Mouth, and Neck Diagnoses
Cancer of the larynx is the most common malignancy of the upper respiratory tract. About 95% of all laryngeal cancers are squamous cell carcinomas; adenocarcinomas and sarcomas account for the other 5%. The American Cancer Society predicts approximately 9880 new cases of laryngeal cancer annually, with approximately 3770 deaths.
Most cases of laryngeal cancer are diagnosed before metastasis occurs. If it is confined to the glottis (the true vocal cords), laryngeal cancer usually grows slowly and metastasizes late because of the limited lymphatic drainage of the cords. Laryngeal cancer that involves the supraglottis (false vocal cords) and subglottis (a rare downward extension from the vocal cords) tends to metas-tasize early to the lymph nodes in the neck because of the rich lymphatic drainage of this area.
The cause of laryngeal cancer is unknown, but the two major predisposing factors are prolonged use of alcohol and tobacco. Each substance poses an independent risk, but their combined use causes a synergistic effect. Other risk factors include a familial tendency, a history of frequent laryngitis or vocal straining, chronic inhalation of noxious fumes, poor nutrition, human papil-lomavirus, and a weakened immune system.
Ongoing studies indicate a role for genetics in the susceptibility and course of laryngeal cancer. Several gene mutations or polymorphisms have been associated with risk, especially in the presence of alcohol and tobacco intake.
Cancer of the larynx is more common in men than in women (5:1 ratio) because, heretofore, men have been more likely to smoke cigarettes and drink alcohol, but the incidence in women is rising as more women also smoke and drink. Cancer of the larynx occurs most frequently between the ages of 50 and 70. Women are more likely to get laryngeal cancer between the ages of 50 and 60 and men between the ages of 60 and 70. Laryngeal cancer is 50% more common in African Americans than in whites.
HISTORY. Be aware as you interview the patient that hoarseness, shortness of breath, and pain may occur as the patient speaks. Obtain a thorough history of risk factors: alcohol or tobacco usage, voice abuse, frequent laryngitis, and family history of laryngeal cancer. Obtain detailed information about the patient's alcohol intake; ask about drinks per day, days of abstinence, and patterns of drinking. Ask the patient how many packs of cigarettes he or she has smoked per day for how many years.
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