EN4.42 | Malignancy of Larynx Hypopharynx — Summary & Reflection

KEY TAKEAWAYS

Laryngeal carcinoma is squamous cell carcinoma (>95%) of the larynx. Three subsites: glottic (~60%, earliest symptom = hoarseness due to direct cord involvement, sparse lymphatics = poor early nodal spread, excellent prognosis at T1 >90%); supraglottic (~35%, late hoarseness, rich bilateral lymphatics = early bilateral nodal spread, worse prognosis); subglottic (~5%, stridor, worst prognosis). Hypopharyngeal carcinoma arises from the piriform sinus (commonest), posterior pharyngeal wall, or postcricoid region — the last associated with Plummer-Vinson syndrome (iron-deficiency anaemia + postcricoid web + koilonychia). Investigations: direct laryngoscopy and biopsy (histological confirmation), CT neck and chest (staging), MRI (soft tissue), panendoscopy for hypopharyngeal. TNM staging — T3 glottic = cord fixation; T4a = cartilage invasion. Management: T1-T2 glottic = primary radiotherapy (>90% survival T1a); T3 = organ-preservation concurrent CRT (RTOG protocol) or total laryngectomy; T4a = total laryngectomy + PORT. Voice rehabilitation after laryngectomy: TEP with voice prosthesis is preferred. Neck: elective dissection for N0 supraglottic; therapeutic for N+. Hypopharyngeal carcinoma carries poor overall prognosis (~25-35% five-year survival).

REFLECT

The treatment of T1 glottic carcinoma with radiotherapy represents one of the best oncological outcomes in head and neck surgery — more than 90% of patients are cured, and most retain a functional voice. Yet in India, a substantial proportion of patients with laryngeal carcinoma present at T3 or T4 — with cord fixation or cartilage invasion — because the early warning symptom of hoarseness was ignored or misattributed for months at the primary-care level. Reflect on the following: How many of these late-presentation cases could have been intercepted earlier with a single correct application of the >3 weeks rule? As a future clinician — whether you go into ENT, general medicine, or family practice — you will be in a position to ask: 'How long have you had this hoarseness?' Think about what it would mean to a patient's family if your question led to a T1 diagnosis instead of a T4 diagnosis. Now reflect on the equity dimension: in your district hospital posting, what barriers might prevent a patient from presenting early (cost, access, health literacy, fear), and what public health interventions could address them?