Glottic Cancer Workup

  • Author: William M Lydiatt, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Feb 28, 2012
 

Laboratory Studies

  • Liver function tests are obtained as part of the metastatic survey.
  • In operative candidates, a preoperative battery of laboratory tests are recommended as follows:
    • CBC count
    • Electrolytes
    • Renal function tests
    • Coagulation profile
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Imaging Studies

  • CT scanning of the neck is useful to evaluate tumor extension, especially cartilage invasion and nodal metastases. However, in patients with early-stage disease, a CT examination is not necessary because both local invasion and nodal metastases are unlikely.
  • Obtain a chest radiograph or chest CT scan to rule out lung metastases and a second primary malignancy.
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Diagnostic Procedures

A tissue biopsy for confirmation of the diagnosis is imperative before initiating any treatment. Some patients may tolerate biopsies of the larynx in the clinic under local anesthesia; however, most laryngeal biopsies are performed during direct laryngoscopy in the operating room. Direct laryngoscopy also allows thorough evaluation of the larynx and the entire upper aerodigestive tract for accurate staging of the disease.

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Histologic Findings

Over 90% of all laryngeal cancers are squamous cell carcinoma, which is the focus of this article. Other histologic types include lymphoma, spindle cell carcinoma, neuroendocrine carcinoma, minor salivary gland carcinomas, mucosal melanoma, and various sarcomas. Metastatic lesions and direct extension of thyroid carcinoma are other possibilities.

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Staging

Staging of glottic carcinoma is based on specific tumor parameters, including extent of the lesion, mobility of the vocal cords, presence of cartilage and/or soft tissue invasion, and nodal metastases.

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American Joint Committee on Cancer Staging System for Glottic Carcinoma

Glottis

T1 - Tumor limited to the vocal cords (involving anterior and/or posterior commissure) with normal mobility

T1a - Tumor limited to 1 vocal cord (see video below)

In this former smoker who was evaluated for hoarseness, a keratotic lesion is seen along the right true vocal fold with surrounding erythema (T1a squamous cell carcinoma). Video courtesy of Vijay R Ramakrishnan, MD.

T1b - Tumor involving both cords (see video below)

In this patient with hoarseness and throat pain, an ulcerative lesion is seen extending from the left true vocal fold across the anterior commissure onto the right side (T1b squamous cell carcinoma). Video courtesy of Vijay R Ramakrishnan, MD.

T2 - Tumor extending to the supraglottis or subglottis with impaired vocal cord mobility

T3 - Tumor confined to the larynx with vocal cord fixation

T4a - Tumor invading through thyroid cartilage and/or with direct extralaryngeal spread

T4b - Tumor invading prevertebral space, encasing carotid artery, or invading mediastinal structures

Regional lymph nodes

NX - Regional lymph nodes cannot be assessed.

N0 - No regional metastasis

N1 - Metastases to 1 ipsilateral cervical lymph node equal or less than 3 cm in greatest dimension

N2a - Metastases to a single ipsilateral cervical lymph node greater than 3 cm but no more than 6 cm in greatest dimension

N2b - Metastases to multiple ipsilateral cervical lymph nodes, none greater than 6 cm in greatest dimension

N2c - Metastases to bilateral or contralateral cervical lymph nodes, none more than 6 cm in greatest dimension

N3 - Metastases to any node(s) greater than 6 cm in greatest dimension

Distant metastases

MX - Distant metastases cannot be assessed

N0 - No distant metastasis

N1 - Distant metastases present

Stage groupings

0 - Tis, N0

I - T1, N0

II - T2, N0

III - T1, N1 or T2, N1 or T3, N0-1

IVA - T1-4a, N2

IVA - T4a, N0-1, M0

IVB - T4b, any N, M0

IVB – Any T, N3, M0

IVC – Any T, any N, M1

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Contributor Information and Disclosures
Author

William M Lydiatt, MD  Professor and Division Director, Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center

William M Lydiatt, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, and Nebraska Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Daniel D Lydiatt, DDS, MD  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center

Disclosure: Nothing to disclose.

Mary C Snyder, MD  Division of Plastic Surgery, Monument Plastic Surgery

Mary C Snyder, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and American Rhinologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mimi S Kokoska, MD  Associate Professor, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences; Chief, Department of Otolaryngology-Head and Neck Surgery, Central Arkansas Veterans Healthcare System

Mimi S Kokoska, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American College of Surgeons, American Head and Neck Society, and Arkansas Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Nader Sadeghi, MD, FRCSC  Professor, Otolaryngology-Head and Neck Surgery, Director of Head and Neck Surgery, George Washington University School of Medicine and Health Sciences

Nader Sadeghi, MD, FRCSC is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Thyroid Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Private Practice in Otolaryngology and Facial Plastic Surgery, 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 of Otolaryngology, Dentistry, and Engineering, 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 Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Medvoy Ownership interest Management position; Cerescan Imaging Consulting; Headwatersmb Consulting fee Consulting; Venturequest Royalty Consulting

Additional Contributors

Medscape Reference thanks Vijay R Ramakrishnan, MD, Assistant Professor, Department of Otolaryngology, University of Colorado School of Medicine, for assistance with the video contribution to this article.

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In this former smoker who was evaluated for hoarseness, a keratotic lesion is seen along the right true vocal fold with surrounding erythema (T1a squamous cell carcinoma). Video courtesy of Vijay R Ramakrishnan, MD.
In this patient with hoarseness and throat pain, an ulcerative lesion is seen extending from the left true vocal fold across the anterior commissure onto the right side (T1b squamous cell carcinoma). Video courtesy of Vijay R Ramakrishnan, MD.
 
 
 
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