History & Examination for Supraglottic Cancer

Objectives

  • Select appropriate surgery
  • Avoid unnecessary surgery
  • Avoid embarking on surgery that is beyond the scope of a surgeon

Primary tumour

  • Site
    • Supraglottic (infra- vs suprahyoid, false cord, arytenoid, pre-epiglottic space, AE fold, epiglottic)
    • Glottic
    • Hypopharynx
    • Vallecula/BOT
    • Can the arytenoid(s) be spared?
  • T-stage
    • Vocal cord mobility
    • Cartilage invasion
    • Extralaryngeal extension
      • Through thyroid cartilage
      • Base of tongue
      • Pre-epiglottic space
  • Bulk
  • Arytenoid involvement
  • Laryngeal dysfunction: Stridor, voice, swallowing, aspiration

Cervical nodes

  • Palpate the neck
  • Consider Ultrasound

Synchronous Primary (upper aerodigestive tract, lungs)

  • Current/recent smokers have 5-10% second primary
  • History and office examination
  • Panendocopy
  • CXR / CT / PET

 

Index: Clinical Practice Guidelines for Supraglottic Cancer

Resource Appropriate Supraglottic Cancer Guideline Scenarios