Pattern of Regional Metasteses in Laryngeal Carcinoma

Abstract

Background: Regional metastases to the cervical lymph node is common in laryngeal carcinoma and this is also the most important prognostic factor of the disease. Objective: The purpose of the present study was to see the frequency of cervical metastases related to the sites of laryngeal carcinoma and also to see the relation between primary site and level of metastatic node as well as the relation between T and N stage of the tumour. Methodology: This cross sectional study was done in the Department of Otolaryngology and Head-Neck Surgery at Bangabandhu Sheikh Mujib Medical University, Dhaka and Specialized ENT Hospital of SAHIC, Dhaka from April 2009 to March 2010. A total number of 50 patients who were histopathologically proven laryngeal carcinoma at any age with both sexes were included in this study. General physical examination and ENT examination was done thoroughly. Direct laryngoscopy was done under general anaesthesia to assess the site, size, and extension of the tumour as well as for staging and biopsy. Results: A total number of 60% laryngeal carcinoma patients presented with regional metastases to the cervical nodes. Highest cases among laryngeal carcinoma were supraglottic carcinoma (72.0%) which also showed the highest rate of lymph node metastases (72.2%). Most frequently involved levels of the neck were level II (56.7%) and level III (33.3%). It was also observed that the rate of regional metastases was increasing with the advancing T-stage of the disease. Conclusion: Regional metastases is a useful prognostic indicator of the laryngeal carcinoma. So, early detection of the disease has a great importance on the management of the disease.

Pattern of Neck Node Metastasis in Laryngeal Carcinoma

“…25 In supra-glottic cancers, the probability of cervical metastasis and the probability of delayed contralateral metastasis increase in direct proportion to the size of the primary lesion (i.e., the T stage). 5 showed N 0 was found 20(40.0%) cases followed by N1 and N2 which were 15(30.0%) cases and 13(26.0%) cases respectively. Kaur et al 16 study 58% (29 cases) were found to be N 0 stageconstituted by 58.3% of the supraglottic lesions, 100% of the glottis lesions and 51.5% of the transglottic lesions.…”

“…Similarly, Jaimanti and Naresh 15 in a 10 year follow up of patients suffering from carcinoma larynx, found the incidence of supraglottic carcinoma was 55.94% of all laryngeal cancers followed by glottis (17.3%), transglottic (13.04%) and subglottis (3.62%). Ahsan et al 5 showed among 36 supraglottis cases, 26 (72.2%) cases showed metastasis. Out of 13 glottis cases, metastasis was found in 4 (30.8%) cases.…”

“…Since the chance of regional metasteses is more in supraglottic carcinoma and it is the commonest among the laryngeal carcinomas in Bangladesh, metastatic lymph nodes in laryngeal carcinoma is also common in Bangladesh. 4 Ahsan et al 5 reported level II nodes were involved in 16 out of 30 cases (53.3%), followed by level III where 7 out of 30 cases (25%) involved. Level IV involved in 2(6.67%) patients.…”

“…Supraglottic carcinoma is characterized by higher prevalence of regional metastases compared with carcinoma of other laryngeal sites. 18,19 In Ahsan et al 5 In fact, because of the profuse lymphatic network of the supraglottic larynx, carcinomas of this area metastasize frequently to the cervical lymph nodes, and failure of treatment is usually a result of metastasis rather than local disease. 21,22 The incidence of patients with clinically positive lymph nodes at the time of diagnosis is 23-50% for all supraglottic sites and stages combined.…”

“…Highest cases among laryngeal carcinoma were supraglottic carcinoma (72.0%) which also showed the highest rate of lymph node metastases (72.2%). 5 Smoking, alcohol consumption, chewing tobacco, genetic factors, occupational factors, vitamin deficiency is the well known causative factors of laryngeal carcinoma. 6 Male are predominant and common age of presentation over 40 years.…”