Laryngeal and hypopharyngeal cancers Flashcards
What is the incidence of laryngeal cancer (LCX) in the United States?
∼12,000 cases/yr of LCX (∼20% of all H&N)
What are the risk factors for developing LCX?
Smoking, alcohol use, and voice abuse
What are the subsites of the larynx?
Supraglottic, glottic, and subglottic
What is the incidence/distribution of LCX according to subsite?
Glottic: 69%
Supraglottic: 30%
Subglottic: 1%
What % of premalignant lesions leukoplakia/erythroplakia) progress to invasive laryngeal lesions?
20% of premalignant laryngeal lesions ultimately progress to invasive cancer (higher for erythroplakia than leukoplakia).
What is the most common LCX histology?
Squamous cell carcinoma (SCC) makes up >95% of LCX. Other histologies include verrucous carcinoma (1%–2%), adenocarcinoma, lymphoma, chondrosarcoma, melanoma, carcinoid tumor, and adenoid cystic carcinoma.
What are the subdivisions of the supraglottic larynx?
Supraglottic larynx: Epiglottis (suprahyoid and infrahyoid), AE folds, arytenoids, ventricles, and false vocal cords (FVCs)
What are the subdivisions of the glottic larynx?
Glottis: Ant/Post commissures, true vocal cords (TVCs)
What are the anatomic borders of the subglottic larynx?
Subglottis: 0.5 cm below the TVCs to the 1st tracheal ring
What are the nodal drainage pathways of the various laryngeal subsites?
Supraglottic: levels II–IV
Glottic: virtually no drainage
Subglottic: pretracheal and Delphian (level VI)
What is the incidence of hypopharyngeal cancer (HPxC) in the United States?
There are ∼2,500 cases/yr.
What is the median age at Dx for HPxC?
The median age at Dx is 60–65 yrs for HPxC.
What are the subsites of the hypopharynx (HPX)?
Pyriform sinus
Postcricoid area
Posterior pharyngeal wall
What are the anatomic boundaries of the HPX?
Show Answer
The HPX spans from C4–6 or from the hyoid bone to the inf edge of the cricoid cartilage.
What is the sex predilection for HPxC based on the different subsites?
The sex predilection is predominantly male for pyriform sinus and post pharynx primaries, but predominantly female for postcricoid area tumors.
What are the classic risk factors for the development of HPxC?
Smoking, alcohol, betel nut consumption, nutritional deficiency (vitamin C, Fe [Fe deficiency is associated with 70% of postcricoid cancers in northern European women]), and prior Hx of H&N cancer
Is nodal involvement common with HPxC?
Yes. Nodal involvement is common due to abundant submucosal lymphatic plexus drainage to the retropharyngeal nodes, cervical LNs, paratracheal LNs,
paraesophageal nodes, and SCV nodes.
What are the most commonly involved nodal stations in HPxC?
Levels II, III, and the retropharyngeal nodes are most commonly involved in HPxC. Level VI can also be involved and therefore should be covered when planning these cases for RT.
What is the name for the most sup of the lat retropharyngeal nodes?
The most sup of the lat retropharyngeal nodes is the Node of Rouviere.
What % of HPxC pts have nodal involvement at Dx?
∼75% overall have nodal involvement at Dx (∼60% for T1).
What is the typical histology seen in HPxC?
The predominant histology is SCC (>95%) → adenoid cystic, lymphoma, and sarcoma.
What are the most common subsites of origin for HPxC?
The pyriform sinus (70%–80%), post pharyngeal wall (15%–20%), and postcricoid (5%) are the most common subsites of origin.
At what cervical spine levels are the hyoid bone and the TVCs located?
The hyoid bone is at C3, whereas the TVCs are located near C5–6.
How do pts with LCX typically present?
Hoarseness, odynophagia/sore throat, otalgia (via the Arnold nerve/CN X), aspiration/choking, and neck mass
What is the typical workup for pts presenting with a possible laryngeal mass?
Possible laryngeal mass workup: H&P (voice change, habits, indirect/direct laryngoscopy), CXR, CT/MRI, PET, basic labs, EUA + triple endoscopy, and Bx of the primary +/– FNA of the neck mass
What does the loss of the laryngeal click on palpation of the thyroid cartilage indicate?
Loss of the laryngeal click on exam indicates postcricoid extension (or postcricoid tumor).
What does pain in the thyroid cartilage indicate on exam?
Pain on palpation of the thyroid cartilage indicates tumor invasion into the thyroid cartilage.
What imaging modality is best to assess for bony or cartilage erosion in pts with LCX?
CT scan is best for assessing bony/cartilage erosion (bone window).
What is the incidence of nodal involvement for T1, T2, and T3–T4 glottic cancer?
T1: 0%–2%
T2: 2%–7%
T3–T4: 15%–30%
What is the incidence of nodal involvement for supraglottic lesions according to T stage?
T1–T2: 27%–40%
T3–T4: 55%–65%
What proportion of pts with supraglottic cancer present with unilat vs. bilat nodal Dz?
∼55% of supraglottic cancer pts present with unilat nodal Dz, and 16% present with bilat nodal involvement. (Lindberg R et al., Cancer 1972)
What % of pts with subglottic cancer present with nodal involvement?
20%–50% of subglottic pts present with nodal Dz (generally the prelaryngeal/Delphian, lower jugular, pretracheal or upper mediastinal nodes).
Describe the T staging for cancers of the supraglottic larynx (AJCC 8th edition, 2017).
T1: 1 subsite with normal VC mobility
T2: more than 1 adjacent subsite of supraglottis or glottis or region outside supraglottis (base of tongue, vallecula, medial wall of pyriform sinus) without fixation of larynx
T3: Larynx-confined with cord fixation and/or invasion of postcricoid area, pre-epiglottic space, paraglottic space and/or inner cortex thyroid cartilage
T4a (resectable): through outer cortex thyroid cartilage and/or beyond larynx (trachea, ST of neck, extrinsic muscles of tongue, strap muscles, thyroid, esophagus)
T4b: invasion of prevertebral space, encased carotid, mediastinum
Describe the T staging for cancers of the glottic larynx
T1: limited to TVCs (+/– commissure involvement), normal mobility (T1a: 1 cord, T1b: both)
T2: extends to supra- or subglottis or impaired vocal cord mobility
T3: fixed vocal cords, confined to larynx and/or paraglottic space invasion and/or inner cortex thyroid
T4a (resectable): through outer cortex thyroid cartilage and/or beyond larynx (trachea, ST of neck, extrinsic muscles of tongue, strap muscles, thyroid, esophagus)
T4b: invasion of prevertebral space, encased carotid, mediastinumcartilage
What is the T-staging breakdown for cancers of the subglottic larynx?
T1: tumor limited to subglottis
T2: extension to vocal cords, with normal or impaired mobility
T3: limited to larynx with vocal cord fixation or paraglottic space extension, invasion of inner cortex thyroid cartilage
T4a (resectable): through outer cortex thyroid cartilage and/or beyond larynx (trachea, ST of neck, extrinsic muscles of tongue, strap muscles, thyroid, esophagus)
T4b: invasion of prevertebral space, encased carotid, mediastinumcartilage
What is the clinical nodal staging for LCX (AJCC 8th edition, 2017)?
N1: single ipsi, ≤3 cm, ENE(–) N2a: single ipsi >3 cm and ≤6 cm ENE(–) N2b: multiple ipsi, ≤6 cm and ENE(–) N2c: bilat or contralat, ≤6 cm and ENE(–) N3a: >6 cm and ENE(–) N3b: clinically overt ENE(+)
What is the pathologic nodal staging for LCX (AJCC 8th edition, 2017)?
N1: single ipsi, ≤3 cm, ENE(–)
N2a: single ipsi or contralat ≤3 cm and ENE(+) or single ipsi >3 cm and ≤ 6 cm ENE(–)
N2b: multiple ipsi, ≤6 cm and ENE(–)
N2c: bilat or contralat, ≤6 cm and ENE(–)
N3a: >6 cm and ENE(–)
N3b: single ipsi >3 cm ENE(+) or multiple ipsi/contralat/bilat nodes any with ENE(+)
