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Glottic Cancer

Updated : November 16, 2022





Background

One of the most prevalent head and neck tumors, laryngeal cancer, is estimated to account for 1 percent of all malignancies in the globe. The actual voice cords, as well as the posterior and anterior commissure of the laryngeal, are considered the sites of glottic carcinoma.

Glottic carcinoma is frequently brought on by alcohol and smoking usage, like some other larynx cancers, but has a favorable prognosis than other larynx cancers due to its lower incidence of local, distant, & nodal invasions.

Glottic malignancies can be treated in a variety of ways, from early-stage radiation or single-modality transoral laser therapy to total laryngectomy for even more advanced illnesses. Therefore, in order to facilitate the most effective therapy strategy for this illness, providers need to have a complete awareness of the anatomy and stages of glottic carcinoma.

Epidemiology

About one percent of all male and 0.3 percent of female cancers globally are primary larynx & glottic tumors, which are rare. According to the American Cancer Society, 12370 cases reported of larynx carcinoma are expected to be diagnosed in 2020, with over 60% of these instances largely originating from the glottis.

With a male-to-female ratio of 4:1, of these new instances, 9820 will be in men, & 3750 will pass away from the condition. Fortunately, these numbers come after a 2 – 3 percent annual drop in overall instances. Male, African American individuals, & low-income have been observed to present with greater rates of advanced disease, and percentages of larynx cancer vary dramatically with individual patient clinical features.

Additionally, the geographical area can affect disease rates; for example, Northern Ireland and Scotland have more than twice as many instances per 100,000 people as England, which is less than half that proportion.

Anatomy

Pathophysiology

Over 90 percent of laryngeal cancers are squamous cell carcinomas. It might manifest as an endophytic and exophytic lesion and grows slowly. Glottic malignancies often develop from the free border of the vocal cords’ anterior portion. The lesion can be long-term contained within the Reinke space by a variety of anatomical constraints. Spread can happen either posteriorly to the arytenoid cartilages or locally across the anterior commissure (even though the anterior commissure ligaments act as a strong barrier to the invasions).

The vocal ligaments & muscles may eventually be directly invaded by cancers, which could lead to vocal cord fixing due to the involvement of the muscles thyroarytenoid. From this point, malignancies can enter the paraglottic region & spread cranially as well as caudally. Although thyroid cartilaginous invasion will frequently occur in severe T4a malignancy, larynx cartilage is particularly resistant to primary cancer invasion.

Although subglottic malignancies frequently invade paratracheal & mediastinal nodal, as well as supraglottic malignancies frequently demonstrate initial bilateral nodes metastases, cancers of the glottis have such a low percentage of lymphatic transmission, which is attributed to an insufficient submucosal lymph supply. When cancer enters another larynx subsite or crosses the anterior commissure, node metastasis frequently spreads to stages two, three, four, & six. The second commonest laryngeal cancer is lymphoma, but it accounts for less than one percent of all malignancies in this area.

Although it rarely necessitates surgical repair beyond early biopsy and tracheostomy in cases of acute airflow limitation, it nonetheless serves as a crucial diagnosis. When treated with chemotherapy and radiation, the prognosis is favorable. Chondrosarcoma, salivary gland type of cell cancers, & neuroendocrine malignancies are only a few of the other larynx cancer subtypes that can develop from a wide range of cells; however, such cancers are exceedingly rare and have only been discussed in a small number of event case studies series.

Etiology

There has always been a link between smoking and binge drinking and the development of glottic & larynx squamous cell carcinomas. Smokers have rates of larynx cancer that are 15 to 30 times greater than non-smokers, and frequent alcohol use further increases the likelihood of developing the disease. Additionally, continuing to smoke after diagnosis and therapy is linked to worse survival results and greater recurrence risk.

A good diet is thought to have a slight protective effect. Other potential risk factors include opium usage, gastric reflux, red meat consumption, occupational overexposure, and lower socioeconomic level. Although the involvement of the HPV (human papillomavirus) in many oropharyngeal malignancies is now well established, the same cannot be said for laryngeal malignancies.

According to numerous meta-analyses, HPV may be linked to 20 to 30 percent of laryngeal malignancies. To demonstrate a real causal relationship between both the virus & glottic carcinoma, additional research will be required because these rates differ significantly by geographic region.

Genetics

Prognostic Factors

Overall, the prognosis for early larynx tumors is favorable, with five-year survival rates of 90 percent for stage 1 & 80 percent for stage 2 tumors when treated with larynx-preserving surgeries or single-modality radiation. The 1990 Veterans Affairs study noted a two-year survival of sixty-eight percent and sixty-four percent for terminal illnesses managed with initial radiotherapy combined with standard chemotherapy against postoperative & laryngectomy radiation, indicating that survival rates are worse for further advanced diseases.

Glottis disease, however, has a marginally better prognosis overall than other larynx locations, with five-year overall survival of eighty-three percent for locally advanced, forty-two percent for all stages of the disease, & seventy-six percent across all phases, as opposed to sixty-one percent, thirty percent, and forty-six percent for supraglottic & sixty percent, forty-five percent, and fifty-two percent for subglottic tumors, respectively. The overall rate of five-year survival for distant and localized glottic carcinoma has, regrettably, declined between 1977 & 2002.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK558979/

Glottic Cancer

Updated : November 16, 2022




One of the most prevalent head and neck tumors, laryngeal cancer, is estimated to account for 1 percent of all malignancies in the globe. The actual voice cords, as well as the posterior and anterior commissure of the laryngeal, are considered the sites of glottic carcinoma.

Glottic carcinoma is frequently brought on by alcohol and smoking usage, like some other larynx cancers, but has a favorable prognosis than other larynx cancers due to its lower incidence of local, distant, & nodal invasions.

Glottic malignancies can be treated in a variety of ways, from early-stage radiation or single-modality transoral laser therapy to total laryngectomy for even more advanced illnesses. Therefore, in order to facilitate the most effective therapy strategy for this illness, providers need to have a complete awareness of the anatomy and stages of glottic carcinoma.

About one percent of all male and 0.3 percent of female cancers globally are primary larynx & glottic tumors, which are rare. According to the American Cancer Society, 12370 cases reported of larynx carcinoma are expected to be diagnosed in 2020, with over 60% of these instances largely originating from the glottis.

With a male-to-female ratio of 4:1, of these new instances, 9820 will be in men, & 3750 will pass away from the condition. Fortunately, these numbers come after a 2 – 3 percent annual drop in overall instances. Male, African American individuals, & low-income have been observed to present with greater rates of advanced disease, and percentages of larynx cancer vary dramatically with individual patient clinical features.

Additionally, the geographical area can affect disease rates; for example, Northern Ireland and Scotland have more than twice as many instances per 100,000 people as England, which is less than half that proportion.

Over 90 percent of laryngeal cancers are squamous cell carcinomas. It might manifest as an endophytic and exophytic lesion and grows slowly. Glottic malignancies often develop from the free border of the vocal cords’ anterior portion. The lesion can be long-term contained within the Reinke space by a variety of anatomical constraints. Spread can happen either posteriorly to the arytenoid cartilages or locally across the anterior commissure (even though the anterior commissure ligaments act as a strong barrier to the invasions).

The vocal ligaments & muscles may eventually be directly invaded by cancers, which could lead to vocal cord fixing due to the involvement of the muscles thyroarytenoid. From this point, malignancies can enter the paraglottic region & spread cranially as well as caudally. Although thyroid cartilaginous invasion will frequently occur in severe T4a malignancy, larynx cartilage is particularly resistant to primary cancer invasion.

Although subglottic malignancies frequently invade paratracheal & mediastinal nodal, as well as supraglottic malignancies frequently demonstrate initial bilateral nodes metastases, cancers of the glottis have such a low percentage of lymphatic transmission, which is attributed to an insufficient submucosal lymph supply. When cancer enters another larynx subsite or crosses the anterior commissure, node metastasis frequently spreads to stages two, three, four, & six. The second commonest laryngeal cancer is lymphoma, but it accounts for less than one percent of all malignancies in this area.

Although it rarely necessitates surgical repair beyond early biopsy and tracheostomy in cases of acute airflow limitation, it nonetheless serves as a crucial diagnosis. When treated with chemotherapy and radiation, the prognosis is favorable. Chondrosarcoma, salivary gland type of cell cancers, & neuroendocrine malignancies are only a few of the other larynx cancer subtypes that can develop from a wide range of cells; however, such cancers are exceedingly rare and have only been discussed in a small number of event case studies series.

There has always been a link between smoking and binge drinking and the development of glottic & larynx squamous cell carcinomas. Smokers have rates of larynx cancer that are 15 to 30 times greater than non-smokers, and frequent alcohol use further increases the likelihood of developing the disease. Additionally, continuing to smoke after diagnosis and therapy is linked to worse survival results and greater recurrence risk.

A good diet is thought to have a slight protective effect. Other potential risk factors include opium usage, gastric reflux, red meat consumption, occupational overexposure, and lower socioeconomic level. Although the involvement of the HPV (human papillomavirus) in many oropharyngeal malignancies is now well established, the same cannot be said for laryngeal malignancies.

According to numerous meta-analyses, HPV may be linked to 20 to 30 percent of laryngeal malignancies. To demonstrate a real causal relationship between both the virus & glottic carcinoma, additional research will be required because these rates differ significantly by geographic region.

Overall, the prognosis for early larynx tumors is favorable, with five-year survival rates of 90 percent for stage 1 & 80 percent for stage 2 tumors when treated with larynx-preserving surgeries or single-modality radiation. The 1990 Veterans Affairs study noted a two-year survival of sixty-eight percent and sixty-four percent for terminal illnesses managed with initial radiotherapy combined with standard chemotherapy against postoperative & laryngectomy radiation, indicating that survival rates are worse for further advanced diseases.

Glottis disease, however, has a marginally better prognosis overall than other larynx locations, with five-year overall survival of eighty-three percent for locally advanced, forty-two percent for all stages of the disease, & seventy-six percent across all phases, as opposed to sixty-one percent, thirty percent, and forty-six percent for supraglottic & sixty percent, forty-five percent, and fifty-two percent for subglottic tumors, respectively. The overall rate of five-year survival for distant and localized glottic carcinoma has, regrettably, declined between 1977 & 2002.

https://www.ncbi.nlm.nih.gov/books/NBK558979/