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Table of Contents
LETTER TO THE EDITOR
Year : 2011  |  Volume : 1  |  Issue : 2  |  Page : 79-80

A study of patient factors and tumor characteristics in malignancy of larynx: A tertiary care center experience


Department of Otolaryngology and Head and Neck Surgery, Maulana Azad Medical College and Associated Hospitals, Delhi, India

Date of Web Publication19-Sep-2011

Correspondence Address:
Bulbul Gupta
B-25, Ashok Vihar, Phase-1, Delhi - 110 052
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-9748.85071

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How to cite this article:
Chadha S, Gupta B, Jatwani S, Gulati A. A study of patient factors and tumor characteristics in malignancy of larynx: A tertiary care center experience. J Laryngol Voice 2011;1:79-80

How to cite this URL:
Chadha S, Gupta B, Jatwani S, Gulati A. A study of patient factors and tumor characteristics in malignancy of larynx: A tertiary care center experience. J Laryngol Voice [serial online] 2011 [cited 2021 Apr 21];1:79-80. Available from: https://www.laryngologyandvoice.org/text.asp?2011/1/2/79/85071

Dear Sir,

Carcinoma of the larynx forms an important group of malignancies as it accounts for approximately 1% of new cancer diagnosis. [1] It is the 14th most common cancer in the world. [2] Sixty percent of the incidence is in developing countries. [2] In India, the incidence is 1.3-8.8 per 1 lakh population, in six different regions (ICMR, 1992). In Delhi Cancer Registry Program, it is the second most common cancer among males, and according to Bombay Cancer Registry Program, it is the third most common cancer. [3]

A prospective study to find out the common clinical presentation of patients with laryngeal carcinoma with reference to the age profile, the symptomatology, disease stage, etiological factors, and histological profile and determine the treatment modalities offered to these patients was carried out in our department. In all, 145 patients diagnosed with laryngeal carcinoma between June, 2006 and June 2008 were included. In the group studied, the age range was 26-76 years in males and 35-68 years in females with an average of 52 and 53 years, respectively. Most males were affected in the fifth and sixth decades and females in the sixth decade with male:female ratio of 10.2:1 (7:1 in the developed countries [4] ). We would like to emphasize that 25 persons were affected in the third and fourth decades of life. Hoarseness was found to be the most common symptom followed by dysphagia. Other symptoms were respiratory distress, pain, swelling in neck, and hamoptysis; 77% patients were chronic smokers (34.78 pack years). The incidence was found to be 80% in males, whereas it was 42% in females. Alcohol intake (average 16.25 ml/day) was found in 18% patients, and habit of tobacco chewing was present in 25% of cases. Most patients presented in stage III of the disease (45%). Nodal metastasis was found in 34% patients only, the commonest stage of nodal metastasis being no.

The most common site of involvement was supraglottis and glottis together followed in order by supraglottis and then glottis. Left side of larynx was found to be more commonly involved when compared with the right side. The histological report of all the patients was squamous cell carcinoma. (This fallacy could be due to the limited sample size) with a majority having moderately differentiated squamous cell carcinoma.

The mean age of presentation (fifth and sixth decade) in our study is consistent with the western world. [5] Early onset of disease seen in some patients may be due to factors such as higher consumption of nicotine containing compounds, occupational exposure [6] to carcinogens, higher concentration of pollutants, laryngopharyngeal reflux, leukoplakia, erythroplakia, asbestos, wood dust, solvents, sheet metal workers, previous irradiation, dietary deficiency of vitamin A, and viral agents such as HPV1, 11, 16, and HSV type 1. The fact that a large percentage of smokers in India smoke unfiltered cigarettes and chew tobacco may be a possible cause for the early onset.

It is more common in males probably because they acquire these habits earlier than females and increase the duration of exposure and dose of the carcinogen. [7],.[8],[9] The lower incidence in females may also be due to the different environmental and cultural influences in our country.

Associated genetic or racial factors need to be studied. The Indian subcontinent accounts for about one third of the cases of head and neck malignancies globally [4] and that squamous cell carcinoma of the head and neck is the most common neoplasm in the adult Indian males, with low 5-year survival rates, further strengthen this belief. Lower socioeconomic status and living standards are also associated factors. Laryngeal carcinoma should be suspected in hoarseness of more than 3 weeks, and like previous studies this was the most common symptom in our study; 53.1% patients showed supraglottic and glottic involvement which is similar to the presentations reported earlier. [10] This is unusual in the west and probably proves the fact that most patients in India are diagnosed at an advanced stage; 34% of the patients had nodal metastasis with N2 stage like previous studies. [10]

Treatment of laryngeal malignancies is based on the stage at presentation. Treatment options include surgery and radiation therapy. Advanced laryngeal cancers are often treated by combining radiation and surgery. [10] An appropriate surgical procedure must be considered in each patient given the anatomic problem, performance status, and clinical expertise. Other modalities being studied under clinical trials include chemotherapy, hyperfractionated radiation therapy, and radiation sensitizers.

We would like to stress that because laryngeal cancer is preventable and curable to a large extent, measures should be taken in this direction. Awareness programs describing ill effects of smoking and alcohol should be started. People should be educated about the disease so that it gets diagnosed early. Health facilities should be provided at periphery, and screening programs for all patients with hoarseness should be started.

 
   References Top

1.Rothman KJ, Cann CI, Flanders D, Fried MP. Epidemiology of laryngeal cancer. Epidemiol Rev 1980;2:195-209.  Back to cited text no. 1
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2.Kapil U, Singh P, Bahadur S, Dwivedi SN, Singh R, Shukla N. Assessment of risk factors in laryngeal cancer in India: A case-control study. Asian Pac J Cancer Prev 2005;6:202-7.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Consolidated Report of the Population Based Cancer Registries Incidence and Distribution of Cancer: 1990-96, National cancer registry programme. New Delhi: Indian council of Medical Research.  Back to cited text no. 3
    
4.Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.  Back to cited text no. 4
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5.Maier H, Tisch M. Epidemiology of laryngeal cancer: Results of the Heidelberg case-control study. Acta Otolaryngol Suppl 1997;527:160-4.  Back to cited text no. 5
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6.Notani PN, Jayant K. Role of diet in upper aerodigestive tract cancers. Nutr Cancer 1987;10:103-13.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Kuriakose M, Sankaranarayanan M, Nair MK, Cherian T, Sugar AW, Scully C, et al. Comparison of oral squamous cell carcinoma in younger and older patients in India. Eur J Cancer B Oral Oncol 1992;28B:113-20.   Back to cited text no. 7
    
8.Falk RT, Pickle LW, Brown LM, Mason TJ, Buffler PA, Fraumeni JF Jr. Effect of smoking and alcohol consumption on laryngeal cancer risk in coastal Texas. Cancer Res 1989;49:4024-9.  Back to cited text no. 8
    
9.Wynder EL, Stellman SD. Comparative epidemiology of tobacco related cancer. Cancer research. 1977;37(12):4608.  Back to cited text no. 9
    
10.Bharti MK, Kumar M, Chauhan A, Kaur P, Sabharwal R. Management of advanced stage of carcinoma larynx. Int J Pharm Sci Res 2010;1:8.  Back to cited text no. 10
    




 

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