ca larynx - etio & types
DESCRIPTION
TRANSCRIPT
SACCULE (appendix of ventricle) • Diverticulum extending from ventricle • Between the vestibular fold, thyroarytenoid & thyroid cartilage• Contains mucous glands , lubricates the vocal folds
CONUS ELASTICUS Elastic tissue layer extending from vocal ligaments to cricoid arch, attaches to inner thyroid lamina & arytenoids
anterior & lateral to epiglottis
Inferolaterally continuous with paraglottic space
PRE EPIGLOTTIC SPACE OF BOYER
PARAGLOTTIC SPACE
Adipose tissue, internal laryngeal nerve, laryngeal saccule
Lat. – thyroid cartilage & thyrohyoid membrane
Superomed. – quadrangular membrane
Inferomed. - conus elasticus
Superiorly continuous with pre – epiglottic space
SITE SUBSITE
Supraglottis Suprahyoid epiglottisInfrahyoid epiglottisAryepiglottic foldsArytenoidsVentricular bands (false vocal cords)
Glottis True vocal cords+ ant and post. Commissure +rima glottidis(slit)
Subglottis Subglottic space upto lower border of cricoid
2.63% of all the body cancers in India
M:F = 10:1
40- 70 years
female incidence increasing
Black tobacco > light tobacco - aromatic amines and tobacco specific nitrosamines & Tar content. Non filter cigarettes > filter cigarettes - tar content Smoking hand-rolled cigarettes > commercially manufactured cigarettes - 2.7* risk. Chewing tobacco or inhaling snuff - 50% in risk. Risk of developing ca larynx decreases with increasing time since cessation of smoking, indicating tobacco as a promoter and initiator in carcinogenesis.
SMOKING
Alcohol formaldehyde
( ) vit. A synthesis
mucosal de-epithelisation
mucosa exposed
Serum IgA levels in patients with alcoholic liver disease
Associated malnutrition
15* RISK
OCCUPATIONAL EXPOSURE - asbestos, mustard gas, process of isopropyl alcohol manufacturing, nickel refining, soot, tars, acid mists, beryllium and bischloromethyl ether & the glass wool production.
GENETIC - Japanese and Russian
VIRUSES - HSV, HPV, EBV ( EBV- specific IgA antibodies block IgG mediated tumor destruction).
Previous RADIATION to head & neck
Low SOCIOECONOMIC STATUS - smoking habits
SUPRAGLOTTIC CANCER
site - epiglottis > false cords > aryepiglottic folds
Spread - vallecula, base of tongue & pyriform fossa. Cancer of infrahyoid epiglottis & anterior ventricular band extend into pre-epiglottic space and penetrate the thyroid cartilage.
Symptoms: Early -Throat pain Dysphagia Ipsilateral otalgia LN mass in the neck.
Late - Weight loss Respiratory obstruction Halitosis (tumor necrosis)
Nodal mets - upper and middle jugular nodes. Bilateral mets (epiglottis)
Supraglottic growths
GLOTTIC CANCER
Most common site - Free edge and upper surface of the vocal cords in its anterior and middle third
spread- anteriorly - anterior commissure &opposite cord posteriorly - vocal process and arytenoids upward – ventricle & false cord downwards - subglottis
Symptoms : Early - Hoarseness
Late – Stridor Laryngeal obstruction (increased size, edema/ cord fixation)
Nodal mets – practically absent, if early stage
Glottic growths
SUBGLOTTIC CANCER
spread – anteriorly - anterior wall to the opposite sidedownwards - trachea.Upward spread – lateMainly invade cricoid & thyroid cartilagesExtralaryngeal spread characteristic
Site - subglottis
Symptom: Early - Stridor Laryngeal obstruction
Late – Hoarseness
Nodal mets - prelaryngeal pretracheal (delphian) paratracheal lower jugular
Subglottic growths
Broadening of the larynx Loss of crepitation Tenderness of larynx Weight loss Chronic cough; Hemoptysis
DysphagiaOdynophagiaIpsilateral otalgia Halitosis Mass in the neck
HISTORY: “patient in cancer age group having persistent or gradually increasing hoarseness of voice for 3 weeks must have laryngeal examination to exclude cancer”
Persistent hoarsenessDyspnea and stridor
Hoarseness of voice
Have you heard a patient with hoarseness of voice beforet.mp4 - YouTube - Copy.mp4
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