eMedicine Specialties > Radiology > Head/Neck

Laryngeal Carcinoma: Follow-up

Author: Nasir Iqbal, MD, Assistant Professor, Department of Radiology, Section of MRI, Loyola University Medical Center
Coauthor(s): Simon Lo, MD, Assistant Professor, Department of Radiation Oncology, Indiana University School of Medicine; Arthur J Frazier, MD, Assistant Professor of Radiation Oncology, Residency Program Director, Wayne State University School of Medicine; Radiation Oncologist, Barbara Ann Karmanos Cancer Institute, Gershenson Radiation Oncology Center, Harper Hospital/DMC; Harold E Kim, MD, Assistant Professor, Department of Radiation Oncology, Wayne State University School of Medicine; Clinical Chief, DMC-Crittenton Radiation Oncology Center, Harper Hospital; Michelle L Mierzwa, MD, Staff Physician, Department of Radiology, University Hospital, University of Cincinnati; Ayesha Waheed, MD, ; Sameer R Keole, MD, Staff Physician, Department of Radiation Oncology, Gershenson Radiation Oncology Center, Karmanos Cancer Institute, Harper Hospital, Wayne State University School of Medicine
Contributor Information and Disclosures

Updated: Apr 10, 2007

Intervention

Supraglottic cancer

Treatment of the primary tumor

Partial laryngectomy may be feasible in select patients. During supraglottic laryngectomy, the upper portion of the thyroid cartilage and its contents, the false vocal cords, the epiglottis, and the aryepiglottic folds are removed. This surgery can preserve the patient's speech and swallowing, but more extensive resection increases the demands on lung function, limiting the utility of that procedure. Patients with impaired lung function do not tolerate supraglottic laryngectomy well because of the risk of aspiration.

Voice-sparing partial laryngectomy performed for the treatment of a supraglottic primary tumor consists of supraglottic laryngectomy. The incision for this procedure is along the ventricle. The portion above the ventricle is removed. Standard supraglottic laryngectomy is contraindicated when the following are present: (1) exolaryngeal spread, (2) vocal cord fixation, (3) involvement of both arytenoids, (4) a tumor-free margin of less than 3 mm between the inferior aspect of the tumor and the anterior commissure, and (5) invasion of the thyroid or cricoid cartilage.

In patients with T1 or T2 tumors, local control rates with conventional fractionated radiation therapy (65-70 Gy in 6-7 wk) are higher than 80% overall. T3 tumors may also be treated with radiation therapy. More-advanced disease requires combined-modality treatment often entailing total laryngectomy. Radiation therapy or induction chemotherapy followed by radiation therapy may be offered with curative intent.

Treatment of the neck

Treatment of the neck is necessary because of the high incidence of cervical metastases. About one third of clinically negative necks have metastatic neck nodes, and the incidence of recurrence in the untreated neck is high. In the surgical treatment of T1 or T2 primary tumors, bilateral modified radical neck dissection is recommended.

Glottic cancer

Treatment of the primary tumor

A variety of surgical procedures are available for treating glottic carcinomas. Advanced lesions are treated with total laryngectomy. Early lesions may be treated with radiation therapy or surgery, such as cordectomy or hemilaryngectomy. Hemilaryngectomy involves resection of the affected true vocal cord along with ipsilateral arytenoids cartilage; this is performed in early glottic cancers. The overlying thyroid ala and its external perichondrium is included in the resection.

Contraindications to standard hemilaryngectomy include the following: (1) tumor extension across the anterior commissure to involve more than one third of the contralateral true cord, (2) subglottic extension more than 10 mm anteriorly and 5 mm posterolaterally, (3) involvement of the cricoarytenoid joint or interarytenoid region; and (4) invasion of the thyroid cartilage.

Carcinoma in situ is highly curable with microexcision, laser vaporization, or radiation therapy. Treatment recommendations should be based on the extent of local disease. Multiple recurrences should suggest an invasive component, and partial or total laryngectomy should be used. T1 and T2 tumors may be treated by means of partial laryngectomy or radiation therapy (65-70 Gy in 6.5-7 wk).

T3 lesions are being treated with primary radiation therapy, followed by salvage laryngectomy if residual disease or recurrence is present. Induction chemotherapy followed by radiation can also be used to preserve the larynx. T4 disease is best treated with total laryngectomy.

Treatment of the neck

Because of the sparse lymphatic network and the low incidence of cervical metastases, elective neck dissection is indicated only for transglottic lesions. Palpable nodal disease requires treatment of the neck.

Subglottic cancer

Total laryngectomy with neck dissection is the usual treatment recommendation. Combination therapy (surgery plus adjuvant radiation therapy) is recommended for more advanced disease.

 


More on Laryngeal Carcinoma

Overview: Laryngeal Carcinoma
Imaging: Laryngeal Carcinoma
Follow-up: Laryngeal Carcinoma
Multimedia: Laryngeal Carcinoma
References
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References

  1. Castelijns JA, Gerritsen GJ, Kaiser MC, et al. Invasion of laryngeal cartilage by cancer: comparison of CT and MR imaging. Radiology. Apr 1988;167(1):199-206. [Medline].

  2. Castelijns JA, van den Brekel MW, Niekoop VA, Snow GB. Imaging of the larynx. Neuroimaging Clin N Am. May 1996;6(2):401-15. [Medline].

  3. Curtin HD. Imaging of the larynx: current concepts. Radiology. Oct 1989;173(1):1-11. [Medline].

  4. Horowitz BL, Woodson GE, Bryan RN. CT of laryngeal tumors. Radiol Clin North Am. Mar 1984;22(1):265-79. [Medline].

  5. Som PM, Curtin HD. Larynx. Head and Neck Imaging. 4th ed. St Louis: Mosby-Year Book;. 2003: 1595-699.

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Further Reading

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Keywords

cancer of the larynx, laryngeal cancer, laryngeal tumor, glottic tumor, glottic cancer, subglottic tumor, head and neck cancer, smoking, throat cancer

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Contributor Information and Disclosures

Author

Nasir Iqbal, MD, Assistant Professor, Department of Radiology, Section of MRI, Loyola University Medical Center
Nasir Iqbal, MD is a member of the following medical societies: Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

Simon Lo, MD, Assistant Professor, Department of Radiation Oncology, Indiana University School of Medicine
Simon Lo, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Society for Therapeutic Radiology and Oncology, and Radiological Society of North America
Disclosure: Nothing to disclose.

Arthur J Frazier, MD, Assistant Professor of Radiation Oncology, Residency Program Director, Wayne State University School of Medicine; Radiation Oncologist, Barbara Ann Karmanos Cancer Institute, Gershenson Radiation Oncology Center, Harper Hospital/DMC
Arthur J Frazier, MD is a member of the following medical societies: American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

Harold E Kim, MD, Assistant Professor, Department of Radiation Oncology, Wayne State University School of Medicine; Clinical Chief, DMC-Crittenton Radiation Oncology Center, Harper Hospital
Harold E Kim, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Therapeutic Radiology and Oncology, and American Society of Clinical Oncology
Disclosure: Nothing to disclose.

Michelle L Mierzwa, MD, Staff Physician, Department of Radiology, University Hospital, University of Cincinnati
Michelle L Mierzwa, MD is a member of the following medical societies: Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Ayesha Waheed, MD, 
Disclosure: Nothing to disclose.

Sameer R Keole, MD, Staff Physician, Department of Radiation Oncology, Gershenson Radiation Oncology Center, Karmanos Cancer Institute, Harper Hospital, Wayne State University School of Medicine
Sameer R Keole, MD is a member of the following medical societies: American Society for Therapeutic Radiology and Oncology
Disclosure: Nothing to disclose.

Medical Editor

Barton F Branstetter IV, MD, Assistant Professor of Radiology and Otolaryngology, University of Pittsburgh; Director of Head and Neck Imaging, Associate Director of Informatics, Department of Radiology, Division of Neuroradiology, University of Pittsburgh Medical Center
Barton F Branstetter IV, MD is a member of the following medical societies: American Medical Association, American Roentgen Ray Society, American Society of Neuroradiology, Pennsylvania Medical Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

C Douglas Phillips, MD, Professor, Departments of Radiology, Neurosurgery, and Otolaryngology, University of Virginia Health Sciences Center
C Douglas Phillips, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Society of Head and Neck Radiology, American Society of Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

James G Smirniotopoulos, MD, Professor of Radiology, Neurology, and Biomedical Informatics, Chairman, Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences
James G Smirniotopoulos, MD is a member of the following medical societies: American College of Radiology, American Roentgen Ray Society, American Society of Head and Neck Radiology, American Society of Neuroradiology, American Society of Pediatric Neuroradiology, Association of University Radiologists, and Radiological Society of North America
Disclosure: Nothing to disclose.

 
 
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