Treatment of choice for laryngeal carcinoma of glottis extending to supraglottic region with vocal cord fixation with papable solitary’ ipsilateral lymph node is –
Correct Answer: Total laryngectomy with radical neck dissection
Description: Ans. is 'c' i.e., Total laryngectomy with radical neck dissection o Patient with with glottis carcinoma extending to the supra glottis region along with vocal cord fixation (bad prognostic sign; involvement of thyroarytenoid muscle) belongs to T3 stage og glottis carcinomao Single ipsilateral lymph node of 2 cm size signifies N1 nodal statuso And there is no evidence of distal metastases so MOo This patient belongs to T3N1 MO.o Treatment of choice in such patient is total laryngectomy with radical neck dissection.STAGING OF LARYNX CANCERo Treatment of larynx cancer depends upon the stage of the tumor,o Therefore, one should know the TNM staging (TNM classification) of large cancer. TNM classification of cancer larvnx ( American Joint Committee on Cancer. 2002)SupraglottisT1Tumour limited to one subsite of supraglottis with normal vocal cord mobility.T2Tumour invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis (e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynxT3Tumour limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space and/or minor thyroid cartilage invasionT4aTumour invades through the thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscle of tongue, strap muscles, thyroid or oesophagus)T4bTumour invades prevertebral space, encases carotid artery or invades mediastinal structuresGlottisT1Tumour limited to vocal cord(s) (may involve anterior or posterior commissures) with normal mobility'T1aTumour limited to one vocal cordTlbTumour involves both vocal cordsT2Tumour extends to suproglottis and/or subglottis, and'or with impaired vocal cord mobility.T3Tumour limited to the larynx with vocal cord fixation and/or invades paraglottic space and'or minor thyroid cartilage erosion.T4aTumour invades through thyroid cartilage and'or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscles of the tongue, strap muscles, thyroid, or oesophagus).T4bTumour invades prevertebral space, encases carotid artery or invades mediastinal structuresSubglottisT1Tumour limited to subglottisT2Tumour extends to vocal cord(s) writh normal or impaired mobilityT3Tumour limited to larynx with vocal cord fixationT4aTumour invades cricoid or thyroid cartilage andor invades tissue beyond the larynx (e.g., trachea, softtissues of neck including deep extrinsic muscle of tongue, strap muscles, thyroid or oesophagus)T4bTumour invades prevertebral space, encases carotid artery or invades mediastinal structuresRegional lymph nodes (N)NxRegional lymph nodes cannot be assessedN0No regional lymph node metastasisN1Metastasis in a single Ipsilateral lymph node, 3 cm or less in greatest dimensionN2Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, or bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.N2aMetastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension.TREATMENT OF LARYNX CANCERTreatment of glottic cancero Stage dependent treatment includei) Carcinoma in situ (CIN) Best treated by transoral endoscopic CO2 laser. If laser is not available stripping of vocal cord is done and the tissue is sent for biopsy. If biopsy shows invasive carcinoma, radiotherapy is given otherwise regular follow up is done.T1 carcinoma Radiotherapy is the treatment of choice,, Surgery is used only after they recur.T1 carcinoma with extension to anterior commissure The treatment of choice is radiotherapy. If it is unavailable, frontolateral partial laryngectomy is done with regular follow up. If it fails, total laryngectomy is performed.T2 Ca with extension to arytenoid :- Treatment is same as above but surgery is preferred.T2 carcinoma :-Treatment depends on- (i) Mobility of vocal cords, and (ii) Involvement of anterior commissure and/or arytenoidIf mobility ofcord is not impaired (cord is mobi le) and anterior comm issure and /or arytenoid not in vol ved: - Radiotherapy is the treatment of choice. In case of recurrence total laryngectomy or partial vertical laryngectomy is done.If the mobility of cord is impaired or anterior commissure and/or arytenoid involved :- Voice preserving conservative surgery such as vertical hemilaryngectomy or frontolateral laryngectomy is done. Total laryngectomy is done if there is recurrence on follow up : -iv) T3 and T4 carcinoma : - Total laryngectomy is the treatment of choice; combined with neck dissection if the nodes are palpable. More advanced lesions are treated by combined therapy, i.e., surgery with post-operative radiotherapy.Treatment of snpragiottic cancerT1 lesions- respond well to radiation. They can also be excised with CO2 laser.T2 lesions- voice conserving supraglottic partial hemi laryngectomy with or without neck dissection if lung function is good, otherwise radiotherapy can be given to the primary cancer and the nodes.T3 and T4 lesions- often require total laryngectomy with neck dissection and post operative radiotherapy.T1 and T2 cancer Radiotherapy.T3 and T4 cancer Total laryngectomy with post-operative radiotherapy.Treatment of subglottic cancerT1 and T2 cancer - RadiotherapyT3 and T4 cancer - Total laryngectomy with post-operative radiotherapy.
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