eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Malignant Tumors of the Larynx: Follow-up

Author: Jonas T Johnson, MD, FACS, Chairman, Department of Otolaryngology, The Eugene N Myers, MD, Professor and Chairman of Otolaryngology, Professor, Department of Radiation Oncology, University of Pittsburgh School of Medicine; Professor, Department of Oral Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine
Coauthor(s): Apostolos Christopoulos, MD, MSc, FRCSC, Fellow in Head and Neck Oncologic Surgery, Department of Otolaryngology, University of Pittsburgh; Emiro E Caicedo-Granados, MD, Fellow in Head and Neck Oncology/Anterior Endoscopic Skull Base Surgery, Department of Otolaryngology, University of Pittsburgh
Contributor Information and Disclosures

Updated: Jan 7, 2009

Outcome and Prognosis

Outcomes in malignant tumor of the larynx are measured by relative survival rates. Data from Surveillance, Epidemiology and End Results Program shows that the 5-year relative survival rates of laryngeal cancer by stage at diagnosis, 1989-1996 is as follows:

  • All stages - 65%
  • Local - 81%
  • Regional - 51%
  • Distant - 41%

Keep in mind that the outcome for laryngeal carcinoma depends on the initial staging. In general, early-stage disease is treated with single modality therapy, either surgery or radiation therapy. The outcomes in early disease are quite good, approaching over 90% 5-year survival rates with either modality of treatment.

Advanced disease (stage III-IV) is generally treated with multimodality therapy, concurrent chemoradiation therapy and surgery. The 5-year survival rates vary depending on the treatment modality. The 5-year survival rate after concurrent chemoradiation therapy is 54% with preservation of 88% of the larynx at 2 years. The 5-year survival after endoscopic laser laryngeal surgery is 55%.

Quality of life is emerging as an outcome measure in the treatment of laryngeal carcinoma. New data are showing the functional outcomes and quality of life after different treatment modalities.

Future and Controversies

Functional preservation of the larynx remains a challenging goal in the treatment of malignant laryngeal tumors. Organ-sparing chemoradiation protocols have become the standard of care for advanced laryngeal cancer. Although these strategies were proven effective in preserving the larynx, the may not necessarily preserve the function. Improving surgical techniques such as endolaryngeal lasers, sophistication of radiation techniques such as IMRT, and the development of novel targeting agents such as cetuximab will surely change the landscape of current trends in laryngeal cancer treatment. Novel work in tumor angiogenesis and immunotherapy also holds promise. In the near future, individualizing treatment through optimal patient selection and biomarker analysis will be an interesting challenge. 

 


More on Malignant Tumors of the Larynx

Overview: Malignant Tumors of the Larynx
Workup: Malignant Tumors of the Larynx
Treatment: Malignant Tumors of the Larynx
Follow-up: Malignant Tumors of the Larynx
Multimedia: Malignant Tumors of the Larynx
References
[ CLOSE WINDOW ]

References

  1. American Joint Comittee on Cancer - Head and Neck cancer staging 2007. Available at http://www.cancerstaging.org/. Accessed August 2008.

  2. 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. Jun 13 1991;324(24):1685-90. [Medline].

  3. NCCN Practice Guidelines in Oncology - v.2.2008 - Head and Neck Cancers. National Comprehensive Cancer Network. Available at http://www.nccn.org/professionals/physician_gls/PDF/head-and-neck.pdf. Accessed 7/1/07.

  4. De Santis M, Tripodi D. [The laryngectomized patient as a psychologically maladjusted person]. Valsalva. Jun 1968;44(3):138-45. [Medline].

  5. Ah-See K. The evidence for different management strategies for laryngeal cancer: summaries of systematic reviews commissioned for an educational meeting. Clin Otolaryngol. Apr 2008;33(2):90-3. [Medline].

  6. American Cancer Society. Cancer Facts and Figures 2005. [Full Text].

  7. Audet N, Beasley NJ, MacMillan C, et al. Lymphatic vessel density, nodal metastases, and prognosis in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. Dec 2005;131(12):1065-70. [Medline].

  8. Blair A, Kazerouni N. Reactive chemicals and cancer. Cancer Causes Control. May 1997;8(3):473-90. [Medline].

  9. Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. Feb 9 2006;354(6):567-78. [Medline].

  10. Cancer of the larynx. In: Myers EN, Suen JY, Myers JN, Hanna EYN. Cancer of the Head and Neck. 4th. Philadelphia: Saunders; 2003:333-378.

  11. Folz BJ, Silver CE, Rinaldo A, et al. An outline of the history of head and neck oncology. Oral Oncol. Jan 2008;44(1):2-9. [Medline].

  12. Garas J, McGuirt WF Sr. Squamous cell carcinoma of the subglottis. Am J Otolaryngol. Jan-Feb 2006;27(1):1-4. [Medline].

  13. Higgins KM, Wang JR. State of head and neck surgical oncology research--a review and critical appraisal of landmark studies. Head Neck. Dec 2008;30(12):1636-42. [Medline].

  14. Holsinger FC. Swing of the pendulum: optimizing functional outcomes in larynx cancer. Curr Oncol Rep. Mar 2008;10(2):170-5. [Medline].

  15. Kapil U, Singh P, Bahadur S, et al. Assessment of risk factors in laryngeal cancer in India: a case-control study. Asian Pac J Cancer Prev. Apr-Jun 2005;6(2):202-7. [Medline].

  16. Koufman JA, Burke AJ. The etiology and pathogenesis of laryngeal carcinoma. Otolaryngol Clin North Am. Feb 1997;30(1):1-19. [Medline].

  17. Lohynska R, Slavicek A, Bahanan A, et al. Predictors of local failure in early laryngeal cancer. Neoplasma. 2005;52(6):483-8. [Medline].

  18. Marks JE, Breaux S, Smith PG, et al. The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus. Head Neck Surg. Sep-Oct 1985;8(1):3-8. [Medline].

  19. McCaffrey TV, Witte M, Ferguson MT. Verrucous carcinoma of the larynx. Ann Otol Rhinol Laryngol. May 1998;107(5 Pt 1):391-5. [Medline].

  20. Mozolewski E, Maj P, Tarnowska C. [The choice of transplantation in reconstructive surgery of the larynx after partial laryngectomy]. Otolaryngol Pol. 1997;51(3):286-96. [Medline].

  21. Myers EN, Suen JY. Cancer of the larynx. Cancer of the Head and Neck. 1996;403-406.

  22. National Cancer Institute. Laryngeal Cancer (PDQ): Treatment.

  23. Nogueira CP, Dolan RW, Gooey J, et al. Inactivation of p53 and amplification of cyclin D1 correlate with clinical outcome in head and neck cancer. Laryngoscope. Mar 1998;108(3):345-50. [Medline].

  24. Oztürk O, Sari M, Inanli S, et al. Basaloid squamous cell carcinoma of the larynx: a case report. Kulak Burun Bogaz Ihtis Derg. 2005;15(5-6):125-9. [Medline].

  25. Rodriguez CP, Adelstein DJ, Rybicki LA, et al. Clinical predictors of larynx preservation after multiagent concurrent chemoradiotherapy. Head Neck. Dec 2008;30(12):1535-42. [Medline].

  26. Santos AB, Cernea CR, Inoue M, et al. Selective neck dissection for node-positive necks in patients with head and neck squamous cell carcinoma: a word of caution. Arch Otolaryngol Head Neck Surg. Jan 2006;132(1):79-81. [Medline].

  27. Sathiakumar N, Delzell E, Amoateng-Adjepong Y, et al. Epidemiologic evidence on the relationship between mists containing sulfuric acid and respiratory tract cancer. Crit Rev Toxicol. May 1997;27(3):233-51. [Medline].

  28. Scheifele C, Reichart PA, Hippler-Benscheidt M, et al. Incidence of oral, pharyngeal, and laryngeal squamous cell carcinomas among 1515 patients after liver transplantation. Oral Oncol. Aug 2005;41(7):670-6. [Medline].

  29. Shah JP, Karnell LH, Hoffman HT, et al. Patterns of care for cancer of the larynx in the United States. Arch Otolaryngol Head Neck Surg. May 1997;123(5):475-83. [Medline].

  30. Silverberg E. Cancer statistics, 1985. CA Cancer J Clin. Jan-Feb 1985;35(1):19-35. [Medline].

  31. Succo G, Bramardi F, Airoldi M, et al. Quality of life after treatment in patients with laryngeal carcinoma [in Italian]. Acta Otorhinolaryngol Ital. 1997/02;17(1):32-44.

  32. Surveillance, Epidemiology and End Results (SEER) Program. NCI; 2008. [Full Text].

  33. Uneri C, Sari M, Baglam T, et al. Effects of vitamin E on cigarette smoke induced oxidative damage in larynx and lung. Laryngoscope. Jan 2006;116(1):97-100. [Medline].

  34. Vermund H, Krajci P, Eide TJ, et al. Histopathological grading of laryngectomy specimens. APMIS. Jul-Aug 2005;113(7-8):473-88. [Medline].

  35. Vermund H, Krajci P, Eide TJ, et al. Laryngectomy whole organ serial sections--histological parameters correlated with recurrence rate. Acta Oncol. 2004;43(1):98-107. [Medline].

  36. Wenig BM. Atlas of Head and Neck Pathology. Philadelphia, Pa: WB Saunders; 1993:255.

  37. Zeitels SM, Vaughan CW, Domanowski GF. Endoscopic management of early supraglottic cancer. Ann Otol Rhinol Laryngol. Dec 1990;99(12):951-6. [Medline].

  38. Zeitels SM, Vaughan CW, Domanowski GF, et al. Laser epiglottectomy: endoscopic technique and indications. Otolaryngol Head Neck Surg. Sep 1990;103(3):337-43. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

malignant tumors of the larynx, laryngeal cancer, cancer of the larynx, neck metastases, lymph node metastases, subglottic cancer, glottic cancer, supraglottic cancer, neck cancer, laryngectomy, neck tumor, subglottic tumor, glottic tumor, supraglottic tumor, transglottic tumor, tumors of the transglottic larynx, vocal cord cancer, vocal cord tumor, laryngeal malignancy, squamous cell carcinoma of the larynx,

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Jonas T Johnson, MD, FACS, Chairman, Department of Otolaryngology, The Eugene N Myers, MD, Professor and Chairman of Otolaryngology, Professor, Department of Radiation Oncology, University of Pittsburgh School of Medicine; Professor, Department of Oral Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine
Jonas T Johnson, MD, FACS is a member of the following medical societies: Allegheny County Medical Society, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American Bronchoesophagological Association, American College of Surgeons, American Head and Neck Society, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Radium Society, American Rhinologic Society, American Society of Clinical Oncology, Pennsylvania Medical Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Coauthor(s)

Apostolos Christopoulos, MD, MSc, FRCSC, Fellow in Head and Neck Oncologic Surgery, Department of Otolaryngology, University of Pittsburgh
Disclosure: Nothing to disclose.

Emiro E Caicedo-Granados, MD, Fellow in Head and Neck Oncology/Anterior Endoscopic Skull Base Surgery, Department of Otolaryngology, University of Pittsburgh
Emiro E Caicedo-Granados, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery
Disclosure: Nothing to disclose.

Medical Editor

Jack A Coleman, MD, Consulting Staff, Franklin Surgical Associates
Jack A Coleman, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Sleep Medicine, American Bronchoesophagological Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Society for Laser Medicine and Surgery, and Association of Military Surgeons of the US
Disclosure: Influent  None Review panel membership; accarent, inc Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Karen Hall Calhoun, MD, William E Davis Professor and Chair, Department of Otolaryngology-Head and Neck Surgery, University of Missouri
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.