Laryngeal Carcinoma

2.5.1 Define the anatomic subsites of the larynx and the staging for each.

2.5.2 Discuss the lymphatic drainage of the larynx and its relevance to the treatment of larynx cancers.

2.5.3 Describe the management of leukoplakia, dysplasia, and carcinoma in situ of the glottis.

2.5.4 Define the paraglottic space and it's role in laryngeal cancer spread.

2.5.5 What is "narrow field" radiation of the larynx and when is it used?

2.5.6 What are the indications for primary total laryngectomy?

2.5.7 How should the thyroid gland be managed during total laryngectomy?

2.5.8 Endoscopic laser excision in early glottic cancer-indications and contraindications.

Gallo A, et al. CO2 laser cordectomy for early-stage glottic carcinoma: a long-term follow-up of 156 cases. Laryngoscope. 2002 Feb;112(2):370-4. PMID:11889399

2.5.9 What are the treatment options for supraglottic cancers?

2.5.10 Describe the different laryngeal conservation surgeries.

2.5.11 Is there a difference is survival in patients with early laryngeal cancer treated with surgery vs. radiation? How about voice outcomes?

Jones AS, Fish B, Fenton JE, Husband DJ. The treatment of early laryngeal cancers (T1-T2 N0): surgery or irradiation? Head Neck. 2004 Feb;26(2):127-35. PMID:14762881

2.5.12 Your patient was treated with XRT for T1bN0M0 glottic cancer. Follow-up identifies persistent tumor confined to the anterior left true vocal fold. What are the surgical options? Consult with your laryngologist or H&N surgeon. Tell us about the criteria for surgery as described by Biller.

Biller HF, Barnhill FR Jr, Ogura JH, Perez CA. Hemilaryngectomy following radiation failure for carcinoma of the vocal cords. Laryngoscope. 1970 Feb;80(2):249-53. PMID:5416458

2.5.13 What pre-operative tests should be considered in a patient scheduled for a supraglottic laryngectomy?

2.5.14 What are the predisposing risk factors for the development of a post-laryngectomy pharyngo-cutatneous fistula? How would you manage this complication?

2.5.15 Discuss the landmark Veterans Affairs Laryngeal Cancer Study Group trial and its affect on the treatment of larynx cancer.

Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med. 1991 Jun 13;324(24):1685-90. PMID:2034244

2.5.16 Is concurrent chemotherapy better than induction chemotherapy followed by radiotherapy in the treatment of patients with advanced laryngeal carcinoma?

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

2.5.17 Controversy about the role of surgery in the treatment of larynx cancer persists. What do you think about this author's view?

Olsen KD. Reexamining the treatment of advanced laryngeal cancer. Head Neck. 2010 Jan;32(1):1-7. PMID:19953627