Squamous cell carcinoma of the larynx

Squamous cell carcinoma of the larynx is the most common primary malignant tumour that affects the laryngeal framework (98%). Typically it is categorised by the laryngeal subsite affected, which affects presentation, treatment and prognosis. 

Male are more affected than females, and usually the older age group (>50 years) are more susceptible.

  • smoking
  • alcohol
  • Greek/Turkish coffee 3
  • mixed evidence that asbestos exposure is a risk factor 4,5

The tumour is classified according to it relation with the glottis, which affects the treatment options: 

  • supraglottic carcinoma (20-30%)
  • glottic carcinoma (50-60%)
  • subglottic carcinoma (5%)
  • transglottic carcinoma: involving two or more of these spaces

SCC arises from epiglottis, aryepiglottic fold, false vocal fold, as well as deep pre-epiglottic and paraglottic space. It metastasises early to cervical lymph nodes.

SCC arises from the true vocal fold. It manifests early due to hoarseness of voice and rarely metastasises due to the paucity of lymphatic drainage of the glottis.

SCC arises from anywhere below the true vocal fold to the inferior edge of the cricoid cartilage. It produces minimal symptoms which are responsible for late detection, early lymph node metastasis and hence poor prognosis.

See: laryngeal squamous cell carcinoma staging

CT and MRI can both be used to assess and stage laryngeal SCC. PET-CT can be used to assess for post-recurrence resection. 

Supraglottic soft tissue mass causing asymmetry of the laryngeal sides and cartilage sclerosis. The mass displays moderate enhancement. Enlarged lymph node >1.5 cm in short axis. CT can assess tumour extension.

  • T1: low signal
  • T2: high signal
  • STIR: high signal 
  • T1C+: homogeneous/heterogeneous enhancement
  • obliteration of paraglottic fat may be seen

Enhancing exophytic or infiltrative true vocal fold mass. CT is useful to assess tumour for extension to anterior commissure (>1 mm thickness), posterior commissure, supra- or subglottis.

  • T1: low signal
  • T2: high signal
  • T1C+: homogeneous enhancement
  • enhancing soft tissue at the level of the cricoid cartilage
  • T1: low signal
  • T2: high signal
  • T1C+: heterogeneous enhancement

Small tumours may be treated with laser therapy or radiotherapy. Larger tumours require combination radiotherapy and total laryngectomy.

Voice-sparing supraglottic laryngectomy for supraglottic lesions with no cord fixation is also possible. 

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Article information

rID: 41669
Synonyms or Alternate Spellings:
  • Laryngeal squamous cell carcinoma
  • Laryngeal squamous cell carcinoma (SCC)
  • Laryngeal SCC
  • Squamous cell carcinomas of the larynx

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Cases and figures

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    Case 1: supraglottic
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    Case 2: transglottic
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    Case 3: supraglottic
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    Case 4: trans-glottic
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