Characteristics and Spread Pattern of Laryngeal Carcinoma : A Tertiary Care Study

Abstract

INTRODUCTION Laryngeal cancer is the eighteenth most common cancer in the UK. It has strong socioeconomic association, wide geographical variations. This study is highly relevant in India where factors like poor socio-economic conditions, oral consumption of tobacco in its various forms, alcohol, smoking habits in form of beedi and cigarette, lack of awareness about cancer, negligence towards the symptom of voice change and primary treatment from quacks , are highly prevalent. MATERIALS AND METHODOLOGY This prospective cohort study was carried out at Tertiary care Hospital over a period of 1 year 4 months( April 2018 to July 2019). Patients attending at our OPD with symptoms of horseness, dysphagia, stridor and other symptoms of Laryngeal Carcinoma were subjected to detailed clinical examination including FOL to confirm the presence of any growth. All patients with growth or vocal cord irregularity or any suspicious lesions underwent biopsy. Socio-demographic, risk factors , characteristics of primary tumor- endoscopic, radiological and histopathological and spread pattern and node status analysed. RESULTS Major bulk of patients belonged to 55-74 years (combined). The mean age of diagnosis is 66.06 years.Males were affected more than females (7.57:1).Majority of patients were farmers (57%) and majority 45(75%) belonged to rural areas. Most patients belonged to low socioeconomic class 30 (50%).Smoke tobacco and smoke tobacco plus alcohol were the major risk factors for laryngeal carcinoma.Majority of patients presented with dysphagia (75%), followed by foreign body sensation (72%), hoarseness (67%), Neck swelling (50%). Cartilage invasion was present among 25% of cases , Both pre-epiglottic and paraglottic space involvement was around 18% and exolaryngeal spread present in 8% of cases.Among them 100% cases delayed symptom recognition was present. 50% cases was attributed due to socio-demographic pattern, 33% due to pshycosocial and behavioural (anxiety) and 13% due to delay in practitioner referral.Among Proliferative and Ulceroproliferative N+ is more than N0.Both moderately differentiated and poorly differentiated had more percentage of N+.In Supraglottic tumor Pre-epiglottic space, Paraglottic Space and cartilage invasion was present in equal proportions. In glottic tumor cartilage invasion and exolaryngeal spread was more common. CONCLUSION Supraglottic tumor being common have tendency for lymphatic spread. It mainly presents with dysphagia and hoarseness later. Majority of patients were diagnosed in stage III and stage IV. This is not desirable and causes for delayed diagnosis must be addressed publicly. Early stage tumor have excellent prognosis with advent of radiotherapy and surgical morbidities can be avoided. The HPE reveals high grade of differentiation is associated with low node status. CT features serve as an excellent tool in identifying spread and node involvement and also management protocol.