Carcinoma of Larynx - Erler Zimmer

Carcinoma of Larynx - Erler Zimmer

Clinical History

A 47-year-old male presented with a 13-month history of dysphonia and odynophagia at the level of his thyroid cartilage, accompanied by a significant smoking history. Investigations revealed a laryngeal tumor, for which he received radiotherapy followed by a laryngectomy. Six months later, pulmonary metastases were discovered, leading to his subsequent demise.

Pathological Findings

This is the patient’s laryngectomy specimen, sliced open and viewed from the posterior aspect. A well-differentiated squamous cell carcinoma (SCC) is evident, causing significant distortion to the right vocal cord with an irregular ulcerating tumor. Mucosal congestion is also noted.

Further Information

Over 95% of laryngeal cancers are SCC, typically developing on the vocal cords but may occur in various laryngeal regions. It often starts as carcinoma in situ, progressing to ulcerated and fungating carcinoma with ongoing exposure to carcinogens.
The primary risk factors for laryngeal cancer are tobacco smoke and alcohol consumption. Additional factors include Human Papilloma Virus (HPV) infection, asbestos exposure, and irradiation, with a higher incidence in males and most commonly presenting in the 6th decade of life.

Laryngeal cancer may spread through invasion into surrounding structures, lymphatics (usually to local cervical nodes), or hematogenous metastasis (commonly to the lungs). Common symptoms include dysphonia, dysphagia, odynophagia, globus, and cough. Less commonly, haemoptysis, stridor, dyspnea, and halitosis may be present. Treatment varies based on disease stage, with smoking and alcohol cessation being crucial. Early-stage treatments may involve laryngeal preservation methods like laser therapy, microsurgery, and radiotherapy, while later stages may require a combination of laryngectomy, radiotherapy, and chemotherapy.