Aerodigestive Tract Malignancies Research Articles

Demography and Pattern of Tobacco Usage in Carcinoma of Upper Aerodigestive Tract.

Upper aerodigestive tract (UADT) malignancies account for significant proportion of all malignancies. The aim of the study is to know the demography and patterns of tobacco consumption and the proportion of non-tobacco consumers in patients with UADT carcinoma. Patient diagnosed with primary UADT carcinoma visiting outpatient department in a tertiary centre from February 2009 to May 2011 were included in the study. 150 patients were documented with UADT carcinoma and analysed. Among these 133 were males and 17 were female. 40% of them had smoking, 25% had smokeless tobacco, 13% had both smoking and smokeless tobacco and 22% hadn't had any form of tobacco. Carcinoma larynx is the most common site and glottis is the commonest subsite. Most individuals who developed UADT carcinoma have used tobacco in some form. The high proportion of UADT carcinoma in non-tobacco consumer is alarming.

Biliary tumorigenic effect on hypopharyngeal cells is significantly enhanced by pH reduction.

Biliary reflux has been considered a potential risk factor in upper aerodigestive tract malignancies. It is not yet clearly known how pH affects the bile‐induced activation of NF‐κB and its related oncogenic pathway previously linked to hypopharyngeal carcinogenesis. In this study, repetitive applications of conjugated primary bile acids with unconjugated secondary bile acid, deoxycholic acid (DCA), on human hypopharyngeal primary cells reveal that strongly acidic pH (4.0) optimally enhances the tumorigenic effect of bile, by inducing activation of NF‐κB, STAT3 nuclear translocation, bcl‐2 overexpression and significant overexpression of the oncogenic mRNA phenotype, compared to weakly acidic pH (5.5) or neutral pH (7.0). As the pH becomes less acidic the partially activated primary bile acids and activated DCA begin to exert their influence; however, with significantly less intensity compared to bile acids at strongly acidic pH. Our findings suggest that biliary tumorigenic effect is strongly pH dependent. Controlling pH during reflux events may be therapeutically effective in reducing the potential risk of bile‐induced hypopharyngeal cancer.

Improving target localization during trans-oral surgery with use of intraoperative imaging.

Trans-oral surgery provides a less invasive means for the surgical management of upper aerodigestive tract malignancies but is limited in its ability to readily assess submucosal tumor extent and location of critical structures intraoperatively. We sought to determine surgeons' baseline target localization accuracy during operative laryngoscopy with preoperative imaging alone and then assess for improvement in localization accuracy when presented with intraoperative CT imaging capturing soft tissue deformation. Fiducial beads were placed submucosally in four cadaver heads. "Preoperative" (PO) and "intraoperative" (IO) neck CTs were acquired before and during suspension laryngoscopy using a CT-compatible laryngoscopy system. Surgeons attempted to localize submucosal fiducials beads using pins based on sequential review of PO and IO images. Mean total error (TE) decreased from 12.8 ± 9.9 to 10 ± 7.5mm from PO to IO (P < 0.001), respectively. TE for base of tongue and vallecula decreased by 1.7 ± 6.7mm (P = 0.015). Right-sided structures were most exposed by scope positioning and experienced a TE reduction of 4.8 ± 9.3mm (P < 0.001). Task completion time decreased from PO to IO by 26% (P < 0.001). Intraoperative imaging significantly improves localization accuracy and task efficiency when targeting submucosal beads in cadaver heads during operative laryngoscopy.

Anatomical site-wise distribution of upper aerodigestive tract malignancies in a rural population

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Upper aerodigestive tract malignancies constitute approximately 4% of all malignancies. These include cancers of the various sites of the upper aerodigestive tract where malignant lesions can be found such as the nasal cavity, paranasal sinuses, nasopharynx, oral cavity and it’s sub-sites, oropharynx, larynx and hypopharynx. Malignancies of these sites are found to be common in people from lower socio-economic strata. Tobacco and alcohol are considered as risk factors for it’s development.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional study was conducted in the outpatient section of Department of ENT, at Chamarajanagar Institute of Medical Sciences and Hospital, Chamarajanagar, India, for a period of 1 years 10 months from October 2014 to July 2016. During the study period, 100 cases that were diagnosed as having upper aerodigestive tract malignancy by histopathology were included in the study group. The aim of this study is to determine the epidemiology, clinical features and anatomical site-wise distribution of malignancy in the study group. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Oral cavity was the commonest site where malignancy developed in the upper aerodigestive tract followed by the larynx. Malignant disease was more common in males and in the elderly. Majority of the patients who developed malignancy had history of tobacco and alcohol consumption.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Oral cavity malignancy is common in rural population, is associated with tobacco chewing and is more common in elderly male. &lt;/p&gt;

Abstract 567: The lysosomal transporter SLC46A3 is a potential predictive biomarker for antibody-drug conjugates bearing the non-cleavable warheads SG3376 and DM1

Abstract Antibody drug conjugates (ADCs) combine a monoclonal antibody with a potent cytotoxic drug to preferentially eliminate antigen-positive cells for the treatment of cancer. ADCs bearing non-cleavable drug-linkers such as the pyrrolobenzodiazepine (PBD) SG3376 or the maytansinoid DM1 rely upon lysosomal degradation of the antibody for release of the cytotoxic warheads, which must then escape the lysosome and bind to their intracellular targets. We sought to identify the mechanism of lysosomal transport of these membrane-insoluble warheads and have recently reported that the lysosomal transporter SLC46A3 is required for cytotoxic activity of ADCs bearing SG3376 and DM1, and that loss of SLC46A3 is a mechanism of acquired resistance to Trastuzumab-DM1 (T-DM1). Here we explore the potential translational relevance of SLC46A3. Analysis of SLC46A3 mRNA expression across several tumors showed that breast cancer cell lines and primary tumor samples have relatively high levels of SLC46A3 compared to samples derived from multiple myeloma (MM), esophageal, and upper aerodigestive tract malignancies, all of which are being targeted in clinical trials with non-cleavable DM1 ADCs. Deeper analysis indicates that levels of SLC46A3 are decreased in MM patients compared to healthy donors, and levels are further decreased in the relapsed/refractory setting compared to samples taken at diagnosis. We measured the expression of SLC46A3 in a panel of MM cell lines by RT-PCR and found that 5 of 9 (56%) had undetectable levels of SLC46A3. In vitro cytotoxicity assays demonstrate that SLC46A3-negative cells are resistant to B-cell maturation antigen (BCMA)-targeted ADCs prepared with non-cleavable DM1 and SG3376 warheads, but remain sensitive to the cleavable payload PBD SG3249 (Tesirine). Taken together, our results suggest that SLC46A3 may be a predictive response marker for ADCs bearing the non-cleavable warheads SG3376 and DM1, and this marker may be particularly useful in trials involving MM. Citation Format: Krista Kinneer, Yu-Tzu Tai, Sriram Sridhar, John Meekin, Sandrina Phipps, Ben Ruddle, Ryan Fleming, Nazzareno Dimasi, Ronald Herbst, Arnaud Tiberghien, Luke Masterson, Philip Howard, Kenneth Anderson, David Tice. The lysosomal transporter SLC46A3 is a potential predictive biomarker for antibody-drug conjugates bearing the non-cleavable warheads SG3376 and DM1 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 567.

New developments in the management of head and neck cancer - impact of pembrolizumab.

Head and neck squamous cell carcinoma (HNSCC), a heterogeneous group of upper aerodigestive tract malignancies, is the seventh most common cancer worldwide. Tobacco use and alcohol consumption were the most identified risk factors of HNSCC. However, human papilloma virus, a sexually transmitted infection, has been determined as another primary cause of HNSCC. Early-stage disease is treated with surgery or radiotherapy. Recurrent or metastatic HNSCC is associated with poor prognosis with a median overall survival of 10 months. The EXTREME protocol is commonly used in first-line setting. Recently, pembrolizumab, an anti-programmed death-1 agent, has been approved by the US Food and Drug Administration for the treatment of patients with recurrent or metastatic squamous cell carcinoma of the head and neck with disease progression on or after a platinum-based therapy. It demonstrated a durable objective response rate with a good safety profile and quality of life. Many ongoing trials are evaluating the use of pembrolizumab for the treatment of HNSCC in various indications such as adjuvant and neoadjuvant setting, maintenance and recurrent disease, alone or in combination with chemotherapy, radiation and targeted therapy. Finding those biomarkers predictive of response to immune checkpoints inhibitors has been a major concern. However, markers have been identified, such as PD-L1 expression, human papilloma virus infection, interferon-γ signature score, microsatellite instability and neoantigen production.

Diagnostic accuracy of touch imprint cytology for head and neck malignancies: a useful intra-operative tool in resource limited countries

BackgroundIntraoperative consultation is an important tool for the evaluation of the upper aerodigestive tract (UAT) malignancies. Although frozen section analysis is a preferred method of intra-operative consultation, however in resource limited countries like Pakistan, this facility is not available in most institutes; therefore, we aimed to evaluate the diagnostic accuracy of touch imprint cytology for UAT malignancies using histopathology of the same tissue as gold standard.MethodsThe study involved 70 cases of UAT lesions operated during the study period. Intraoperatively, after obtaining the fresh biopsy specimen and prior to placing them in fixative, each specimen was imprinted on 4-6 glass slides, fixed immediately in 95% alcohol and stained with Hematoxylin and Eosin stain. After completion of the cytological procedure, the surgical biopsy specimen was processed. The slides of both touch Imprint cytology and histopathology were examined by two consultant histopathologists.ResultsThe result of touch imprint cytology showed that touch imprint cytology was diagnostic in 68 cases (97.1%), 55 (78.6%) being malignant, 2 cases (2.9%) were suspicious for malignancy, 11 cases (15.7%) were negative for malignancy while 2 cases (2.9%) were false negative. Amongst the 70 cases, 55 cases (78.6%) were malignant showing squamous cell carcinoma in 49 cases (70%), adenoid cystic carcinoma in 2 cases (2.9%), non-Hodgkin lymphoma 2 cases (2.9%), Mucoepidermoid carcinoma 1 case (1.4%), spindle cell sarcoma in 1 case (1.4%). Two cases (2.9%) were suspicious of malignancy showing atypical squamoid cells on touch imprint cytology, while 13 cases (18.6%) were negative for malignancy, which also included 2 false negative cases. The overall diagnostic accuracy of touch imprint cytology came out to be 96.7% with a sensitivity and specificity of 96 and 100%, respectively while PPV and NPV of touch imprint cytology was found to be 100 and 84%, respectively.ConclusionOur experience in this study has demonstrated that touch imprint cytology provides reliable specific diagnoses and can be used as an adjunct to histopathology, particularly in developing countries, where the facility of frozen section is often not available, since a rapid preliminary diagnosis may help in the surgical management planning.

Head and neck free flap reconstruction: What is the appropriate post-operative level of care?

Patients undergoing head and neck reconstruction require complex, multidisciplinary postoperative care which may include wound care, flap monitoring, tracheostomy management, and management of comorbid conditions. Historically, patients undergoing major resection of a head and neck or aerodigestive tract malignancy with regional or free flap reconstruction were routinely admitted to the ICU. Although head and neck cancer patients may have multiple medical comorbidities that may require postoperative critical care, the current trend in many institutions is to transfer stable and less medically complex patients to non-intensive care-level units with specialty trained nursing staff. These units have been shown to decrease the total cost of care without compromising the quality of care, length of stay, or postoperative complications.

Incidence of complications of emergency tracheostomy in a rural medical college setting: a prospective study

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tracheostomy done as an emergency procedure for the purpose of saving lives, is mostly associated with aerodigestive tract malignancies, though a few may be associated with foreign body aspiration. The incidences of complications intraoperatively as well as postoperatively are high in emergency tracheostomies. Few studies exist documenting the incidence of these complications .Thus this study was undertaken in a rural Medical College setting to find the incidence of complications associated with emergency tracheostomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;After Institutional ethical committee clearance, a prospective study was conducted over a period of 2 years which included 120 patients of all ages and both genders, who presented to the emergency room with stridor. All tracheostomies were performed, using standard techniques, in the emergency operation theatre under monitored anaesthesia care or general anaesthesia. Complications were noted during the procedure as well as in the postoperative period at regular intervals upto one year and were categorized as immediate, intermediate and late.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Though there was no case of mortality, the incidence of complications was 53.3%. The commonest immediate complication was haemorrhage (12.5%) followed by cardiopulmonary arrest (5%) and apnoea (3.3%). The commonest intermediate complications were infection (18.3%), crusting (12.5%), displacement of tube (8.3%) and bleeding (8.3%).Late complications noted were stomal stenosis (8.3%), keloid formation (5%) and tracheocutaneous fistula (3.3%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Some of these complications can be avoided by early intervention as a semi emergency procedure when you first think about it. This can avoid the hazzle of hurried tracheostomy in a struggling patient thus bringing down the incidence of complications.&lt;/p&gt;

Insurance status as a predictor of mortality in patients undergoing head and neck cancer surgery.

Explore relationship between insurance status and survival, determine outcomes that vary based on insurance status, and identify potential areas of intervention. Retrospective cohort analysis of patients who underwent resection of an upper aerodigestive tract malignancy at a single tertiary care hospital during a 5-year period. Patients were categorized into four groups by insurance status: Medicaid or uninsured, Medicare and under 65 years of age, Medicare and 65 years or older, and private insurance. Data were collected from the medical record and analyzed with respect to survival and other outcomes. The final cohort consisted of 860 patients. Survival analysis demonstrated a hazard ratio of 2.1 (95% confidence interval [CI], 1.5-3.0) for the Medicaid/uninsured group when compared to the private insurance group. When adjusted for other variables, mortality was still different across insurance groups (P = 0.002). The following also were different across insurance groups: tumor stage (P < 0.001), American Society of Anesthesiologists score (P < 0.001), length of stay (P < 0.001), and complications (P = 0.021). The Medicaid/uninsured group was most likely to have a complication (odds ratio [OR] = 2.10, 95% CI 1.24-3.56, P = 0.006). Medicaid/uninsured patients present with more advanced tumors and have poorer survival than privately insured patients. Insurance status is predictive of tumor stage, comorbidity burden, length of stay, and complications. Specifically, the Medicaid/uninsured group had high rates of tobacco use and alcohol abuse, advanced stage tumors, and postoperative complications. Because alcohol abuse and advanced stage also were predictors of poor survival, they may contribute to the survival disparity for socially disadvantaged patients. 4. Laryngoscope, 127:2784-2789, 2017.

Cancers de la cavité buccale : facteurs de risque et prise en charge

Oral cavity is the most frequent anatomical subsite of upper aero-digestive tract malignancies. Squamous cell carcinoma is the most common histological type and totalizes more than 95% of oral cancer. Main risk factors are tobacco and alcohol exposure and also potentially malignant lesions. These precancerous lesions are a chronic disease of oral mucosa and are responsible for about 20% of oral cancer. The treatment of oral cancer depends on clinical, radiological and endoscopic staging and according to the multidisciplinary tumor board decision. Indeed, tumor staging gives information about loco-regional and metastatic spread. Treatment can include surgery, radiation therapy and chemotherapy. However, the prognostic mainly depends on tumor resectability and patient comorbidities. Tumor removal is often associated with reconstruction procedures in order to restore phonation, swallowing and breathing functions with acceptable aesthetic outcomes. The usual delayed diagnosis explains the poor prognostic of oral cancer in spite of prevention attempt and therapeutic improvement. Indeed, the profile of tobacco and alcoholic patients outside of medical system, the high rate of recurrence and the frequency of second primary malignancies explain the stable incidence for years.

Pattern of Upper Aerodigestive Tract Malignancies and Metastatic Lymph Nodes

Pattern of Upper Aerodigestive Tract Malignancies and Metastatic Lymph Nodes

Prevalence and major causative factors of upper aerodigestive tract malignancies

Background: The upper aerodigestive tract (UADT) malignancies vary with geography. Data on epidemiology of UADT are few in India, especially southern states such as Kerala. Objective: To estimate the prevalence and major causative factors of UADT malignancies. Materials and Methods: In this cross-sectional study, 60 patients (54 male and 6 female subjects) who showed proven UADT malignancies were included. Main epidemiological factors such as age, distribution, site, histopathological types, symptoms, and levels of lymph nodes were determined. The clinical and radiological stages of each site at the time of presentation were also assessed and statistically analyzed. Result: The male to female ratio was 9:1, with peak incidence in 50% cases at the 60–69 years age group. Most common symptom at presentation was change in voice with hoarseness (21/60) and neck swellings (18/60) with lymph node metastasis at the time of presentation. The most commonly involved site was glottis (19/60) with T1 presentation (15/19). Oral cavity lesions found in 11 of 60 cases with seven cases in T4 presentation. Hypopharyngeal malignancies were found in eight cases. Other sites found to be involved were oropharynx, nasopharynx, maxillary sinus, and salivary gland with lesser frequency. Fifty-three cases showed addictions such as tobacco smoking, alcoholism, or tobacco chewing. Conclusion: The distribution of UADT cancers was the highest in the 60–69 years age group with male:female ratio of 9:1. Glottic malignancy showed the highest frequency. Smoking and alcoholism were the major causative factors identified. Hence, the need for education and awareness that are aimed at reducing exposure habit forming substances are emphasized. This study showed limitations such as small sample size and short duration, which warranted further multicenter studies for a longer duration.

Optical diagnostic methods for early tumour diagnosis in the upper aerodigestive tract: Quo vadis?

Optical diagnostic methods may simplify and improve the early diagnosis of tumours of the upper aerodigestive tract; however, these have not yet found their way into clinical routine. This article aims to define the problems that have prevented routine use of optical diagnostic methods so far, as well as listing and also explaining potential trendsetting approaches to overcome these difficulties. The study is based on a combined analysis of publically accessible databases (PubMed MEDLINE, Thompson Reuters Web of Science, SPIE. Digital Library; full time period available; search strings: "oral cavity", "pharynx", "larnyx", "optical diagnosis", "optical biopsy", "optical coherence tomography", "confocal endomicroscopy", "fluorescence endoscopy", "narrow band imaging", "non-linear imaging", "fluorescence lifetime imaging"), as well as personal experiences. Both conceptual and methodical problems were determined, and possible solutions based on current developments are discussed. Optical diagnostic methods have the potential to revolutionise early diagnosis of upper aerodigestive tract malignancies, providing the different hurdles listed in this review can be overcome.

Undifferentiated Type Nasopharyngeal Carcinoma With Rare Periportal Lymph Node Metastasis

Nasopharyngeal carcinoma (NPC) is an aggressive Epstein Barr virus (EBV) associated carcinoma accounting for 3.7% of upper aerodigestive tract malignancies. At presentation, most patients (60-72%) demonstrate cervical lymphadenopathy, and 5-11% will have clinically apparent distant metastases, with 78% developing distant metastatic disease within 18 months of presentation. The most common sites for distant metastases are …

Red and far-red fluorescent dyes for the characterization of head and neck cancer at the cellular level.

Primary upper aerodigestive tract malignancy remains a cancer having a poor prognosis, despite current progress in treatment, due to a generally late diagnosis. We conducted a preliminary assessment of five dyes approved for human use for the imaging of head and neck tissues at the cellular level, which could be considered for clinical examination. We investigated fluorescence endomicroscopic images on fresh samples obtained from head and neck surgeries after staining with hypericin, methylene blue, toluidine blue, patent blue or indocyanine green to provide a preliminary consideration as to whether these images contain enough information for identification of non-pathologic and pathologic tissues. The distribution pattern of dye has been examined using probe-based confocal laser endomicroscopy (pCLE) in ex vivo specimens and compared with corresponding histology. In most samples, the image quality provided by pCLE with both dyes allowed pathologists to recognize histological characteristics to identify the tissues. The combination of pCLE imaging with these dyes provides interpretable images close to conventional histology; a promising clinical tool to assist physicians in examination of upper aerodigestive tract, as long as depth imaging issues can be overcome.

Aetiology of secondary otalgia in Mosul Medical City

Objectives: The aim of the present study is to evaluate the aetiology of secondary (referred) otalgia. Patients and methods: A case series study of 79 patients clinically diagnosed as secondary otalgia, collected from the Outpatient Department of ENT at Al-Jamhory Teaching Hospital, Mosul/IRAQ, and private clinics, for the period from Jan. 2010 to Sept. 2011. Results: The average age of the patients was 33.3 years with a range of 4-80 years. The peak age incidence was in the fourth decade of life. The study included 34 male patients (43.1%) and 45 females (56.9%) with a ratio of 1:1.3. Temporomandibular joint dysfunction was found to be the main cause of secondary otalgia (37.9%). Pharyngitis (24%), dental pain (17.7%) and cervical spine pain (7.6%) came next in that order. Conclusion: Temporomandibular joint dysfunction, pharyngitis, dental problems and cervical nerve root pain were the commonest causes of secondary otalgia. Moreover, upper aerodigestive tract malignancies should be considered in differential diagnosis. Keywords: Secondary otalgia, referred otalgia, referred ear pain.

Contemporary acute care surgery percutaneous endoscopic gastrostomy tube placement

As the role of acute care surgery (ACS) becomes more prevalent, clinicians in this specialty will be placing more percutaneous endoscopic gastrostomy (PEG) tubes. In this contemporary series of ACS PEG procedures, we hypothesized that technical aspects of PEG tube placement may play an important role. For our retrospective study, we queried our tertiary Level I trauma center's prospectively maintained ACS database for PEG tube placement. Our study period was from July 1, 2010, through June 30, 2012. We excluded patients who underwent "push" PEG placement, an outpatient PEG tube placement, or an open or laparoscopic gastrostomy tube operation. We conducted a multivariate logistic regression analysis of factors contributing to complications. During our 24-month study period, of 184 patients, 133 underwent "pull" PEG tube placement with sufficient data for analysis. The mean (SD) age was 56 (22) years; 66% were male. Overall, 33 (25%) experienced complications: 13 (10%) were major and 20 (15%) were minor complications. In our multivariate logistic regression analysis, we found that an extreme bumper height (<2 or >5 cm) (odds ratio, 1.57; 95% confidence interval, 1.14-2.16) and upper aerodigestive tract malignancy as the operative indication (odds ratio, 1.54; 95% confidence interval, 1.06-2.26) were significantly associated with complications. Although pull PEG tube placement is typically a straightforward procedure, morbidity can be significant. Bumper height is an easily modifiable variable; obtaining the proper height for each patient could decrease complications after PEG tube placement. Therapeutic study, level IV.

Prophylactic percutaneous endoscopic gastrostomy in head and neck cancer patients: results of tertiary institute

To evaluate the use and complications of a prophylactic percutaneous endoscopic gastrostomy (PEG) in head and cancer patients in our institute. A retrospective study of 194 consecutive patients with a newly diagnosed upper aero digestive tract malignancy who underwent mainly prophylactic PEG tube placement. The procedure is relatively safe: 15 (7.7%) of the complications were considered serious; no deaths occurred. Of the patients 23 (12.5%) did not use the PEG tube at all, but it was not possible to single out a group of patients in which this could be predicted. The majority of the patients were considered to benefit from the prophylactic PEG insertion.

Surgical Innovations for Larynx and Pharynx Cancer

Program Description: Transoral treatment of larynx and pharynx cancer has been done for over a century. Despite substantial technical innovations such as enhanced imaging, innovative laser technologies, and robotic guidance systems, chemoradiation protocols dominate treatment strategies at many institutions. Outcomes data on transoral microsurgical management for advanced oropharynx and larynx cancer will be presented to illustrate the efficacy of surgical management of these diseases. Robotics and laser photoangiolysis of laryngeal cancer are two emerging technologies that can enhance endoscopic surgery. This miniseminar will highlight advantages and disadvantages of endoscopic techniques and innovative technology through presentations from experts in the field. Educational Objectives: 1) Evaluate outcomes data on transoral laser microsurgery for advanced oropharyngeal and laryngeal cancer. 2) Interpret the emerging role of robotics in the endoscopic surgical management of larynx and pharynx cancer. 3) Apply concepts of photoangiolysis in treatment of aerodigestive tract malignancy.