Squamous Cell Carcinoma of the Larynx

Key Features

Essentials of Diagnosis

• New and persistent (> 2 weeks duration) voice changes and hoarseness, especially in a smoker

• Persistent throat pain, especially with swallowing

• Weight loss

• Neck mass

• Hemoptysis

• Stridor or other symptoms of a compromised airway

General Considerations

• There may be an association between laryngeal cancer and human papillomavirus (HPV) type 16 or 18 infection, but this association is much less strong than that between HPV 16 or 18 and oropharyngeal cancer

• In both cancer types, the association with HPV seems to be strongest in nonsmokers

• Laryngeal cancer is very treatable and early detection is the key to maximizing posttreatment voice, swallowing, and breathing function

Demographics

• Occurs almost exclusively in patients with a history of significant tobacco use

• Most common in men between ages 50 and 70

• Incidence, prevalence, and mortality rates per 100,000

  • Incidence: 2.76 cases/year

  • Prevalence: 14.33 cases/year

  • Mortality: 1.66 deaths/year

• While the incidence and prevalence have increased by 12% and 24%, respectively, during the past 3 decades, mortality has declined by about 5%

Clinical Findings

Symptoms and Signs

• Throat or ear pain

• Weight loss

• Hemoptysis

• Change in speech/voice quality (including hoarseness or dysarthria)

• Dysphagia

• Airway compromise

• Neck metastases are not common in early glottic (true vocal fold) cancer; however, one-third of patients with impaired vocal fold mobility will also have involved lymph nodes at neck dissection

• Supraglottic carcinoma (false vocal folds, aryepiglottic folds, epiglottis) often metastasizes to both sides of the neck early in the disease

• Visible mass (as seen on oral examination or indirect or fiberoptic pharyngoscopy)

• Palpable mass in base of tongue or tonsil

• Neck adenopathy (usually hard)

Diagnosis

Laboratory Tests

• Complete blood count

• Liver biochemical tests

Imaging Studies

• CT or MRI is helpful in assessing tumor extent

• Indications for chest CT

  • Level VI enlarged nodes (around the trachea and the thyroid gland)

  • Level IV enlarged nodes (inferior to the cricoid cartilage along the internal jugular vein)

  • Chest film is concerning for a second primary lesion or metastases

• PET or PET-CT may be indicated to assess for distant metastases when there appears to be advanced local or regional disease

Diagnostic Procedures

• Laryngoscopy

• Esophagoscopy and bronchoscopy are recommended at the same time to exclude synchronous primary cancers in these locations

• Fine-needle aspiration biopsy may confirm the presence of the carcinoma and the histologic type, but caution and clinical judgment should be exercised in interpreting an apparently negative result

• Open biopsies of nodal metastases should be discouraged because they may lead to higher rates of tumor treatment failure