Skip to main content

Advertisement

SpringerLink
Log in

Management of Laryngeal Dysplasia and Early Invasive Cancer

  • Head and Neck Cancer (JL Geiger, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion Statement

Dysplasia and early laryngeal cancer lie on a spectrum of cellular changes. These start with early changes to the cells including epithelial hyperplasia and expand to dysplasia, squamous cell carcinoma in situ and finally developing in to invasive cancer. Dysplasia can range from low to high grade, with each being treated in a different manner. Treatment options are typically determined by where the dysplasia/invasive cancer lie on this spectrum along with the site within the larynx. Hyperkeratosis, mild dysplasia and moderate dysplasia typically involve primary endoscopic excision. Severe dysplasia and squamous cell carcinoma in situ involve primary endoscopic resection with the addition of possible laser resection and/or ablation. At this stage, surgery will be followed by close surveillance. Finally, early laryngeal cancer such as T1 and T2 lesions is typically more involved. Treatment depends on the site and degree of involvement of the structures, along with spread to surrounding structures. Typical treatment options of more involved early laryngeal cancer can range from radiation therapy, endoscopic transoral laser resection, endoscopic transoral robotic resection to open resection. Often times, my choice of treatment will be aimed at voice preservation but patient preference will also play a role in the decision making between treatment modalities. Chemotherapy and immunotherapy are typically not used in early stage laryngeal cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin. 2009;59(4):225–49.

    Article  PubMed  Google Scholar 

  2. Adeel M, Faisal M, Rashid A, et al. An overview of laryngeal cancer treatment at a tertiary care oncological center in a developing country. Cureus. 2018;10(6):e2730.

    PubMed  PubMed Central  Google Scholar 

  3. Koroulakis A, Agarwal M. Laryngeal Cancer. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan

  4. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin. 2017;67(2):93–9.

    Article  PubMed  Google Scholar 

  5. Weller MD, Nankivell PC, McConkey C, Paleri V, Mehanna HM. The risk and interval to malignancy of patients with laryngeal dysplasia; a systematic review of case series and meta-analysis. Clin Otolaryngol. 2010;35(5):364–72.

    Article  CAS  PubMed  Google Scholar 

  6. Chen AM, Chen LM, Vaughan A, Sreeraman R, Farwell DG, Luu Q, et al. Tobacco smoking during radiation therapy for head-and-neck cancer is associated with unfavorable outcome. Int J Radiat Oncol Biol Phys. 2011;79(2):414–9.

    Article  PubMed  Google Scholar 

  7. Al-Mamgani A, van Rooij PH, Mehilal R, Verduijn GM, Tans L, Kwa SL. Radiotherapy for T1a glottic cancer: the influence of smoking cessation and fractionation schedule of radiotherapy. Eur Arch Otorhinolaryngol. 2014;271(1):125–32.

    Article  PubMed  Google Scholar 

  8. Chen YL, Bao YY, Zhou SH, Yao HT, Chen Z. Relationship between pepsin expression and dysplasia grade in patients with vocal cord leukoplakia. Otolaryngol Head Neck Surg. 2020;21:194599820938654.

    Google Scholar 

  9. Isenberg JS, Crozier DL, Dailey SH. Institutional and comprehensive review of laryngeal leukoplakia. Ann Otol Rhinol Laryngol. 2008;117(1):74–9.

    Article  PubMed  Google Scholar 

  10. Karatayli-Ozgursoy S, Pacheco-Lopez P, Hillel AT, Best SR, Bishop JA, Akst LM. Laryngeal dysplasia, demographics, and treatment: a single-institution, 20-year review. JAMA Otolaryngol Head Neck Surg. 2015;141(4):313–8.

    Article  PubMed  Google Scholar 

  11. Hellquist H, Ferlito A, Mäkitie AA, et al. Developing classifications of laryngeal dysplasia: the historical basis. Adv Ther. 2020;37(6):2667–77.

    Article  PubMed Central  PubMed  Google Scholar 

  12. •• Gale N, Hille J, Jordan RC, Nadal A, Williams MD. Precursor lesions. Dysplasia. In: El-Naggar AK, JKC C, Grandis JR, Takata T, Slootweg PJ, editors. WHO classification of head and neck tumours. Lyon: IARC; 2017. p. 91–3. Provides the most recent WHO classification scheme for dysplastic lesions which is used to determine treatment strategies.

    Google Scholar 

  13. Barnes L, Eveson JW, Reichart P, Sidransky D. editors. Pathology and genetics head and neck tumours. WHO classification of tumours. Lyon: IARC Press; 2005.

    Google Scholar 

  14. Eversole LR. Dysplasia of the upper aerodigestive tract squamous epithelium. Head Neck Pathol. 2009;3:63–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sarioglu S, Cakalagaoglu F, Elagoz S, Han U, Etit D, Hucumenoglu S, et al. Inter-observer agreement in laryngeal pre-neoplastic lesions. Head Neck Pathol. 2010;4:276–80.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fleskens SA, Bergshoeff VE, Voogd AC, van Velthuysen ML, Bot FJ, Speel EJ, et al. Interobserver variability of laryngeal mucosal premalignant lesions: a histopathological evaluation. Mod Pathol. 2011;24:892–8.

    Article  PubMed  Google Scholar 

  17. Yang SW, Chao WC, Lee YS, Chang LC, Hsieh TY, Chen TA, et al. Treatment outcome of vocal cord leukoplakia by transoral laser microsurgery. Lasers Med Sci. 2017;32(1):19–27.

    Article  PubMed  Google Scholar 

  18. Niu YY, Wang J, Huo H, Jin XF, Li WY, Gao ZQ. Clinical analyses of 263 patients with laryngeal leukoplakia. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2018;53(8):575–80.

    CAS  PubMed  Google Scholar 

  19. Koss SL, Baxter P, Panossian H, Woo P, Pitman MJ. Serial in-office laser treatment of vocal fold leukoplakia: Disease control and voice outcomes. Laryngoscope. 2017;127(7):1644–51.

    Article  CAS  PubMed  Google Scholar 

  20. Lim JY, Park YM, Kang M, Lee SJ, Baek K, Na J, et al. Angiolytic laser stripping versus CO2 laser microflap excision for vocal fold leukoplakia: Long-term disease control and voice outcomes. PLoS One. 2018;13(12):e0209691.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Baird BJ, Sung CK, Beadle BM, Divi V. Treatment of early-stage laryngeal cancer: a comparison of treatment options. Oral Oncol. 2018;87:8–16.

    Article  PubMed  Google Scholar 

  22. Kujath M, Kerr P, Myers C, Bammeke F, Lambert P, Cooke A, et al. Functional outcomes and laryngectomy-free survival after transoral CO2 laser microsurgery for stage 1 and 2 glottic carcinoma. J Otolaryngol Head Neck Surg. 2011;40:S49–58.

    PubMed  Google Scholar 

  23. Higgins KM. What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope. 2011;121(1):116–34.

    Article  PubMed  Google Scholar 

  24. Remacle M, Eckel HE, Antonelli A, Brasnu D, Chevalier D, Friedrich G, et al. Endoscopic cordectomy. A proposal for a classification by the working committee, European laryngological society. Eur Arch Otorhinolaryngol. 2000;257(4):227–31.

    Article  CAS  PubMed  Google Scholar 

  25. Carta F, Mariani C, Sambiagio GB, Chuchueva N, Lecis E, Gerosa C, et al. CO2 Transoral microsurgery for supraglottic squamous cell carcinoma. Front Oncol. 2018;8:321.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Peretti G, Piazza C, Mora F, Garofolo S, Guastini L. Reasonable limits for transoral laser microsurgery in laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg. 2016;24(2):135–9.

    Article  PubMed  Google Scholar 

  27. • Lechien JR, Fakhry N, Saussez S, Chiesa-Estomba CM, Chekkoury-Idrissi Y, Cammaroto G, et al. Surgical, clinical and functional outcomes of transoral robotic surgery for supraglottic laryngeal cancers: a systematic review. Oral Oncol. 2020;109:104848. https://doi.org/10.1016/j.oraloncology.2020.104848 Recent systematic review article that reviews the clinical outcomes of transoral robotic surgery on early supraglottic cancers.

    Article  PubMed  Google Scholar 

  28. Durmus K, Gokozan HN, Ozer E. Transoral robotic supraglottic laryngectomy: surgical considerations. Head Neck. 2015;37(1):125–6.

    Article  PubMed  Google Scholar 

  29. Chiu RJ, Myers EN, Johnson JT. Efficacy of routine bilateral neck dissection in the management of supraglottic cancer. Otolaryngol Head Neck Surg. 2004;131(4):485–8.

    Article  PubMed  Google Scholar 

  30. Mendenhall WM, Hinerman RW, Amdur RJ, Malyapa RS, Lansford CD, Werning JW, et al. Postoperative radiotherapy for squamous cell carcinoma of the head and neck. Clin Med Res. 2006;4(3):200–8.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Succo G, Crosetti E, Bertolin A, Lucioni M, Caracciolo A, Panetta V, et al. Benefits and drawbacks of open partial horizontal laryngectomies, Part A: early- to intermediate-stage glottic carcinoma. Head Neck. 2016;38(Suppl 1):E333–40.

    Article  PubMed  Google Scholar 

  32. •• Elicin O, Giger R. Comparison of current surgical and non-surgical treatment strategies for early and locally advanced stage glottic laryngeal cancer and their outcome. Cancers (Basel). 2020;12(3):732 Recent review article on surgical and non-surgical treatment strategies for laryngeal cancer which provides up to date evidence supporting different approaches.

    Article  Google Scholar 

  33. Adeel M, Faisal M, Rashid A, Rasheed S, Hussain R, Malik KI, et al. Outcomes of definitive radiotherapy for early laryngeal cancer in terms of survival and patterns of failure. J Laryngol Otol. 2019;133(12):1087–91.

    Article  CAS  PubMed  Google Scholar 

  34. Zouhair A, Azria D, Coucke P, Matzinger O, Bron L, Moeckli R, et al. Decreased local control following radiation therapy alone in early-stage glottic carcinoma with anterior commissure extension. Strahlenther Onkol. 2004;180(2):84–90.

    Article  PubMed  Google Scholar 

  35. Elicin O, Ermiş E, Oehler C, Aebersold DM, Caparrotti F, Zimmermann F, et al. Influencing factors on radiotherapy outcome in stage I-ii glottic larynx cancer-a multicenter study. Front Oncol. 2019;9:932.

    Article  PubMed  PubMed Central  Google Scholar 

  36. De Santis RJ, Poon I, Lee J, Karam I, Enepekides DJ, Higgins KM. Comparison of survival between radiation therapy and trans-oral laser microsurgery for early glottic cancer patients; a retrospective cohort study. J Otolaryngol Head Neck Surg. 2016;45(1):42.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Smith JC, Johnson JT, Cognetti DM, Landsittel DP, Gooding WE, Cano ER, et al. Quality of life, functional outcome, and costs of early glottic cancer. Laryngoscope. 2003;113(1):68–76.

    Article  PubMed  Google Scholar 

  38. Prettyjohns M, Winter S, Kerawala C, Paleri V, the NICE cancer of the upper aerodigestive tract guideline committee. Transoral laser microsurgery versus radiation therapy in the management of T1 and T2 laryngeal glottic carcinoma: which modality is cost-effective within the UK? Clin Otolaryngol. 2017;42(2):404–15.

    Article  CAS  PubMed  Google Scholar 

  39. Phillips TJ, Sader C, Brown T, Bullock M, Wilke D, Trites JR, et al. Transoral laser microsurgery versus radiation therapy for early glottic cancer in Canada: cost analysis. J Otolaryngol Head Neck Surg. 2009;38(6):619–23.

    PubMed  Google Scholar 

  40. van Gogh CDL, Verdonck-de Leeuw IM, Langendijk JA, Kuik DJ, Mahieu HF. Long-term efficacy of voice therapy in patients with voice problems after treatment of early glottic cancer. J Voice. 2012;26(3):398–401.

    Article  PubMed  Google Scholar 

  41. Ouyoung LM, Swanson MS, Villegas BC, Damodar D, Kokot N, Sinha UK. ABCLOVE: Voice therapy outcomes for patients with head and neck cancer. Head Neck. 2016;38:E1810–3.

    Article  PubMed  Google Scholar 

  42. Angadi V, Dressler E, Kudrimoti M, Valentino J, Aouad R, Gal T, et al. Efficacy of voice therapy in improving vocal function in adults irradiated for laryngeal cancers: a pilot study. J Voice. 2020;34(6):962.e9–962.e18. https://doi.org/10.1016/j.jvoice.2019.05.008.

    Article  Google Scholar 

  43. Gono K, Obi T, Yamaguchi M, Ohyama N, Machida H, Sano Y, et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Opt. 2004;9(3):568–77.

    Article  PubMed  Google Scholar 

  44. De Vito A, Meccariello G, Vicini C. Narrow band imaging as screening test for early detection of laryngeal cancer: a prospective study. Clin Otolaryngol. 2017;42(2):347–53.

    Article  PubMed  Google Scholar 

  45. Sun C, Han X, Li X, Zhang Y, Du X. Diagnostic performance of narrow band imaging for laryngeal cancer: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2017;156(4):589–97.

    Article  PubMed  Google Scholar 

  46. Campo F, D'Aguanno V, Greco A, Ralli M, de Vincentiis M. the prognostic value of adding narrow-band imaging in transoral laser microsurgery for early glottic cancer: a review. Lasers Surg Med. 2020;52(4):301–6.

    Article  PubMed  Google Scholar 

  47. Kimza H, Jackowska J, Wierzbicka M. The usefulness of the NBI - narrow band imaging for the larynx assessment. Otolaryngol Pol. 2018;72(3):1–3.

    Article  PubMed  Google Scholar 

  48. Lin RJ, Iakovlev V, Streutker C, Lee D, Al-Ali M, Anderson J. Blue light laser results in less vocal fold scarring compared to KTP laser in normal rat vocal folds. Laryngoscope. 2020

Download references

Author information

Authors and Affiliations

  1. Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH, 44195, USA

    Candace Hrelec MD

Authors
  1. Candace Hrelec MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Candace Hrelec MD.

Ethics declarations

Conflict of interest

Candace Hrelec declares that she has no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Head and Neck Cancer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hrelec, C. Management of Laryngeal Dysplasia and Early Invasive Cancer. Curr. Treat. Options in Oncol. 22, 90 (2021). https://doi.org/10.1007/s11864-021-00881-w

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11864-021-00881-w

Keywords

Search

Navigation