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Laryngeal SCC: T Staging

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Hello everyone, Dr. Sidney Levy here.

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3 00:00:04,850 --> 00:00:06,780 I'm continuing our discussion of the

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diagnosis and staging of laryngeal squamous

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cell malignancy, using our example case of a

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large transglottic squamous cell carcinoma.

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I would like to talk about the staging of laryngeal

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squamous cell malignancy in general terms now.

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This tumor is a challenge because it has

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predominant glottic and some supraglottic

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components with less involvement of the subglottis.

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So, a decision needs to be made as to

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where we think the tumor is centered.

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And sometimes the best way to do that is to look

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at where the level of the vocal cords are and then

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decide whether the bulk of the tumor is centered

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at that level, superior or inferior to that level.

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So, let's do that.

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First thing.

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There are a lot of structures that are effaced

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here, so let's find something we can recognize.

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This is the cricoid cartilage here.

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So, it's a good place to start.

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If we go a few slices superiorly, we

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should see the arytenoid cartilages.

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And they are at this level, but abnormal.

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So, they are involved by tumor, but abnormal.

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As soon as we see the arytenoid cartilages,

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we know that we are at the level of the vocal

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cords because the vocal cords attach to the

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arytenoid cartilages in the axial plane.

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Once we are at the level of the arytenoid

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cartilages, we can cross-reference and identify

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the relevant position in the sagittal projection.

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And from there we can extend superiorly as far as

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the tumor goes, which is about this level here.

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And we can make an assessment as to

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where the tumor ends inferiorly.

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And in this case, it's a large tumor.

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It's extending over approximately this distance.

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And the center of the tumor is indeed

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at a similar level to what we identified

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as the arytenoid cartilages here.

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So hopefully through that little process,

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I've demonstrated to you that this

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tumor is primarily a glottic tumor.

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So therefore, let us use the

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staging system for glottic tumors.

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So, glottic tumors have T staging, which

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goes from T1, T2, T3, T4a, and T4b.

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There is a separate staging system for

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supraglottic tumors and for subglottic tumors.

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And I will not go into detail of both of those because

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we don't have a specific example case to show you.

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So what I will do is I will focus on this

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transglottic tumor using the glottic tumor staging.

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And I would refer you to the AJCC 8th edition

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guidelines where you can see specific details of

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the staging of supraglottic and subglottic tumors.

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In our next vignette, I will go into detail

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as to what constitutes a glottic tumor.

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T staging, N staging, and M staging of glottic tumors.

Report

Description

Faculty

Sidney Levy, PhD, MBBS

Radiologist and Nuclear Medicine Specialist

I-MED

Tags

Neuroradiology

Neuro

Neoplastic

MRI

Larynx

Head and Neck

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