Cancer of the larynx: current concepts of diagnosis and treatment

Evaluation of the Roles of Serum Vitamin B12, Folate and Homocysteine Levels in Laryngeal Squamous Cell Carcinoma

Metabolic changes in head and neck carcinogenesis are often non-specifically correlated with carcinomas. The study of metabolic disorders can improve the understanding of tumourigenesis at the cellular level. This study was designed to evaluate the role of serum homocysteine, folate, and vitamin B12 levels in the pathogenesis of laryngeal squamous cell cancer (LSCC) by measuring serum levels in 60 consecutive untreated patients with LSCC and 60 controls (30 smokers and 30 non-smokers). Compared with smoker and non-smoker control groups, significantly lower levels of vitamin B12 were found in patients with LSCC. Folate levels in patients with LSCC were also significantly lower than in the smoker and non-smoker control groups. There were no significant differences in the homocysteine levels between these three groups. Metabolic alterations in vitamin B12 and folate levels, particularly hypofolataemia, could be associated with the development of LSCC, although further research is required to confirm their roles definitively.

Cancer of the larynx in Hong Kong: a clinico-pathological study

Laryngeal cancer is a relatively common cancer in Hong Kong when compared with other cities over the world. The purpose of this study is to characterize and identify the clinico-pathological features of patients with laryngeal cancer being resected or autopsied in our hospital for the years 1973 to 1992. The peak age at presentation of 451 patients (408 males, 43 females) with primary laryngeal cancer resected was 62 years old and 1.6% of patients were under 40. The incidence increased with age in both sexes. The patients were noted to be ageing steadily in the 20-year study period. Most patients (30%) had tumours involving both the supra-glottis and glottis. Histological examination revealed that the cancers comprised squamous cell carcinomas (98.3%), spindle cell carcinoma (0.7%), adenoid cystic carcinoma (0.2%), mucoepidermoid carcinoma (0.2%), atypical carcinoid (0.2%) and chondrosarcoma (0.4%). Most cases of squamous cell carcinoma were moderately differentiated (67.3%). Poorly differentiated squamous cell carcinomas were more often noted in females. Forty-six laryngeal cancers were noted in the study period giving an autopsy incidence of laryngeal cancers of 0.46%. Distant metastases were found in 50% of these autopsied cases. The metastatic lesions were found in the lung (43%), liver (18%), diaphragm/pleura (18%), kidney (9%), bone (7%), heart (5%), spleen (2%), nostril (2%) and small intestine (2%). The results indicate that there are different histological subtypes of laryngeal cancer in Hong Kong Chinese and they share similar epidemiological characteristics with those reported in other studies.

Communication status following laryngectomy: the Iowa experience 1984-1987

Data regarding treatment and outcome for a consecutive series of 73 total laryngectomy patients were collected from clinical records with a follow-up period of 30 to 78 months postoperatively. Notable findings were that 27% were women; 75% reported hoarseness or a voice change as an early symptom; and 22% reported combined heavy use of both cigarettes and alcohol. Of the 73 patients, 38 (52%) died during the follow-up period; 18 of the 38 died within 1 year postoperatively. Thirty-nine (53%) of the 73 had received a surgical tracheoesophageal fistula (TEF) for voice restoration, as either a primary or a secondary procedure. Of the 39, 75% were using the TEF at last examination, with no failures attributed to sphincter spasm. Of the total group, the primary communication modality was reported to be use of a TEF by 44% and use of an electrolarynx by 50%. Limitations of the study and directions for future investigations are discussed.

Polyarthritis as the presenting symptom of the occurrence and recurrence of a laryngeal carcinoma

A 50 year old male smoker presented with an identical seronegative polyarthritis before both the occurrence and recurrence of a laryngeal tumour. The interval between the joint symptoms and discovery of the tumour was 11 and 13 months respectively. Treatment of the tumour resulted in complete disappearance of the arthritis on both occasions.

Radical radiotherapy for carcinoma of the larynx--Westmead Hospital experience

Between January 1980 and December 1988, 141 patients were treated with radical radiotherapy for carcinoma of the larynx. One hundred and ten (78%) tumours arose on the vocal cords, twenty nine (21%) from the supraglottis and two (1%) from the subglottis. All 63 stage T1 cases, and all except three of 62 T2 cases seen in the time period, were treated by radiotherapy. In addition 14 selected T3 and 5 T4 cases were irradiated. Only 7% had clinical evidence of regional lymph node metastases at presentation. Median follow up is 47.5 months and 2+ year actuarial local control rates are T1-87%, T2-63%, T3-79% and T4-53%. The rates for vocal cord primaries are T1-86%, T2-58%, and T3-75%. Median time to local failure was 8 months with none occurring beyond 21 months. Two of 130 N0 cases (1.5%) relapsed in cervical lymph nodes with a policy of selective prophylactic irradiation of the regional lymphatic areas. Thirty three/thirty seven patients with locoregional failure underwent salvage surgery with 27/32 (84%) evaluable patients achieving ultimate locoregional control with median follow up of 18.5 months from salvage. Four patients (3%) developed distant metastases and 21 (15%) developed a second primary malignancy (including 13 lung cancers) with an actuarial rate of second primary tumours of 23% at five years. Three year actuarial survival for the whole group is 77% but 66% of deaths were due to causes other than larynx cancer. Tumour specific mortality by stage is T1-1.6%, T2-12%, T3,4-21%.(ABSTRACT TRUNCATED AT 250 WORDS)