Cancer spread in the larynx: A pathologic basis for conservation surgery

Abstract

Background Previous pathologic studies of the spread of laryngeal carcinoma have drawn inferences about the site of origin of tumors, their mechanisms of growth, or the role of structures as potential barriers to tumor spread. Most of the information is based on the study of advanced or recurrent tumors and is difficult to apply to conservation surgical technique. We carried out a systematic analysis of a wide range of laryngeal tumors with the aim of providing a basis for conservation surgery. Methods We analyzed tumor invasion of the laryngeal spaces and the laryngeal framework in relation to the mucosal tumor extent by axial sectioning of 80 sequential partial and total laryngectomy specimens. Results Invasion of a particular laryngeal space could be accurately predicted by mucosal tumor extent and vocal cord mobility. Invasion of the laryngeal framework was associated with tumor extension to the ventricle, subglottis, or pyriform fossa. The thyroid cartilage and the cricothyroid space and ligament were the most frequent sites of invasion. Conclusions The mucosal distribution of a tumor and observation of vocal cord mobility can be used to determine accurately the extent of tumor invasion of the laryngeal spaces and framework and therefore the extent of resection necessary. © 2000 John Wiley & Sons, Inc. Head Neck 22: 265–274, 2000.

Hypothyroidism in surgically treated T4 hypopharyngeal and laryngeal cancers

“…4 Similarly subglottic extension of more than 1cm and paraglottic extension also have been reported as a predictor for extralaryngeal spread and thyroid involvement. 3,[5][6][7][8][9] Subglottic extension more than 1.5 cm has been reported to have 100% chance of thyroid gland involvement as against 8% when its 0.5 cm into subglottis. 3,6 One of the main reasons for treatment failure has been attributed to, inadequate level 6 clearance in subglottic extension cases.…”

Evaluación histopatológica del espécimen de laringectomía subtotal

“…Los sitios en donde con mayor frecuencia se pueden encontrar los márgenes de sección infiltrados por tumor son: la unión de la cuerda vocal con la mucosa aritenoidea (sitio de corte posterior) o bien el propio aritenoides si este se incluyó en la cirugía; la presencia de tumor en él implica extensión del tumor a la región interaritenoidea y gran riesgo de residual tumoral en el aritenoides remanente; la mucosa localizada por debajo de la comisura anterior; sitio de corte inferior, entre el límite de la glotis con la subglotis y la mucosa por debajo de las cuerdas vocales, lo que implica infiltración tumoral subglótica [16][17][18] .…”

Contemporary Important Considerations in Diagnosis and Treatment of Head and Neck Cancer

“…It is also important to remember that organ preservation does not necessarily equate with conservation of organ function (2). Supraglottic laryngectomy is pathologically justi ed when there is no mucosal extension of the tumor to the ventricle, petiole of the epiglottis, vocal cord, pyriform sinus apex and laryngeal framework (1,3). The clinical validity of this technique is amply con rmed in the literature (4), but it is unacceptable to justify its application on embryological grounds (5).…”