ENT (Otorhinolaryngology) · MU Sofia

41. Malignant diseases of the larynx, pharynx and oral cavity - general pathogenesis and clinic.

Covers squamous cell carcinoma and other malignancies of the larynx, pharynx and oral cavity, from viral and chemical risk factors through stepwise pathogenesis to spread, staging and clinical features. It sets out site-based and histological classifications, the TNM criteria, a symptom list for each region, diagnostic tests, treatment by stage, complications and differential diagnosis.

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Topic 41 of 52 in the MU Sofia syllabus for ENT (Otorhinolaryngology) (Medicine, Year 4). The free AceMed note covers it in 1 section, about 630 words (4 min of reading), with 14 flashcards.

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  1. Malignant diseases of the larynx, pharynx, and oral cavity – general pathogenesis and clinic.

Malignant diseases of the larynx, pharynx, and oral cavity – general pathogenesis and clinic.

1. Definition: Malignant diseases of the larynx, pharynx, and oral cavity are cancers arising from the epithelial lining (mostly squamous epithelium) of these regions.

  • Most common type: squamous cell carcinoma (SCC)
  • They have local invasion, lymphatic spread, and potential for distant metastasis.

These cancers are common in adults, especially men over 40 years.

2. Etiopathogenesis - a multi-step process involving the accumulation of oncogenes and tumor suppressor genes like p53

A. Risk Factors

  • Chemical Carcinogens: Tobacco (strongest factor) and alcohol are the primary risk factors. They have a synergistic effect, meaning the risk of combined use is much higher than the sum of each alone.
  • Viral Factors:
  • HPV (Human Papillomavirus): Specifically types 16 and 18. major cause of Oropharyngeal SCC.
  • EBV (Epstein-Barr Virus): Strongly linked to Nasopharyngeal carcinoma.
  • Physical Factors: Chronic irritation (poor-fitting dentures), poor oral hygiene, and UV radiation (lip cancer).
  • Dietary: Deficiencies in vitamins A and C (Plummer-Vinson Syndrome).

B. Pathogenesis

  • Chronic mucosal irritation
  • Stepwise epithelial transformation:
  1. 1. Hyperplasia → dysplasia → carcinoma in situ → invasive carcinoma
  • Local spread: infiltration of underlying muscles, cartilage, and bone
  • Lymphatic spread: early to regional cervical nodes
  • Hematogenous spread: late, to lungs, liver, bone

3. Classification

A. By Site

  1. 1. Laryngeal carcinoma: Glottic (most common), Supraglottic, Subglottic
  2. 2. Pharyngeal carcinoma: Nasopharyngeal (EBV-related), Oropharyngeal (HPV-related), Hypopharyngeal (most aggressive)
  3. 3. Oral cavity carcinoma: Tongue, Floor of mouth, Buccal mucosa, Retromolar trigone, Lip

B. Histological

  • Squamous cell carcinoma (SCC) – most common
  • Verrucous carcinoma – low-grade variant
  • Adenocarcinoma (rare, salivary origin)
  • Basaloid carcinoma (rare, aggressive)

TNM Staging - Clinical staging follows the AJCC TNM System.

  • T (Tumor):
  • T1: Small tumor (usually <2 cm) limited to one subsite.
  • T2: 2–4 cm.
  • T3: >4 cm or limited extension (eg, vocal cord fixation).
  • T4: Invasion of "massive" structures (bone, deep muscle, skin).
  • N (Nodes):
  • N1: Single ipsilateral node ≤3 cm.
  • N2: Multiple nodes or nodes 3–6 cm.
  • N3: Node >6 cm.
  • M (Metastasis): M0 (none) or M1 (distant spread, most commonly to lungs).

4. Clinical Picture

A. Laryngeal Carcinoma

  • Hoarseness (early in glottic tumors), glo- min lympohatic spr, better prg
  • Dysphagia, odynophagia (supraglottic), early LN mets, for body sens
  • Stridor (airway obstruction)
  • Neck mass (cervical metastasis)

B. Pharyngeal Carcinoma

  • Nasopharyngeal: nasal obstruction, epistaxis, serous otitis media, neck nodes
  • Oropharyngeal: sore throat, dysphagia, referred otalgia, neck mass
  • Hypopharyngeal: dysphagia, weight loss, late presentation

C. Oral Cavity Carcinoma

  • Non-healing ulcer over 2 weeks
  • Induration
  • Pain, bleeding
  • Loose teeth

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