上海交通大学耳鼻咽喉科学英文版课件 carcinoma of the larynx.ppt

Surgical treatment Rehabilitation of speech after total laryngectomy Blom- Singer valve Esophageal speech Electrical larynx Radiotherapy T1N0M0 tumors located at the mid-portion of the VC Contraindication for surgery because of poor general condition Pre-operative irradiation for some advanced tumors Other treatment modality Chemotherapy Genetherapy Carcinoma of the larynx Epidemiology Accounts for 1% of all new cancers diagnosed in the U.S. and 0.75% of all cancer deaths. Accounts for 30% in all head and neck cancers. More frequently happened in patients at 50~70 years of age. M:F ratio: 5~10:1 (foreign country)，6.75:1(shanghai). Carcinoma of the larynx Etiology Cigarette Wine (combined smoking and alcohol abuse increases the risk by 50% over the additive rate ) air pollution Virus (HPV) precancerous lesions (Leukoplakia, Papilloma) sex hormones Leukoplakia of the larynx Carcinoma of the larynx Pathology Nearly 98% are squamous cell carcinoma. adenocarcinoma and undifferentiated carcinoma is rare. Carcinoma of the larynx Clinical classification: Glottic (60%)：well differentiated, late metastasis Supraglottic (30%)：poor differntiated, early metastasis Subglottic (6%)：poor differentiated, early metastasis Anatomic divisions of the larynx Carcinoma of the larynx Spread of tumor Direct spread Supraglottic cancer→ epiglottis, pre-epiglottic space, vallecula, and tongue base. piriform sinus, lateral wall of hypopharynx. paraglottic space, ventricle or the VC. Carcinoma of the larynx Spread of tumor Direct spread Glottic cancer→ anteriorly, contralateral VC. posteriorly, arytenoid cartilage superiorly, supraglottic area. inferiorly, paraglottic space and subglottic area. Carcinoma of the larynx Spread of tumor Direct spread Subglottic cancer→superiorly, glottis. anteriorly and laterally, strap muscle and thyroid gland. posteriorly, esophagus. Carcinoma of the larynx Spread of tumor Lymph nodes metastases Supraglottic cancer →