Biopsy
A biopsy (tissue removal) should be performed as an excisional biopsy. That is, small circumscribed malignancy-specific mucosal lesions should be completely removed.
Primary tumor treatment
Laryngeal carcinoma is operated on if the tumor is resectable, that is, R0 resection (removal of the tumor in healthy tissue; no tumor tissue is detectable in the resection margin on histopathology) can be performed with appropriate safety margins:
- At least 1 mm for transoral laser surgical resection (surgical removal by laser therapy through the mouth) of T1/T2- glottic carcinomas with strict limitation to the vocal fold.
- At least 5 mm in laryngectomy (removal of the larynx) of T3 and T4a carcinomas.
Resection margins should be completely visible in healthy tissue in an intraoperative frozen section. Overview standards of therapy of laryngeal carcinoma [see below S3 guideline].
| T category | Partial resection (TR)TLM* , TORS* * , open TR | Laryngectomy | Radiation/multimodal organ preservation |
| Supraglottic carcinoma | |||
| T1 | x | x | |
| T2 | x | (x) Individual cases | x |
| T3 | x | x | x |
| T4a | (x) Individual cases | x | x |
| T4b* | x Prim. Radiochemotherapy | ||
| Glottic carcinoma | |||
| T1 | x | x Small field irradiation | |
| T2 | x | x Small field irradiation | |
| T3 | x | X | x Prim. Radiochemotherapy |
| T4a | (x) Individual cases | X | x Prim. Radiochemotherapy |
| T4b | x Prim. Radiochemotherapy | ||
| Subglottic carcinoma | |||
| T1 | (x) Individual cases | x | (x) Individual cases |
| T2 | x | (x) Individual cases | |
| T3 | x | x Prim. Radiochemotherapy | |
| T4a | x | x Prim. Radiochemotherapy | |
| T4b | x Prim. Radiochemotherapy | ||
Legend: * TLM: transoral laser microsurgery; * * TORS: “transoral robotic surgery.”
Supraglottic carcinoma (malignant (malignant) tumor above the glottis (vocal fold apparatus)).
- T1 and T2 carcinomas: transoral laser surgical resection.
- T3 and esp. T3 carcinomas: vertical frontolateral partial resection (surgical partial removal) of the larynx according to Leroux-Robert or external classical partial resection according to Alonso
- T3 to T4a carcinomas for which partial resection is no longer possible: laryngectomy (safety margin 5 mm)Radiotherapy can be omitted if
- Resection in the area of the mucosa and the tumor portions not surrounded by cartilage with > 5 mm of tissue in sano (“in healthy”) and
- Unilateral or bilateral neck dissection with evidence of > 10 noninvolved lymph nodes in each case.
- Hemilaryngectomy (surgical removal of one half of the larynx) for strictly unilateral findings.
- Horizontal supraglottic partial resection for involvement of the epiglottis (epiglottis).
- Laryngectomy with neck dissection en bloc for extensive findings with metastases (daughter tumors); additional percutaneous postradiation (radiation therapy from outside the body).
Glottic carcinoma (vocal fold carcinoma).
- T1 and T2 carcinomas strictly confined to the vocal fold: transoral laser surgical resection (surgical removal through the mouth) or primary radiotherapy (radiotherapy alone); for transoral laser surgical resection, a minimum safety margin of 1 mm must be maintained
- Stage pT3 pNx: vertical frontolateral partial resection of the larynx according to Leroux-Robert (in rare cases transoral) possibly also laryngectomy alternatively organ-preserving concept (radiochemotherapy, RCTX) in patients who refuse surgical therapyRadiation therapy can be omitted, if
- Resection in the area of the mucosa (mucous membrane) and the tumor portions not surrounded by cartilage with > 5 mm of tissue in sano and
- Unilateral or bilateral neck dissection (dt.”Neck preparation”) each with evidence of > 10 unaffected lymph nodes.
Subglottic carcinoma (malignant (malignant) tumor below the glottis (vocal fold apparatus)).
- T1 and T2 carcinomas: partial hypopharyngectomy (hypopharynx: lowest part of the pharynx (throat) from the upper edge of the epiglottis (epiglottis) to the upper esophageal mouth (esophageal mouth) or an imaginary line at the level of the annular cartilage of the larynx (larynx)).
- Laryngectomy with hypopharyngeal partial resection with radiotherapy (radiotherapy, radiatio) for advanced tumors.
- For inoperable tumors: tumor reduction by laser and radiotherapy (radiotherapy, radiatio) or radio-chemotherapy possible.
Hypopharyngeal carcinoma (cancer of the pharynx) with involvement of the larynx.
- Hypopharyngeal carcinoma resectable and larynx strictly unilaterally infiltrated: Partial laryngo-pharyngectomy (partial removal of the larynx and removal of the pharynx).
- Hypopharyngeal carcinoma infiltrating the larynx beyond the midline: pharyngo-laryngectomy.
