Near-Total Laryngectomy Workup

Updated: Dec 20, 2016
  • Author: Brian Kip Reilly, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

Laboratory Studies

Order routine laboratory studies, including a basic chemistry panel (BMP), liver function test (LFT), and a complete blood count (CBC) to get a health baseline and look for metastases.

Elevated alkaline phosphatase indicates possible metastases or concomitant liver disease.

Elevated calcium levels should prompt further work-up for metastases.

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Imaging Studies

Obtain a CT scan of the chest to rule out pulmonary metastases or synchronous primary tumors.

Order a neck/laryngeal CT scan with contrast for evaluation of cervical metastases to determine the presence or absence of cartilage invasion.

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Other Tests

Patients often have chronic obstructive pulmonary disease (COPD) because of their heavy history of smoking. Pulmonary function tests may be indicated for some patients to determine pulmonary reserve and can help predict if lungs have sufficient power for phonation via the vibratory myomucosal shut.

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Diagnostic Procedures

Endoscopy should be performed prior to any type of laryngectomy to rule out synchronous primary cancers and to evaluate the primary laryngeal lesion and its appropriateness for surgery.

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Histologic Findings

See the list below:

  • Greater than 93% of laryngeal tumors have a squamous cell histopathology.

  • Verrucous carcinomas are present in 2-4% of cases.

  • Adenocarcinomas and sarcomas occur in approximately 1% of cases, respectively.

  • The use of intraoperative frozen sections determines how extensive the resection must be to ensure complete excision of the lesion.

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Staging

Laryngeal cancers are staged both clinically and radiographically prior to surgery. CT scans of the larynx with fine cuts, CT scans of the neck with and without contrast, and CT scans of the chest are obtained to characterize local spread and metastatic disease. Staging is generally performed as part of the endoscopy of stage T3 and T4 lesions.

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