Squamous cell carcinoma of the larynx

Squamous cell carcinoma of the larynx is the most common primary malignant tumor 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.

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

The tumor 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
Supraglottic carcinoma

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.

Glottic carcinoma

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

Subglottic carcinoma

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.

Staging

See: laryngeal squamous cell carcinoma staging

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

Supraglottic carcinoma
CT

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 tumor extension.

MRI
  • T1: low signal
  • T2: high signal
  • STIR: high signal 
  • T1C+: homogeneous or heterogeneous enhancement
  • obliteration of paraglottic fat may be seen
Glottic carcinoma
CT

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

MRI
  • T1: low signal
  • T2: high signal
  • T1C+: homogeneous enhancement
Subglottic carcinoma
CT
  • enhancing soft tissue at the level of the cricoid cartilage
MRI
  • 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. 

Share article

Article information

rID: 41669
System: Head & Neck
Section: Pathology
Tags: larynx, cancer
Synonyms or Alternate Spellings:
  • Laryngeal squamous cell carcinoma
  • Laryngeal squamous cell carcinoma (SCC)
  • Laryngeal SCC
  • Squamous cell carcinomas of the larynx

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1: supraglottic
    Drag here to reorder.
  • Drag
    Case 2: transglottic
    Drag here to reorder.
  • Drag
    Case 3: supraglottic
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.