Difficulties in management of vocal cord precancerous lesions

Kambič, Vinko

doi:10.1017/s0022215100085388

Cited by 30 publications

(9 citation statements)

References 5 publications

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“…Such referral patterns tend to select for more seriously affected patients, a feature readily demonstrated by comparing the transformation rates of the 2 investigations which have followed large numbers of untreated LK cases: 22.2% of such lesions became malignant in a patient cohort derived from a teaching hospital, whereas only 0.9% did so in a general population. 23,41 The KWONKWA segregation has helped to clarify the risk of malignant transformation in LK, but has several major flaws. First, it requires a biopsy specimen and, therefore, does not take into account the 53% of LK lesions which are never b i~p s i e d .~~ Second, the word "atypia" encompasses a number of histologic changes not associated with malignancy or premalignancy ; in this light, "keratosis with dysplasia" would be preferred.…”

Section: Association With Cancermentioning

confidence: 99%

Laryngeal precancer: A review of the literature, commentary, and comparison with oral leukoplakia

1991

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Laryngeal keratosis (LK) is a precancerous mucosal change with great similarity to oral leukoplakia. Its malignant transformation rate varies from 1% to 40%, with the highest rates being found in patients microscopically diagnosed as "keratosis with atypia" (KWA). Recent evidence indicates that even cases with only mild or moderate epithelial dysplasias are at increased risk for malignant transformation, with the highest rates occurring in patients with more severe dysplasia or carcinoma in situ. Approximately 81% of LK patients are men and the average age at diagnosis is 50 years, a decade younger than that for laryngeal carcinoma patients. A high proportion of LK patients are tobacco smokers (84%) and alcohol abusers (at least 35%). LK is almost always found on the true vocal cords and is usually bilateral (67%). Clinical signs of high risk include, in decreasing order of importance: erythroplakia, surface granularity, increased keratin thickness, increased size, recurrence after conservative removal, and long duration. The annual incidence of LK in the United States is 10.2 and 2.1 lesions per 100,000 males and females, respectively.

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Section: Association With Cancermentioning

confidence: 99%

Laryngeal precancer: A review of the literature, commentary, and comparison with oral leukoplakia

1991

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“…During recent decades, various aspects of laryngeal carcinogenesis have been intensively studied, including the aetiology, histological classification, treatment, frequency of malignant transformation and predictive factors. Many researchers have provided meticulous analyses of histological classifications of SILs in relation to their biological behaviour 2–4,6–27 . These analyses have been recently further supplemented by molecular genetic investigations trying to elucidate the pathogenic mechanisms of SCC development, and to improve the prognostic evaluation of SILs 1,28–51 …”

Section: Introductionmentioning

confidence: 99%

“…Particular interest in the spectrum of SILs has always been focused on lesions with the highest rate of malignant transformation 3,8,23–25,52–54 . These lesions are variously designated as potentially malignant, risky, precursor, preneoplastic or precancerous lesions.…”

Section: Introductionmentioning

confidence: 99%

Current review on squamous intraepithelial lesions of the larynx

Gale¹,

Michaels²,

Luzar³

et al. 2009

Histopathology

121

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Squamous intraepithelial lesions (SILs) of the larynx, clinically usually defined as leukoplakia and chronic laryngitis, have remained the main controversial topic in laryngeal pathology for decades as regards classification, histological diagnosis and treatment. SILs are caused by smoking and alcohol abuse. There is also mounting evidence that gastroesophageal reflux is a potential aetiological factor. Human papillomavirus infection seems to play little if any role in laryngeal carcinogenesis. Histological classification of SILs is the central disputed aspect of these lesions. There are as yet no generally accepted criteria for histological grading of laryngeal SILs. Three currently used classifications of SILs are reviewed here: the dysplasia system, the Ljubljana classification and the binary system of squamous intraepithelial neoplasia. One of the most important issues of SILs is the risk of malignant transformation. Data in the literature are controversial because of inconsistent use of morphological criteria in different classifications. It is often difficult for clinicians to agree on the most appropriate therapeutic option for a particular grade of SIL that has been diagnosed. Transition from normal epithelium to SILs and squamous cell carcinoma is related to progressive accumulation of genetic changes leading to a clonal population of transformed epithelial cells. Despite extensive research into these genetic changes in laryngeal carcinogenesis, reliable genetic markers with diagnostic and prognostic value are still lacking.

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“…Particular attention has been directed to the analysis of the interrelationship between histological parameters and their biological behaviour (Gale et al 2005, Gale et al 2006Kambicˇ&Gale, 1986;Putney&O'Keefe 1953;Kambicˇ 1978;Crissman 1979;Henry 1979;Hellquist et al, 1982;Gillis et al, 1983;Grundmann 1983;Goodman 1984;Crissman&Fu 1986;Velasco et al 1987;Olde-Kalter et al 1987;Crissman&Zarbo 1989;Sllamniku et al 1989;Bouquot et al, 1991a;Kambic&Gale 1995;Hellquist et al 1999;Gallo et al 2001;Ricci et al 2003). These analyses have been recently further supplemented by molecular genetic investigations trying to include the molecular events involved in the pathogenesis of oral squamous cell carcinoma (OSCC) to improve the prognostic evaluation of OIN (Ha&Califano 2002;Somers et al 1992;Saglam et al 2007).…”

Section: Introductionmentioning

confidence: 99%