OncologyTier 2Disease (DEADMAN)

Cancer - laryngeal

Description

Squamous cell carcinoma arising from the laryngeal mucosa (glottic, supraglottic, or subglottic) - the most common head and neck cancer subtype in many populations

Strongly associated with smoking and alcohol (synergistic risk when combined); M>F, typically older adults

Field cancerisation from chronic mucosal carcinogen exposure (tobacco, alcohol) drives sequential dysplasia -> carcinoma in situ -> invasive carcinoma across the upper aerodigestive tract mucosa - explains the risk of synchronous/metachronous second primaries elsewhere in this field

Glottic tumours present early with hoarseness (any persistent hoarseness >3 weeks in an at-risk patient warrants laryngoscopy) given the vocal cords' sensitivity to even small lesions
Supraglottic tumours present later (richer lymphatic drainage, less sensitive to small mass effect) - often with a neck mass (nodal metastasis) as the presenting feature
Direct laryngoscopy with biopsy for tissue diagnosis; CT/MRI neck for local staging; PET-CT for nodal/distant staging

Early-stage glottic disease - radiotherapy or transoral laser surgery, both with excellent voice-preserving outcomes and high cure rates
Advanced disease - combined modality (surgery, often laryngectomy +/- radiotherapy +/- chemotherapy); organ-preservation chemoradiotherapy protocols avoid total laryngectomy in many patients who would previously have lost their voice box
Total laryngectomy requires a permanent stoma and voice rehabilitation (tracheoesophageal puncture/voice prosthesis, electrolarynx, or oesophageal speech)

Smoking, alcohol (synergistic), second primary tumours of the upper aerodigestive tract (field cancerisation)

Early glottic cancer has excellent (>90%) cure rates given early presentation with hoarseness; advanced/supraglottic disease carries substantially worse prognosis, reflecting later detection

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