Glottic Cancer Workup

Updated: Oct 05, 2016
  • Author: Andrew M Coughlin, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Workup

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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Other Tests

A modified barium swallow (MBS) prior to treatment of glottic cancers can be very helpful to assess a patient’s swallowing function. This is a radiographic study where a patient swallows several different food consistencies, including thin liquids, purees, and solids coated with barium, in order to determine whether oropharyngeal dysphagia, penetration, or aspiration is present.

Fiberoptic endoscopic evaluation of swallowing (FEES) is a different type of swallowing assessment where the practitioner is able to directly visualize a patient’s ability to swallow different consistencies of food. Again, penetration and aspiration can be assessed; however, this test can clearly identify any areas of pooling or poor laryngeal sensation. These findings can then be used to incorporate swallowing techniques that may prevent penetration and aspiration before, during, or after treatment.

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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. Esophagoscopy and bronchoscopy should also be performed at the time of surgery to rule out metachronous second primary tumors.

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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 and/or invasion of the paraglottic/pre-epiglottic space and/or invasion of the thyroid cartilage inner cortex

T4a - Tumor invading through thyroid cartilage and/or with direct extralaryngeal spread into the neck, including trachea, extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus

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

M0 - No distant metastasis

M1 - 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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