of small glottic tumors further imagingmay be unnecessary. Laryngoscopy can be helpful to visualize the tumor.

Other Diagnostic Studies

Fine needle aspiration biopsy has high sensitivity and specificity for laryngeal cancer

Medical Therapy

The medical therapy combined with radiation has largely replaced the surgical cure for laryngeal cancer. However, the treatment truly depends on the stage at the time of diagnosis. Multiple factors will be taken into account when considering treatment like laryngeal preservation, maintaining the airway, swallowing and speech. Induction includes three cycles of continuous infusion of cisplatin (100 mg/m2 on day 1) plus fluorouracil (1000 mg/m2/day ) followed by definitive radiation therapy in the induction phase and concurrent cinsists of Cisplatin (100 mg/m2 on days 1, 22, and 43) with radiation therapy

Surgery

The feasibility of surgery depends on the stage of laryngeal cancer at the time of diagnosis. The goal of treatment is to completely remove the tumor, achieve tumor free margins and prevent the spread. The options of surgery can be transoral laser surgery, transoral robotic surgery, total laryngectomy, and total laryngectomy with partial pharyngectomy

Primary Prevention

Effective measures for the primary prevention of laryngeal cancer include smoking cessation and limiting or avoiding alcohol consumption

Secondary Prevention

Secondary prevention measures of laryngeal cancer include routine physical examination and imaging at scheduled intervals after treatment. Dental screening and screening for thyroid cancers are recommended among patients who had received radiation therapy to the oral cavity and cervical region, respectively

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Faizan Sheraz, M.D. [3]

Historical Perspective

Historical Perspective

Overview

Laryngeal carcinoma was first discovered by Dr. Morgagni, a Byzantine physician. Theodore Bilroth reported a century ago, the first few examples of primary malignant tumors. The surgery for laryngeal cancer started in the 19th century and kept advancing through the 20th century. Total laryngectomy was performed for the first time was by Billroth in Vienna on the 31st of December, 1873.

Historical Perspective

References

  1. ↑ Assimakopoulos D, Patrikakos G, Lascaratos J (2003). “Highlights in the evolution of diagnosis and treatment of laryngeal cancer”. Laryngoscope. 113 (3): 557–62. doi:10.1097/00005537-200303000-00030. PMID 12616214.
  2. ↑ Moertel CG (October 1977). “Multiple primary malignant neoplasms: historical perspectives”. Cancer. 40 (4 Suppl): 1786–92. PMID 332330.
  3. ↑ Cocek A (2008). “The history and current status of surgery in the treatment of laryngeal cancer”. Acta Medica (Hradec Kralove). 51 (3): 157–63. PMID 19271683.
  4. ↑ Ceachir O, Hainarosie R, Zainea V (June 2014). “Total laryngectomy – past, present, future”. Maedica (Buchar). 9 (2): 210–6. PMC 4296768. PMID 25705281.


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Faizan Sheraz, M.D. [3]

Classification

Classification

Overview

Laryngeal carcinoma may be classified into more than 14 subtypes based on the anatomical and histological characteristics of the tumor. Anatomical classification includes supraglottic, glottic and subglottic laryngeal cancer. Based on histology, laryngeal carcinoma may be classified into acantholytic squamous cell carcinoma, adenosquamous carcinoma, basaloid squamous cell carcinoma, papillary squamous cell carcinoma, spindle cell squamous cell carcinoma, verrucous carcinoma, giant cell carcinoma, lymphoepithelial carcinoma (non-nasopharyngeal), neuroendocrine carcinoma, typical carcinoid tumor (well differentiated neuroendocrine carcinoma) and atypical carcinoid tumor (moderately differentiated neuroendocrine carcinoma)

Classification

Anatomical Classification of Laryngeal Carcinoma

 
 
 
 
 
 
 
 
Laryngeal cancer
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Supraglottis
 
 
Glottis
 
 
Subglottis

Histologic Classification of Laryngeal Carcinoma

References

  1. ↑ 1.0 1.1 Thompson L (February 2006). “World Health Organization classification of tumours: pathology and genetics of head and neck tumours”. Ear Nose Throat J. 85 (2): 74. PMID 16579185.
  2. ↑ 2.0 2.1 Jaipuria B, Dosemane D, Kamath PM, Sreedharan SS, Shenoy VS (July 2018). “Staging of Laryngeal and Hypopharyngeal Cancer: Computed Tomography versus Histopathology”. Iran J Otorhinolaryngol. 30 (99): 189–194. PMC 6064760. PMID 30083524.
  3. ↑ 3.0 3.1 Lund C, Sogaard H, Jorgensen K, Hjelm-Hansen M (August 1976). “Epidermoid carcinoma of the larynx. VI. Histologic grading in the clinical evaluation”. Acta Radiol Ther Phys Biol. 15 (4): 293–304. PMID 983778.
  4. ↑ 4.0 4.1 4.2 Jakobsson PA, Eneroth CM, Killander D, Moberger G, Mårtensson B (February 1973). “Histologic classification and grading of malignancy in carcinoma of the larynx”. Acta Radiol Ther Phys Biol. 12 (1): 1–8. PMID 4725642.
  5. ↑ Ferlito A (1976). “Histological classification of larynx and hypopharynx cancers and their clinical implications. Pathologic aspects of 2052 malignant neoplasms diagnosed at the ORL Department of Padua University from 1966 to 1976”. Acta Otolaryngol Suppl. 342: 1–88. PMID 195442.


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Faizan Sheraz, M.D. [3]

Pathophysiology

Pathophysiology

Overview

Laryngeal cancer arises from squamous cells, which are cells that are normally involved in protection of upper respiratory airway. Genes involved in the pathogenesis of laryngeal cancer include p16, NOTCH1, cyclin D1, and TP53. On gross pathology, flattened plaques, mucosal ulceration, and raised margins of the lesion are characteristic findings of laryngeal cancer. On microscopic histopathological analysis, spindle cells, basaloid cells, and nuclear atypia are characteristic findings of laryngeal cancer.

Pathophysiology

Laryngeal cancer arises from squamous cells, which are cells that are normally involved in protection of upper respiratory airways.[1]

Genetics

Development of laryngeal cancer is the result of multiple genetic mutations. These mutations lead to activation of oncogenes and inactivation of tumor suppression genes which ultimately result in deregulated cellular proliferation. Genes involved in the pathogenesis of laryngeal cancer include:[2]

Gross Pathology

On gross pathology, laryngeal cancer is characterized by:[3][4]

Microscopic Pathology

On microscopic histopathological analysis, laryngeal carcinoma is characterized by:[5][6][7][8]

Squamous cell carcinoma is subdivided histopathologically:[5][6][9]

Squamous Cell Carcinoma Subtypes

There are several histological subtypes of squamous cell carcinoma of larynx which include:

Immunohistochemistry

There are several immunohistochemistry markers of laryngeal carcinoma which include:[10][11]

  • p63 positive
  • EBER negative
  • p16 negative
  • BCL2 positive/negative

References

  1. ↑ Koufman JA, Burke AJ (February 1997). “The etiology and pathogenesis of laryngeal carcinoma”. Otolaryngol. Clin. North Am. 30 (1): 1–19. PMID 8995133.
  2. ↑ de Miguel-Luken MJ, Chaves-Conde M, Carnero A (May 2016). “A genetic view of laryngeal cancer heterogeneity”. Cell Cycle. 15 (9): 1202–12. doi:10.1080/15384101.2016.1156275. PMC 4894505. PMID 26940775.
  3. ↑ Sessions DG (June 1976). “Surgical pathology of cancer of the larynx and hypopharynx”. Laryngoscope. 86 (6): 814–39. doi:10.1288/00005537-197606000-00009. PMID 933673.
  4. ↑ “journals.sagepub.com”.
  5. ↑ 5.0 5.1 Hilly O, Raz R, Vaisbuch Y, Strenov Y, Segal K, Koren R, Shvero J (November 2012). “Thyroid gland involvement in advanced laryngeal cancer: association with clinical and pathologic characteristics”. Head Neck. 34 (11): 1586–90. doi:10.1002/hed.21972. PMID 22180291.
  6. ↑ 6.0 6.1 Caldas-Magalhaes J, Kasperts N, Kooij N, van den Berg CA, Terhaard CH, Raaijmakers CP, Philippens ME (February 2012). “Validation of imaging with pathology in laryngeal cancer: accuracy of the registration methodology”. Int. J. Radiat. Oncol. Biol. Phys. 82 (2): e289–98. doi:10.1016/j.ijrobp.2011.05.004. PMID 21719209.
  7. ↑ MUSTAKALLIO S (August 1946). “Relation of microscopic structure of laryngeal cancer to radiocurability”. Acta radiol. 27 (5): 473–80. PMID 20286025.
  8. ↑ Franz B, Wetzel M (July 1980). “[Cytology of the early invasive laryngeal cancer (author’s transl)]”. Laryngol Rhinol Otol (Stuttg) (in German). 59 (7): 401–5. PMID 7453440.
  9. ↑ Lewis JS (March 2011). “Not your usual cancer case: variants of laryngeal squamous cell carcinoma”. Head Neck Pathol. 5 (1): 23–30. doi:10.1007/s12105-010-0232-0. PMC 3037456. PMID 21165725.
  10. ↑ Rodrigo JP, Martínez P, Allonca E, Alonso-Durán L, Suárez C, Astudillo A, García-Pedrero JM (March 2014). “Immunohistochemical markers of distant metastasis in laryngeal and hypopharyngeal squamous cell carcinomas”. Clin. Exp. Metastasis. 31 (3): 317–25. doi:10.1007/s10585-013-9630-5. PMID 24370715.
  11. ↑ Wittekindt C, Sittel C, Kvasnicka HM, Eckel HE (August 2006). “Immunohistochemistry of whole-organ sections of advanced human laryngeal cancer”. Eur Arch Otorhinolaryngol. 263 (8): 741–6. doi:10.1007/s00405-006-0055-5. PMID 16683119.


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Faizan Sheraz, M.D. [3]

Causes

Causes

Overview

There are no established causes for laryngeal cancer. However, chromium or nickel, asbestos, alcohol and smoking have been associated with laryngeal cancer

Causes

There are no established causes for laryngeal cancer. However, the following have been seen to be associated with laryngeal cancer:

References

  1. ↑ Olsen J, Sabroe S (June 1984). “Occupational causes of laryngeal cancer”. J Epidemiol Community Health. 38 (2): 117–21. PMID 6747509.
  2. ↑ Battista G, Belli S, Comba P, Fiumalbi C, Grignoli M, Loi F, Orsi D, Paredes I (November 1999). “Mortality due to asbestos-related causes among railway carriage construction and repair workers”. Occup Med (Lond). 49 (8): 536–9. PMID 10658307.
  3. ↑ Roh S, Park S, Tae G, Song J (2016). “A case of laryngeal cancer induced by exposure to asbestos in a construction site supervisor”. Ann Occup Environ Med. 28: 34. doi:10.1186/s40557-016-0114-3. PMC 4976513. PMID 27504188.
  4. ↑ 4.0 4.1 Ahrens W, Jöckel KH, Patzak W, Elsner G (1991). “Alcohol, smoking, and occupational factors in cancer of the larynx: a case-control study”. Am. J. Ind. Med. 20 (4): 477–93. PMID 1785612.


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Faizan Sheraz, M.D. [3]

Differentiating Laryngeal cancer from other Diseases

Differentiating Laryngeal cancer from other Diseases

Overview

Laryngeal carcinoma must be differentiated from laryngeal syphilis, lymphoma, and chronic laryngitis.[1]

Differentiating Laryngeal Cancer from other Diseases

Laryngeal cancer should be differentiated from other diseases presenting as a neck mass. The following are the differentials:

Category Diseases Benign/

Malignant

Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Others
Congenital Branchial cleft cyst[2]
  • Age: 1-15 years old
  • Familial occurrence
  • Lateral neck mass
 − ±
  • Solitary
  • Smooth
  • Mobile
  • Well-defined
  • Non-pulsatile
  • Fluctuant
  • A pit at the opening of the cyst
 − −
Thyroglossal duct cyst[3][4]
  • Age: 1-10 years old
  • Midline neck mass
 − − − − − −
Hemangioma[5]
  • Presents with a flat red or purple patch
  • Regress gradually with age
 − −
  • Firm
  • Rubbery
  • Well-demarcated
Vascular malformation[6][7]
  • Incidence: 1 in 2000 to 5000 births
  • Gender: No predilection
 ± −
  • Grow proportionally with age
  • MRI
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Congenital Lymphatic malformation[8][9]
  • Age: Birth-5 years old
  • Gender: No predilection
 − + − −
Laryngocele[10][11][12] − +
  • Soft
  • Reducible
  • Increase in size on valsalva
  • Common in glass blowers and trumpet players
 − −
Ranula[13][14] − −
  • Well circumscribed
  • Fluctuant
  • Soft
 − − − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Congenital Teratoma[15][16]
  • Incidence: 1:4000 births
  • Gender: No predilection
  • Presents as a firm lateral neck mass
 − −
  • Firm
  • Non-tender
 −
  • High ALP levels
 − −
Dermoid cyst[17][18] − −
  • Freely mobile
  • Solitary
  • Rubbery
  • Nonpulsatile
  • Noncompressible
 −
  • Ultrasound: Thin walled, unilocular
  • CT with contrast: Well circumscribed, unilocular, sac-of-marbles appearance due to fatty tissue
 − −
Thymic cyst[19]
  • Presents as a soft mass, gradually enlarging, on left side of the neck (usual)
 − −
  • Soft
  • Compressible
 − − − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Acute sialadenitis[20]
  • Age: Occurs in all age groups
  • Gender: No predilection
 + – −
Chronic sialadenitis[21]
  • Age: Occurs in all age groups
  • Gender: No predilection
  • Presents with an unilateral swelling
  • Recurrent episodes common
 + −
  • Non-tender
  • Firm
  • Smooth
 −
Reactive viral lymphadenopathy CMV[22]
  • Age: 10-35 years old
  • Gender: No predilection
  • Flu-like illness
 − −
  • Non-tender
  • Soft
  • Usually not necessary
 −
EBV[23][24]
  • Age: Mainly adolescents
  • Gender: No predilection
 − −
  • Non-tender
  • Firm
  • Usually not necessary
 −
HIV[25] − −
  • Non-tender mass
  • Usually not necessary
 −
Viral URI[26]
  • Incidence: More in fall & winter
  • Age: Common in elderly and infants
 − −
  • Non-tender
  • No specific findings
 − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Bacterial lymphadenopathy Tularemia[27][28]
  • Age: Affects all age groups
  • Gender: No predilection
 + −
  • No specific findings
 −
Brucellosis[29]
  • Flu-like illness
 + −
  • No specific findings
 −
Cat-scratch disease[30][31]
  • More common in the Southern of U.S among children and young adults
 + − − −
Actinomycosis[32][33]
  • No predilection in race, age
  • [[Male] to female ratio : 1.5 to 3:1
 − −
  • Tender at the beginning
  • Painless
  • Fluctuant
  • Non-tender at late stage
 −
Mycobacterial infections[23][34][35] − − −
Streptococcal infection[22][36] + + −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Parasitic lymphadenopathy Toxoplasma gondii[37][38]
  • 6 years old and older adults are more affected in U.S.
  • Seen in hot climates
 + −
  • Bilateral
  • Non-tender
  • Symmetrical
  • Non-fluctuant
 −
Sarcoidosis_National_Heart,_Lung,_and_Blood_Institute_(NHLBI)-39|[39][20]
  • More common in African American women aged 20-40 years
 − −
Sjögren syndrome[40]
  • Female to male ratio: 9 to 1
  • May happen at any age
  • Mean age: 40-50
 − + −
Castleman disease (angiofollicular lymphoproliferative disease)[41][42]
  • Mean age: 30-40 years
 − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Inflammatory Kikuchi disease (histiocytic necrotizing lymphadenitis)[43]
  • High prevalence in Japan
  • More common in young adults < 30 years old
 + − −
Kimura disease[44]
  • More common in Asian males
 − − −
Rosai-Dorfman disease_Genetic_and_Rare_Diseases_Information_Center_(GARD)_–_an_NCATS_Program-45|[45][46] − − − − − −
Kawasaki disease_Kawasaki_Disease_|_CDC-47|[47]_National_Heart,_Lung,_and_Blood_Institute_(NHLBI)-48|[48]
  • More common in children < 5 years old
  • Highest incidence in Japan
  • Most leading cause of acquired heart disease in U.S
 − − − −
Category Diseases Benign or Malignant Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Pleomorphic adenoma[49][50] − + − −
  • MRI: Homogenous on T1
  • Abundant myxochondroid stroma on T2
 −
Warthin’s tumor[51]_Genetic_and_Rare_Diseases_Information_Center_(GARD)_–_an_NCATS_Program-52|[52]
  • Male to female ratio: 4:1
  • More common in people aged 60-70 years old
 − + − − −
Oncocytoma

[53]

  • Race: Caucasian patients predilection
  • Gender: No gender preference
  • Age: 50–70 years
 ± ±
  • CT:
    • Isodense expansive mass
    • Enhancement after intravenous contrast
    • Hypodense areas
  • MRI:
    • Isodensties on T1
    • Mass is hyperintense on T2
    • Enhancement on contrast
 –
Monomorphic adenoma [54][55][56]
  • Age: 26-76 years
  • Rare in children
  • Gender: No predilection
 ± ±
  • Normal
 –
Mucoepidermoid carcinoma

[57]

  • Age: Mean age of 59
  • Female predilection
 ± ± −
  • Cystic and solid component with variable appearance on CT and MRI
  • Association with CMV
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Salivary gland neoplasm Adenoid cystic carcinoma [58]
  • Age: 40s-60s
  • Gender: Female predominance
 ± ± − −
Adenocarcinoma

[59]

  • Age: young age predilection
 − − −
Salivary duct cancer[60][61][62]

(Highly aggressive)

  • Incidence: 1-3%
  • Gender: Male predilection
  • Mean age: 55-61 years old
  • Rapidly growing mass with jaw involvement
 ± ±
  • Painless
  • Hard
  • Non-compressible mass
 −
Squamous cell carcinoma[63][64]
  • Incidence: rare
  • Age: Old age , 61-68 years
  • Male predilection
  • Present as painful growing mass on jaw
 + −
  • Tumor dimension can be delineated using both CT and MRI
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Hypopharyngeal cancer[65][66][67]
  • More common in males
  • Age: 55-65 years old
  • Incidence: < 1/100,000 in U.S.
  • More common in Japan, India, Iran
 − + − −
Parathyroid cancer[68][69][70]
  • Incidence: Rare
  • Mean age : 44-54 years old
  • Gender: Female predilection
 + +
Carotid body tumors[71][72][73][74]
  • Age: 26-55 years
  • Male predominance
 + − −
Paraganglioma[75][76][77]
  • Age 50-70 years
  • More in females
 − − − −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Schwannoma[78][79][80]
  • Rare tumor
  • Incidence: 1-10%
 + ±
  • Multiple
  • Slow growing nodules on the skin
  • May be normal
  • Encapsulated neural tissue growth
Lymphoma [81][82][83][84][85][86]
  • Age: Predilection for older age
  • Mean age: 55
 − ±
  • On complete node analysis four patterns are described:
    • Nodular/follicular
    • Diffuse pattern
    • Transition from a nodular to a diffuse pattern in adjacent nodes
    • Transition from a lower to a higher grade of involvement within a single node
Liposarcoma [87][88][89][90]
  • Rare tumor
  • Age: Relatively in older age
  • Gender: No gender predilection
  • Mobile mass
  • Few symptoms until they grow enough to compress the surrounding structures
  • Symptoms of neural deficit, pain, tingling, or skin changes
 ± −
  • Intact skin and normal color
  • Normal
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Neoplasm Lipoma [91][92][93]
  • One or multiple soft, painless skin nodules
  • May causes pain or compressive symptoms
 ± −
  • Normal
  • Normal
  • Diagnoses is usually clinical
  • Tissue biopsy may show:
    • Bundle of well-demarcated lipocytes
    • Single nuclei aligned to the side
    • Intra-cytoplasimic fat granules
Glomus vagale, glomus jugulare tumors[94][95][96][97][98][99]
  • Rare tumor
  • Painless slowly enlarging mass in the neck
 − ±
  • Normal
 −
Metastatic head and neck cancer[100][101] − ±
  • Vary depending on the underlying cancer
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings
Other Laryngeal cancer[102][103] Benign/Malignant
  • Older males
  • Younger patients with HPV infection or smoking history
 ± ±

human papillomavirus (HPV) infection

−
Arteriovenous fistula

[104][105]

  • Depends on the risk factors
 − −
  • Varies depending on the etiology
 −
Thyroid nodule/ Goiter

[106][107][108][109]

  • Female predominance
  • Young age (benign causes)
  • Old age (malignant etiology)
 ± ±
  • Painless
  • Non-tender
  • Asymmetrical neck mass in front of neck
  • With smooth overlying skin
  • Nodular surface
  • Depending on the type:
  • Normal to low TSH levels in case of malignancy
  • High TSH levels in case of goiter
 −
Category Diseases Benign Demography History Pain Dysphagia Mass exam Others Lab findings Histopathology Imaging Gold standard diagnosis Associated findings

References

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  96. ↑ Urquhart AC, Johnson JT, Myers EN, Schechter GL (April 1994). “Glomus vagale: paraganglioma of the vagus nerve”. Laryngoscope. 104 (4): 440–5. doi:10.1288/00005537-199404000-00008. PMID 8164483.
  97. ↑ Stein PP, Black HR (January 1991). “A simplified diagnostic approach to pheochromocytoma. A review of the literature and report of one institution’s experience”. Medicine (Baltimore). 70 (1): 46–66. PMID 1988766.
  98. ↑ Sajid MS, Hamilton G, Baker DM (August 2007). “A multicenter review of carotid body tumour management”. Eur J Vasc Endovasc Surg. 34 (2): 127–30. doi:10.1016/j.ejvs.2007.01.015. PMID 17400487.
  99. ↑ Boedeker CC, Ridder GJ, Schipper J (2005). “Paragangliomas of the head and neck: diagnosis and treatment”. Fam. Cancer. 4 (1): 55–9. doi:10.1007/s10689-004-2154-z. PMID 15883711.
  100. ↑ Gluckman JL, Robbins KT, Fried MP (1990). “Cervical metastatic squamous carcinoma of unknown or occult primary source”. Head Neck. 12 (5): 440–3. PMID 2211107.
  101. ↑ Waltonen JD, Ozer E, Hall NC, Schuller DE, Agrawal A (October 2009). “Metastatic carcinoma of the neck of unknown primary origin: evolution and efficacy of the modern workup”. Arch. Otolaryngol. Head Neck Surg. 135 (10): 1024–9. doi:10.1001/archoto.2009.145. PMID 19841343.
  102. ↑ Feldman PS, Kaplan MJ, Johns ME, Cantrell RW (November 1983). “Fine-needle aspiration in squamous cell carcinoma of the head and neck”. Arch Otolaryngol. 109 (11): 735–42. PMID 6639441.
  103. ↑ Grénman R, Koivunen P, Minn H (2015). “[Laryngeal cancer in Finland]”. Duodecim (in Finnish). 131 (4): 331–7. PMID 26237923.
  104. ↑ Guneyli S, Cinar C, Bozkaya H, Korkmaz M, Oran I (September 2016). “Endovascular management of congenital arteriovenous fistulae in the neck”. Diagn Interv Imaging. 97 (9): 871–5. doi:10.1016/j.diii.2015.08.006. PMID 26972281.
  105. ↑ Gobin YP, Garcia de la Fuente JA, Herbreteau D, Houdart E, Merland JJ (November 1993). “Endovascular treatment of external carotid-jugular fistulae in the parotid region”. Neurosurgery. 33 (5): 812–6. PMID 8264877.
  106. ↑ Madjar S, Weissberg D (July 1995). “Retrosternal goiter”. Chest. 108 (1): 78–82. PMID 7606997.
  107. ↑ Hedayati N, McHenry CR (March 2002). “The clinical presentation and operative management of nodular and diffuse substernal thyroid disease”. Am Surg. 68 (3): 245–51, discussion 251–2. PMID 11893102.
  108. ↑ Hughes K, Eastman C (August 2012). “Goitre – causes, investigation and management”. Aust Fam Physician. 41 (8): 572–6. PMID 23145396.
  109. ↑ Hermus AR, Huysmans DA (August 2000). “[Diagnosis and therapy of patients with euthyroid goiter]”. Ned Tijdschr Geneeskd (in Dutch; Flemish). 144 (34): 1623–7. PMID 10972051.

References


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Epidemiology and Demographics

Epidemiology and Demographics

Overview

The prevalence of laryngeal cancer is approximately 19.5 per 100,000 individuals in the United States. The incidence of laryngeal cancer is approximately 3.3 per 100,000 individuals in the United States. The estimated number of new cases in the United States in 2014 is 12,630 which corresponds to 0.8% of all new cancer cases. Laryngeal cancer is listed as a “rare disease” by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH), which means that laryngeal cancer affects less than 200,000 people in the US population. In the United Kingdom, 2,369 people were diagnosed with laryngeal cancer in 2011.

Epidemiology and Demographics

Prevalence

Incidence

Age

Genetics

Loss of chromosomes 3p, 5q, 8p, 9p, 18q and 21q have been reported in laryngeal cancer[6]

Gender

  • In the United States, the age-adjusted prevalence of laryngeal cancer by gender in 2011 was:[1]
    • In males: 35.8 per 100,000
    • In females: 6.6 per 100,000
  • In the United States, the delay-adjusted incidence of laryngeal cancer by gender in 2011 was:[1]
    • In males: 5.28 per 100,000 persons
    • In females: 1.1 per 100,000 persons
  • In the United States, the age-adjusted incidence of laryngeal cancer by gender on 2011 was:[1]
    • In males: 5.18 per 100,000 persons
    • In females: 1.08 per 100,000 persons
  • Shown below is an image depicting the delay-adjusted incidence and observed incidence of laryngeal cancer by gender and race in the United States between 1975 and 2011. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[1]

Race

All Races White Black Asian/Pacific Islander Hispanic
Age-adjusted prevalence 19.5 per 100,000 20.5 per 100,000 26.3 per 100,000 8.8 per 100,000 15 per 100,000

API: Asian/Pacific Islander; AI/AN: American Indian/ Alaska Native

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
  2. ↑ 2.0 2.1 Lambert R, Sauvaget C, de Camargo Cancela M, Sankaranarayanan R (August 2011). “Epidemiology of cancer from the oral cavity and oropharynx”. Eur J Gastroenterol Hepatol. 23 (8): 633–41. doi:10.1097/MEG.0b013e3283484795. PMID 21654320.
  3. ↑ 3.0 3.1 Siegel RL, Miller KD, Jemal A (January 2017). “Cancer Statistics, 2017”. CA Cancer J Clin. 67 (1): 7–30. doi:10.3322/caac.21387. PMID 28055103.
  4. ↑ 4.0 4.1 Bray F, Ren JS, Masuyer E, Ferlay J (March 2013). “Global estimates of cancer prevalence for 27 sites in the adult population in 2008”. Int. J. Cancer. 132 (5): 1133–45. doi:10.1002/ijc.27711. PMID 22752881.
  5. ↑ Cancer research UK
  6. ↑ de Miguel-Luken MJ, Chaves-Conde M, Carnero A (May 2016). “A genetic view of laryngeal cancer heterogeneity”. Cell Cycle. 15 (9): 1202–12. doi:10.1080/15384101.2016.1156275. PMID 26940775.
  7. ↑ Settle K, Posner MR, Schumaker LM, Tan M, Suntharalingam M, Goloubeva O, Strome SE, Haddad RI, Patel SS, Cambell EV, Sarlis N, Lorch J, Cullen KJ (September 2009). “Racial survival disparity in head and neck cancer results from low prevalence of human papillomavirus infection in black oropharyngeal cancer patients”. Cancer Prev Res (Phila). 2 (9): 776–81. doi:10.1158/1940-6207.CAPR-09-0149. PMC 4459126. PMID 19641042.
  8. ↑ DeSantis C, Naishadham D, Jemal A (May 2013). “Cancer statistics for African Americans, 2013”. CA Cancer J Clin. 63 (3): 151–66. doi:10.3322/caac.21173. PMID 23386565.


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Rim Halaby, M.D. [3], Faizan Sheraz, M.D. [4]

Risk Factors

Risk Factors

Overview

Common risk factors in the development of laryngeal cancer are smoking tobacco, chewing tobacco, and heavy alcohol consumption.

Risk Factors

Common risk factors for the development of laryngeal cancer include:

References

  1. ↑ 1.0 1.1 Andre K, Schraub S, Mercier M, Bontemps P (September 1995). “Role of alcohol and tobacco in the aetiology of head and neck cancer: a case-control study in the Doubs region of France”. Eur. J. Cancer, B, Oral Oncol. 31B (5): 301–9. PMID 8704646.
  2. ↑ De Stefani E, Boffetta P, Oreggia F, Fierro L, Mendilaharsu M (March 1998). “Hard liquor drinking is associated with higher risk of cancer of the oral cavity and pharynx than wine drinking. A case-control study in Uruguay”. Oral Oncol. 34 (2): 99–104. PMID 9682771.
  3. ↑ Lewin F, Norell SE, Johansson H, Gustavsson P, Wennerberg J, Biörklund A, Rutqvist LE (April 1998). “Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck: a population-based case-referent study in Sweden”. Cancer. 82 (7): 1367–75. PMID 9529030.
  4. ↑ Kobayashi I, Shima K, Saito I, Kiyoshima T, Matsuo K, Ozeki S, Ohishi M, Sakai H (September 1999). “Prevalence of Epstein-Barr virus in oral squamous cell carcinoma”. J. Pathol. 189 (1): 34–9. doi:10.1002/(SICI)1096-9896(199909)189:1<34::AID-PATH391>3.0.CO;2-4. PMID 10451485.
  5. ↑ Mahale P, Sturgis EM, Tweardy DJ, Ariza-Heredia EJ, Torres HA (August 2016). “Association Between Hepatitis C Virus and Head and Neck Cancers”. J. Natl. Cancer Inst. 108 (8). doi:10.1093/jnci/djw035. PMC 5017939. PMID 27075854.
  6. ↑ Das CM, Schantz SP, Shillitoe EJ (May 1993). “Antibody to a mutagenic peptide of herpes simplex virus in young adult patients with cancer of the head and neck”. Oral Surg. Oral Med. Oral Pathol. 75 (5): 610–4. PMID 8387664.
  7. ↑ Rabinovics N, Mizrachi A, Hadar T, Ad-El D, Feinmesser R, Guttman D, Shpitzer T, Bachar G (February 2014). “Cancer of the head and neck region in solid organ transplant recipients”. Head Neck. 36 (2): 181–6. doi:10.1002/hed.23283. PMID 23554129.
  8. ↑ Guha N, Warnakulasuriya S, Vlaanderen J, Straif K (September 2014). “Betel quid chewing and the risk of oral and oropharyngeal cancers: a meta-analysis with implications for cancer control”. Int. J. Cancer. 135 (6): 1433–43. doi:10.1002/ijc.28643. PMID 24302487.
  9. ↑ Olsen J, Sabroe S (June 1984). “Occupational causes of laryngeal cancer”. J Epidemiol Community Health. 38 (2): 117–21. PMID 6747509.
  10. ↑ Battista G, Belli S, Comba P, Fiumalbi C, Grignoli M, Loi F, Orsi D, Paredes I (November 1999). “Mortality due to asbestos-related causes among railway carriage construction and repair workers”. Occup Med (Lond). 49 (8): 536–9. PMID 10658307.
  11. ↑ Roh S, Park S, Tae G, Song J (2016). “A case of laryngeal cancer induced by exposure to asbestos in a construction site supervisor”. Ann Occup Environ Med. 28: 34. doi:10.1186/s40557-016-0114-3. PMC 4976513. PMID 27504188.
  12. ↑ Vaughan TL, Stewart PA, Davis S, Thomas DB (September 1997). “Work in dry cleaning and the incidence of cancer of the oral cavity, larynx, and oesophagus”. Occup Environ Med. 54 (9): 692–5. PMC 1128846. PMID 9423585.
  13. ↑ Boffetta P, Hayes RB, Sartori S, Lee YC, Muscat J, Olshan A, Winn DM, Castellsagué X, Zhang ZF, Morgenstern H, Chen C, Schwartz SM, Vaughan TL, Wunsch-Filho V, Purdue M, Koifman S, Curado MP, Vilensky M, Gillison M, Fernandez L, Menezes A, Daudt AW, Schantz S, Yu G, D’Souza G, Haddad RI, La Vecchia C, Hashibe M (July 2016). “Mouthwash use and cancer of the head and neck: a pooled analysis from the International Head and Neck Cancer Epidemiology Consortium”. Eur. J. Cancer Prev. 25 (4): 344–8. doi:10.1097/CEJ.0000000000000179. PMC 4752930. PMID 26275006.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Faizan Sheraz, M.D. [3]

Screening

Screening

Overview

According to the American Cancer Society, screening for laryngeal cancer is not recommended.

Screening

According to the American Cancer Society, screening for laryngeal cancer is not recommended.

References


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Natural History, Complications and Prognosis

Natural History, Complications and Prognosis

Overview

If left untreated, laryngeal cancer produces few symptoms early in the course. Once the tumor has expanded from its site of origin, it may obstruct the airway. Common complications of laryngeal cancer include airway obstruction, neck disfigurement, and voice abnormalities. The prognosis varies with the type and stage of laryngeal cancer. Stage 4 squamous cell carcinoma of larynx has the most unfavorable prognosis. The 3-year survival rate for supraglottic laryngeal cancer and T3 transglottic carcinoma are 91.7% and 73.2%, respectively.

Natural history

The natural history of laryngeal carcinoma depends on the site:[1]

Supraglottic tumors [2][3]

Glottic tumors [4][5]

Subglottic tumors [5][6]

Complications

Common complications of laryngeal cancer include:[7][8]

Prognosis

References

  1. ↑ Ferlito A (March 1995). “The natural history of early vocal cord cancer”. Acta Otolaryngol. 115 (2): 345–7. PMID 7610838.
  2. ↑ Ding W, Liu T, Liang J, Hu T, Cui S, Zou G, Cai W, Yang A (2017). “Supraglottic squamous cell carcinomas have distinctive clinical features and prognosis based on subregion”. PLoS ONE. 12 (11): e0188322. doi:10.1371/journal.pone.0188322. PMC 5695779. PMID 29155864.
  3. ↑ Bocca E (August 1975). “Supraglottic cancer”. Laryngoscope. 85 (8): 1318–26. doi:10.1288/00005537-197508000-00007. PMID 1160463.
  4. ↑ Zainuddin N, Mohd Kornain NK (2016). “Glottic cancer in a non-smoking patient with laryngopharyngeal reflux”. Malays Fam Physician. 11 (2–3): 35–37. PMC 5408877. PMID 28461858.
  5. ↑ 5.0 5.1 Hinerman RW, Mendenhall WM, Amdur RJ, Villaret DB, Robbins KT (February 2002). “Early laryngeal cancer”. Curr Treat Options Oncol. 3 (1): 3–9. PMID 12057082.
  6. ↑ Sessions DG, Ogura JH, Fried MP (September 1975). “Carcinoma of the subglottic area”. Laryngoscope. 85 (9): 1417–23. doi:10.1288/00005537-197509000-00001. PMID 1177633.
  7. ↑ Jones TM, De M, Foran B, Harrington K, Mortimore S (May 2016). “Laryngeal cancer: United Kingdom National Multidisciplinary guidelines”. J Laryngol Otol. 130 (S2): S75–S82. doi:10.1017/S0022215116000487. PMC 4873912. PMID 27841116.
  8. ↑ Issa MR, Samuels SE, Bellile E, Shalabi FL, Eisbruch A, Wolf G (November 2015). “Tumor Volumes and Prognosis in Laryngeal Cancer”. Cancers (Basel). 7 (4): 2236–61. doi:10.3390/cancers7040888. PMC 4695888. PMID 26569309.
  9. ↑ Woo JS, Baek SK, Kwon SY, Jung KY, Lee J (October 2003). “T3 supraglottic cancer: treatment results and prognostic factors”. Acta Otolaryngol. 123 (8): 980–6. PMID 14606603.
  10. ↑ Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML (July 2010). “Human papillomavirus and survival of patients with oropharyngeal cancer”. N. Engl. J. Med. 363 (1): 24–35. doi:10.1056/NEJMoa0912217. PMC 2943767. PMID 20530316.


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Diagnosis

Diagnosis

Staging | History and Symptoms | Physical Examination |Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case Studies

Case #1

Template:Tumors


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Omer Kamal, M.D.[2], Faizan Sheraz, M.D. [3]