Larynx/vocal cord cancer – Flashcards
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5% of all malignancies comprise of?
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H&N cancer
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Management of H&N cancers require a?
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multidiscipline approach
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2% of total cancer risk and most common H&N cancer? Most common in males or females?
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Larynx cancer/males from 60-70
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histology for larynx?
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squamous cell carcinoma
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most common presenting factor in vocal cord?
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hoarseness, sore throat, and pain when tumor arises in supraglottic region.
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the larynx is divided into what 3 regions?
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Supraglottic-34% glottic-65% subglottic1%
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supraglottic
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largest region of the larynx and includes the laryngeal surface of the epiglottis, aryepiglottic folds, arytenoids, false vocal cords and laryngeal ventricles.
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Glottis
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includes the right and left true vocal cords and the anterior/posterior commissures. The majority of glottis lesions arise in the anterior one half of the vocal cords. The anterior commissure is usually 1.0 cm from the skin surface. Special attention to anterior border must be given.
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Subglottis
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extends from .5 cm below glottis to lower margin of cricoids cartilage.
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Routes of Spread:
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There are no capillary lymphatics in the true vocal cords. Therefore, lymph node metastasis does not occur until the tumor spreads beyond the true vocal cords.
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Treatment of Glottic Cancer:
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1. External beam radiation 2. Hemi-laryngectomy 3. Cordectomy or transoral removal of the lesion
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Why is radiation therapy preferred larynx treatment?
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preferred treatment for early stage tumors to preserve voice quality and good cure rates.
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chin to SSN measurement should be taken if?
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no mask is used
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Surgery is generally reserve for?
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salvage therapy
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Glottic tumors spread by?
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local invasion to the supraglottic or subglottic regions.
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Impairment in the mobility of the vocal cords may occur by?
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direct invasion of the tumor into the underlying intrinsic muscle (thyroarytrenoid).
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Vocal cord immobility prognosis?
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poor
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The incidence of distant metastasis is?
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10-20% with LUNG being the most common site for mets.
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Most common larynx cancer
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glottis
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What is important about patient positioning for larynx cancer?
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location of larynx and chin extended.
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why is a wedge used in the treatment of vocal cord cancer?
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curvature of neck and to avoid hotspots.
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what cartilage comprises the outside shell of the larynx.
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Thyroid C4 sup and cricoid cartilage C6 inf.
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What lymphatics are vocal cord cancer comprised of?
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mets does not occur until cancer is past vocal cords.
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Most common pattern of spread in larynx cancer?
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supraglottic or subglottic regions
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Does surgery play a role in larynx cancer?
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salvage
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does fixed vocal cords are good prognosis?
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no, poor
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Chicken wing postion
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Lateral decubitus w/arm fixed at the elbow and tuck under thorax.
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when would supraclav fields be treated in laraynx cancer?
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in supraglottic cancers
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Dose shape distribution in vocal cord cancer?
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bell shape
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What is verrucous carcinoma of the larynx?
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Uncommon variant of squamous cell carcinoma. found in people who chew tobacco. well differentiated, slow growing wart like lesion.
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prescription for vocal cord cancer T1 N0 M0?
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6000cgy, 200cgy/fx, 33fx, 6mv, midplane, and wedges to compensate for neck contour.
