Cases Of Laryngeal Cancer Research Articles

Retrospective analysis of selected tumor markers (p53, PCNA, Ki67; DNA ploidy) and ultrastructure in patients with larynx carcinomas

A comparison was made of the staining intensities of selected immunohistochemical proliferating antigens (p53, PCNA, Ki67), DNA flow-cytometry and ultrastructures of neoplastic cells from 120 cases of laryngeal cancers. Clinically very advanced tumors were in the majority (T3, 43%; T4, 18%). A 5-grade scale was adopted to evaluate the level of immunohistochemical staining of the carcinoma cell nuclei. Positive staining was obtained in 70% for p53, 57% for Ki67 and 80% for PCNA. Sixty-two percent of the cases were DNA-diploid and 38% DNA-aneuploid. The DNA-diploid carcinomas were accompanied by enlargement of the cell nuclei, preservation of wide margins of nuclear heterochromatin, enlargements of the nuclear areas and increases in the number of nuclei. In the aneuploid-polyploid cancers the nuclei had a substantial polymorphism, with large cleaved nuclei showing significant variations in size and having a nuclear envelope. A frequent finding was euchromatization of chromatin. Dense chromatin appeared in the form of small clumps spread over the whole area of these irregular nuclei. Enlargement and activation of nucleoli were found. There was a positive (chi-square) correlation between T- and N-stage and immunohistochemical staining. There was also a positive correlation in staining intensity between p53, Ki67 and PCNA markers and strong correlation between these markers for proliferative activity and the degree of aggressiveness of a tumor.

喉頭癌の治療成績

One hundred and nine cases of laryngeal cancer were treated between 1987 and 1997 in the Department of Otorhinolalyngology at Obihiro Kousei Hospital. The average age of the patients was 65.4 years old, and the male to female ratio was 21:1. Based on histopathological diagnosis, 108 cases were reported as squamous cell carcinoma and one case was reported as spindle cell carcinoma. There were 15 cases of supraglottic carcinoma, 91 cases of glottic carcinoma and 3 cases of subglottic carcinoma. There were 33 cases in stage I, 35 cases in stage II, 22 cases in stage III and 19 cases in stage IV. The five-year survival rates of the patients for stages I to IV were 100%, 90%, 66% and 65% respectively.

Neaivtotal laryngectomy for treatment of advanced laryngeal cancer

In order to assess whether near-total laryngectomy (NTL) could successfully reach the cure and preserve the voice in advanced laryngeal cancer, we studied 28 patients with T3/T4 squamous cell carcinoma of the larynx treated with NTL in our institution. A retrospective analysis has been carried out from 1990 through 1994. We classified 24 patients as Stage III and 4 patients as Stage IV. All patients had lateral neck dissection. Survival was analyzed under the Kaplan-Meier method. Twenty-six patients achieved voice preservation. Two patients in the bilateral neck dissection group had a metastatic lymph node on the opposite side. No patient had local recurrence. Three patients died of the disease, and 1 patient was salvaged with neck dissection. Three-year disease-free survival was 85%. This technique is useful in the treatment of selected cases of advanced laryngeal cancer and achieves local control of the lesion in all cases. The survival is comparable with that of patients submitted to total laryngectomy, regarding the extent of lesion. Voice preservation can be achieved in most cases.

Prognostic factors and survival of laryngeal cancer patients from Turin, Italy. A population-based study.

Little information is available on the role of risk factors for cancer of the larynx in survival. This study analyzed survival through the end of 1994 for 355 cases of laryngeal cancer diagnosed among residents of Turin, Italy, during 1979-1982. Relative survival at 5 years was 75% in women and 67% in men. The role of clinical and etiologic factors was analyzed in detail among 222 male cases. The role of nodal involvement as a strong predictor of poor survival was confirmed. Patients of low socioeconomic status experienced poorer survival than other patients, as did heavy smokers. Alcohol drinking and diet did not seem to strongly influence survival. Survival in this series of laryngeal cancer cases closely parallels that observed in other case series from Europe. While the results regarding socioeconomic status, tobacco smoking, and alcohol drinking parallel those of the few previous studies available, this investigation did not confirm a role for diet in the survival of laryngeal cancer patients, a finding that was recently seen in another study from northern Italy.

Art Therapy with Laryngectomy Patients

Approximately 12,500 new cases of laryngeal cancers are diagnosed each year in the United States, many of which require partial or total removal of the larynx (voice box). Psychological factors affecting these patients include anxiety, grief, depression, and altered body image. Due to the nature of surgical treatment which often results in loss of speech, art therapy is an important diagnostic and therapeutic adjunct. Experiences of patients with laryngeal cancer using art therapy have not been previously reported. Treatment results and case material substantiating the distinct role of art therapy in laryngeal patients are described, based on 14 years of experience managing 109 laryngeal cancer patients. An overview of the special medical and therapeutic needs of this group is provided.

Occupational exposure to machining fluids and laryngeal cancer risk: contrasting results using two separate control groups.

This death certificate-based case-control study linked Connecticut Tumor Registry and Connecticut Division of Vital Statistics death data to determine whether machining fluid exposure is associated with laryngeal cancer risk. Laryngeal cancer cases were compared with oral cancer controls and general population controls. Level of exposure to machining fluids was imputed from the usual occupation and industry on the death certificate. Because exposure was infrequent among females, analysis was limited to males. When cases were compared to oral cancer controls, high exposure to machining fluids was associated with laryngeal cancer (odds ratio = 1.48; 95% confidence interval = 1.01-2.16), with a p-value for trend of 0.08. When cases were compared to population controls, no association between machining fluid exposure and laryngeal cancer was observed. A possible reason for the contrasting results, other than chance, is that exposure data quality for the cases and oral cancer controls may have differed from that of the population controls.

Etiological Factors of Laryngeal Cancer

In order to evaluate the etiological factors, all 318 cases of laryngeal cancer diagnosed during the period of 1962–91 in the Tampere University Hospital area with a population of 400,000 were reviewed. Among males the annual age-adjusted incidence decreased significantly from 7.1 to 2.3 per 100,000. No significant difference in the occurrence was found between urban and rural areas. In males the relative risk (RR) was significantly higher in the lower socio-economic groups. In both sexes smokers had significantly higher risk compared to non-smokers. For male smokers RR was 15.5 (95% CI 10.0–25.4) and for female smokers 12.4 (95% CI 3.9–39.5). Changes in smoking habits seem to be the most important factor contributing to the decreasing incidence of laryngeal cancer in Finland, but other factors like changes in dietary and sauna habits may also have some significance.

喉頭癌114例の臨床的検討

喉頭癌114例の臨床的検討

Tobacco smoking, alcohol drinking and dietary factors as determinants of new primaries among male laryngeal cancer patients: a case-cohort study.

The paper examines the determinants associated with second primary occurrence in laryngeal cancer cases. A series of 220 incident male laryngeal cancer cases was interviewed 10 years ago within the framework of a population-based, case-control study. The occurrence of other primaries among these patients was assessed by means of the Lombardy Cancer Registry, which covers their area of residence. The relationship between tobacco, alcohol, dietary factors and the risk of occurrence of new primaries was analyzed by means of a nested case-control study. Cases were defined as those subjects who developed a new primary, and controls as those without. New primaries occurred among 36 subjects during an 8-year follow-up; 147 control cancer patients were matched for age and length of follow-up. A twofold risk increase was associated with the highest tobacco consumption, as registered at time of first primary; a weaker relationship, i.e. risk of 1.2 for the highest tertile, was seen for alcohol drinking. The occurrence of new primaries was also influenced by dietary habits. In particular, those who had a high intake of monosaturated fatty acids had a one-third lower risk of developing a new primary. Our results support the hypothesis that a healthy diet is protective among those who experience a laryngeal neoplasm and suggests that diet could be a potential preventive agent against the occurrence of new primaries among these patients.

Speech results and complications of near-total laryngectomy.

Near-total laryngectomy provides a functional alternative to total laryngectomy in selected cases of laryngeal and hypopharyngeal cancer. We report our experience with the first 49 patients treated with near-total laryngectomy over a 3-year period. Successful speech rehabilitation was obtained in 79.5% of the patients in a median time of 40 days. Speech was acquired in 89.6% of the patients with follow-up longer than 6 months. Hands-free conversation was possible in 51.4% of the speaking patients. Five patients had symptomatic aspiration and 23 developed postoperative pharyngocutaneous fistula. Four local recurrences occurred in the laryngeal remnant. These results confirm that near-total laryngectomy provides a relatively safe, simple, and reproducible speech rehabilitation method for patients in whom total laryngectomy otherwise would be required.

Tobacco and diet as determinants of survival in male laryngeal cancer patients.

In a series of 213 incident cases of laryngeal cancer, interviewed 10 years ago in the framework of a population-based case-control study, survival has been evaluated in relation to tobacco, alcohol consumption and dietary habits. The occurrence of other primaries and stage at diagnosis were taken into account as possible confounding factors. Heavy tobacco smoking appeared to worsen the prognosis in a dose-dependent manner. No effect was apparent for alcohol. The consumption of vegetables, citrus fruit, olive oil and orange juice was associated with a better prognosis; an opposite association was found for butter and milk. A tentative differentiation between dietary patterns showed a 36% advantage in survival for those whose dietary habits corresponded to the "Mediterranean diet". Our results support the hypothesis that diet may interfere with the mechanisms of cancer progression, and suggest that dietary intervention could be a means of improving survival in laryngeal cancer patients.

福井医科大学喉頭癌症例の検討

During 11 years from 1983 to 1994,134 cases of laryngeal cancer were treated. In this paper, the clinical analyses of these patients are reported. There were 127 male and 7 female patients (ratio 18 : 1), and their pathological diagnoses were all squamous cell carcinoma. The primary site of 34 cases was supraglottic type and 96 cases were glottic type. Only 4 cases were subglottic type. All cases were grouped by T classification (UICC in 1987); 57 cases (43%) with T1, 37 cases (26%) with T2, 24 cases (19%) with T3, and 16 cases (12%) with T4. The patients were treated using not only single therapy such as radiotherapy or surgery, but also using combination therapy. The 5-year survival rate up to now was 78.4%, which was a little higher than the rates reported by other investigators.Also examined were the factors that prevent improvement of the laryngeal cancer cure rate. Based on our long-term observations, examination of the deaths by recurrent cancer revealed the importance of preventing cervical recurrence, especially stomal recurrence. Furthermore, from the examination of other causes of death, it was revealed that early detection of secondary digesitive cancer, particularly esophageal and stomach cancer, is necessary.

Anthropometric measures and risk of cancers of the upper digestive and respiratory tract

Data from a case-control study on the upper digestive and respiratory tract cancers were analyzed to investigate the relationship with anthropometric measures. The data set included 538 oropharyngeal, 410 esophageal, and 388 laryngeal cancer cases and 2,102 controls in hospital for acute nonneoplastic diseases, unrelated to tobacco or alcohol use, recruited in the same catchment areas as the cases. Lower body weight appeared to be an indicator of oropharyngeal and esophageal cancer and, more moderately, of laryngeal cancer. The multivariate odds ratio (OR) for oropharyngeal cancer was 5.0 for subjects in the lowest compared with the highest quartile of weight. The corresponding ORs were 6.2 for esophageal and 2.2 for laryngeal cancer. When quartiles of body mass index (BMI) were considered, the ORs in the lowest quartile were 4.0 for oropharyngeal, 6.3 for esophageal, and 2.4 for laryngeal cancer. Subjects in the lowest quartile of height had ORs of 2.0 for oropharyngeal, 1.6 for esophageal, and 1.4 for laryngeal cancer. When all the upper digestive and respiratory tract neoplasms were considered together, the OR for subjects with lower BMI who were also current smokers compared with never-smokers with higher BMI was 11.4. The OR was 5.0 for those consuming six or more drinks/day and with low BMI. Although the nature of the association needs to be clarified, these data suggest that leanness may be involved in the process of upper digestive and respiratory tract carcinogenesis.

Radiotherapy for Laryngeal Cancer in Patients under 50 Years Old

Fifty-nine cases of laryngeal cancer treated by radiotherapy at the National Cancer Center Hospital between 1962 and 1990 were analyzed retrospectively. All the patients were less than 50 years old. The median total dose of the radiation delivered to the primary tumor site was 70 Gy. The overall 5-yr survival rate and 5-yr local control rate were 88% and 72%, respectively. Five (8.5%) of the 59 patients developed late recurrence more than five yr after initial treatment, but subsequent salvage operations were successful for disease control; three patients had T1 glottic cancer, one had T2-3 glottic cancer and one had T3N1 supraglottic cancer. Since the local control rate and the 5-yr survival rate after radiotherapy are satisfactory, radiotherapy, which allows both functional and esthetic conservation, has an important role in the treatment of laryngeal cancer in adults under 50 yr of age.

Occupational respiratory cancer and exposure to asbestos: A case‐control study in a cohort of workers in the electricity and gas industry

Cancers of the pleura, lung, and larynx between 1978 and 1989 among active male workers of Electricité de France-Gaz de France were studied in association with asbestos exposure using a case-control design nested within the cohort of workers of the company. The cohort included about 1,400,000 person-years, corresponding to a mean of 117,000 men per year. Exposure to asbestos and to some potential occupational confounders selected among agents from groups I, IIa, and IIb of the International Agency for Research on Cancer was assessed by a job-exposure matrix specific to the company. During the observation period, 12 cases of pleural cancer, 310 cases of lung cancer, and 116 cases of larynx cancer were registered in the cancer register of the company social security department. Four controls per case, matched for year of birth, were randomly selected among the cohort. Conditional logistic regression was used to estimate the odds ratios. A first analysis was conducted in order to assess the validity of the job-exposure matrix by investigating already known relationships between asbestos exposure and asbestosis. For asbestosis, a strong exposure-response relation was found with an odds ratio (OR) of 57.4 [95% confidence interval (CI): 17.0-194.0] in the highest exposure group. There was an elevated risk of pleural cancer (OR, 4.8, CI, 1.2-19.8). For lung cancer, significant ORs of 2.0 (CI, 1.3-3.2) and 1.9 (CI, 1.2-3.0) were found among the two highest cumulative exposure groups; adjustement for confounders slightly decreased the ORs. Squamous cell neoplasm of the lung was associated with asbestos exposure. The association between larynx cancer and asbestos exposure showed a tendency towards a nonsignificant increase in ORs in the highest cumulative exposure categories; this tendency disappeared when adjusting for occupational confounders. This study showed that occupational exposure to asbestos could increase the risk of pleural and lung cancer in a sector in which exposure levels are not considered to be high compared with other industrial settings.

Expression of EGF, EGFR and PCNA in laryngeal lesions

The expression of EGF/EGFR in 47 laryngeal surgical specimens from 44 patients was examined. PCNA analysis as an index of proliferating cells was also performed in 32 cases of laryngeal cancer, six cases of pre-cancerous lesions and nine cases of normal laryngeal mucosa. EGFR failed to show a significant correlation with tumour behaviour, but EGF expression was statistically significantly higher in malignant (SCC) than in non-malignant tissues (pre-cancerous and normal tissues) (p < 0.006), and PCNA also showed a statistically significant difference (p < 0.016) between the two. In malignant tissues when EGF/EGFR in 'double-positive' and 'double-negative' cases was compared, a statistically significant difference in PCNA was found (p < 0.029); but this was not seen in non-malignant tissues. Our results support the hypothesis that an autocrime mechanism exists in laryngeal cancer and in this mechanism EGF may play an important role in tumour progression, especially when EGFR is overexpressed.

Outcome following radiotherapy in verrucous carcinoma of the larynx

To evaluate the outcome of patients with verrucous carcinoma of the larynx treated at the Princess Margaret Hospital with respect to control rates with radiotherapy, the salvage of local failure, the risk of regional lymph node metastasis following radiation therapy, and the risk of anaplastic transformation following radiotherapy. Forty-eight patients underwent primary treatment for verrucous carcinoma of the larynx in the period between January 1961 and December 1990. This represented 1.1% of cases of laryngeal cancer seen in this time period. Forty-three received radiotherapy and 5 had surgery as the primary treatment. Several radiation dose-fractionation schedules were used, the most frequent being 50 Gy in 20 fractions in 4 weeks (31 cases), while eight patients were treated with 55 Gy over 5 weeks. The 5-year rate of local control was 59% for the 43 patients treated with radiotherapy. Surgical salvage was universally successful in all cases where it was attempted. The five cases treated with surgery alone did not experience relapse. Only one patient died of verrucous carcinoma. He had been medically unfit for surgical intervention at the time of initial treatment and at the time of relapse. He underwent a truncated course of radiotherapy (24 Gy in 3 fractions over three weeks in 1975). There was no evidence of increased neck relapse compared to other forms of laryngeal carcinoma following radiation treatment. No evidence to support anaplastic transformation of tumors treated with radiotherapy was evident in this series. Local control using radiation treatment is less successful than with ordinary invasive and in situ squamous carcinomas of the larynx. Nevertheless, the treatment is effective and provides an appropriate option for laryngeal conservation, especially in advanced lesions where total laryngectomy may be the only treatment alternative. Surgical salvage of radiation failures contributes to very high rates of cure for verrucous carcinoma of the larynx. Anaplastic transformation of cases treated with radiotherapy was not observed in any case in this series.

Surgical Procedure and Indications for the Cervical Lymph Node Metastasis of Oropharyngeal Cancer and Laryngeal Cancer

We observed the results of neck dissection on oropharyngeal and laryngeal cancer for the last 15 years, and report on the modified technique for neck dissection procedure, boundaries of the lymph node groups removed, and elective dissection. First, based on cases of neck dissection on oropharyngeal cancer, we showed how we decide whether a redical or a modified neck dissection procedure would be taken. Next, we calculated the frequency of positive pathological metastasis cases by lymph node group, and a certain pattern could be observed. We found that if the oropharygeal cancer was located on the lateral wall, the internal jugular group and posterior triangular group of the affected side, and the contralateral upper jugular group should be dissected. In the same way, if the oropharyngeal cancer was located on the anterior wall, the bilateral internal jugular group should be dissected. In the case of a supraglottic laryngeal cancer, the bilateral internal jugular group, and the case of glottic laryngeal cancer, the internal jugular group of the affected side as well as the paratracheal area should be dissected respectively. For the indication of elective dissection, we observed the pathological metastasis frequency of laryngeal cancer . Here, we reached the conclusion that the indication was necessary in cases of advanced supraglottic laryngeal cancer, and for residual and recurrent cases over T2 or above which underwent radiotherapy.

当科における喉頭癌症例10年間の統計

One hundred fifty-nine cases of laryngeal cancer that were diagnosed and treated between 1983and 1992 at the Department of Otolaryngology, Sapporo Medical University Hospital were evaluated. There were 101 glottic (66.0%),53 supraglottic (33.3%) and 5 subglottic (3.1%) tumors.The overall five-year survival rate was 74.2%, while the ten-year survival rate was 62.7%. Regarding the primary site of the tumor, the glottic type was more curable than the supraglottic type and its five-year survival rate was 82.8%, while that of the supraglottic type was only 63.8%. There was no significant difference in the five-year survival rate of laryngeal cancer patients with and without lymph node metastasis.

Mortality studies of machining fluid exposure in the automobile industry III: A case‐control study of larynx cancer

A case-control study of larynx cancer was conducted within a cohort of automobile workers exposed to metal working fluids, commonly referred to as machining fluids (MF). Results are based on 108 cases of larynx cancer and 5:1 matched controls. Risks associated with specific types of MF, as well as specific components of the fluids were evaluated. Based on a retrospective exposure assessment, lifetime exposures to straight and soluble fluids, grinding particulate, biocides, selected metals, sulfur, and chlorine were examined. Exposure to asbestos and acid mists at two of the three study sites was also characterized. Results suggest that straight mineral oils are associated with almost a two-fold excess in larynx cancer risk. There was also evidence of an association with elemental sulfur, commonly added to straight MF to improve the integrity of the materials under extreme pressure and heat. It is not clear whether sulfur is causally related to an excess relative risk of larynx cancer or whether the observed association is the result of unmeasured confounding by another contaminant or process feature. For example, the high stress operations that require MF enriched with sulfur are also more likely to produce polycyclic aromatic hydrocarbons (PAHs) during the process. Thus, the observed association with sulfur may be due to an association with PAH. The finding of excess risk of laryngeal cancer associated with MF is consistent with several previous reports in the literature. This is the first study, however, to distinguish straight mineral oils from other types of MF. Based on these findings, a general reduction in concentrations of straight mineral oil particulate in occupational environments would be prudent.