7171 ## Chapter 44 7172 Tumors of the Larynx 7173 7174 7175 ## Laryngeal Cancer 7176 7177 Second most common malignancy of upper aerodigestive tract (Table 44-1) 7178 7179 Represents 1% to 5% of all malignancies 7180 7181 40% arise in the supraglottis, 59% in the glottis, and 1% in the subglottis 7182 7183 Squamous cell carcinoma (SCC) represents 85% to 95% of laryngeal malignancies 7184 7185 M:F ratio 4:1 7186 7187 Risk factors 7188 7189 (a) Current smokers have 10 to 20-fold increased risk 7190 7191 60% risk reduction after 10+ years of smoking cessation 7192 7193 (b) Alcohol 7194 7195 (c) Prior head and neck SCC 7196 7197 (d) Recurrent respiratory papillomatosis: 3% to 7% undergo malignant degeneration to SCC. Typically related to human papillomavirus (HPV) types 6 and 11. 7198 7199 (e) Relationship of HPV from types 16 and 18 is weak and under investigation 7200 7201 (f) Environmental factors reported in literature such as exposure to wood dust, paint, asbestos, nickel, leather products, and diesel fumes 7202 7203 (g) Gastroesophageal reflux 7204 7205 Functions of the larynx 7206 7207 (a) Three primary functions including phonation, respiration, and airway protection during swallowing. 7208 7209 (b) These functions affect clinical manifestations of laryngeal cancer. 7210 7211 Clinical presentation: Glottic tumors present earlier as they are more symptomatic at a smaller size 7212 7213 (a) Hoarseness/dysphonia (most common symptom) 7214 7215 (b) Sore throat (second most common symptom) 7216 7217 (c) Referred otalgia 7218 7219 (d) Dyspnea/stridor 7220 7221 (e) Dysphagia/aspiration (late manifestations typically in larger supraglottic tumors) 7222 7223 (f) Hemoptysis 7224 7225 (g) Weight loss 7226 7227 (h) Globus sensation 7228 7229 7230 7231 *Table 44-1 Differential Diagnosis of Laryngeal Mass* 7232 7233 7234

Nonneoplastic Lesions	Primary Laryngeal Malignancies
Mucus retention cyst	Epithelial
Laryngocele	Squamous cell carcinoma
Vocal fold polyp	Verrucous
Vocal process granuloma	Spindle cell
Keratosis	Adenoid
Hyperplasia—squamous cell	Basaloid
Hyperplasia—pseudoepitheliomatous	Clear cell
Amyloidosis	Adenosquamous
Infectious—tuberculosis (TB), Candida	Giant cell
Inflammatory—Wegener, relapsing	Lymphoepithelial
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