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CASE PRESENTATION DEPARTMENT: SURGERY (ENT)

CASE: LARYNGEAL CARCINOMA

PRESENTER: DR ALIHUSSEIN KASSAM

SUPERVISER:DR FEI JIE (ENT SPECIALIST)

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DR ALIHUSSEIN KASSAM (MD),

MNAZI MOJA HOSPITAL,ZANZIBAR.

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NAME: K.K.AAGE: 77YRSSEX: MALEADDRESS: DUNGAD0A:17th July 2015

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M/C: DIB 3/12 Started gradually, progressing in nature,

aggravated by lying supine, no relieving factors,no chest tightness, no cough, no LL edema

Patient also noted change in voice which was hoarse progressing in nature, there was hx of loss of significant weight, no hx of night sweats, no hx of fever, no contact with tb patient

This patient was treated as TB & pneumonia in several health facilities including MMH

ENT was consulted for hoarseness of voice

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ROS-NADPMHX: no hx of BT, surgery, no chronic

illness (HTN, DM and HIV)FSHX: Has 4 wives with 20 children, he is

a farmerHeavy Smoker for nearly 30yrs with

accumulated smoking of 15packyear

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General examination:Ill looking, conscious, , hoarse voice, not jaundiced , not

pale, no lower limb edema, no cyanosis, no clubbing, no lymphadenopathy

Oral cavity- Normal

Vital signs:BP: 130/87mmHgRR: 30c/mPR: 96b/mTEMP: 36 c

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Indirect laryngoscopy- left vocal cord fixed which was pale and had a cauliflower like lesion noted

Right vocal cord was normal

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SYSTEMIC EXAMINATIONR/S : STRIDOR

CVSGI GU NADCNS

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Provisional dx: Upper airway obstruction sec to laryngeal carcinoma

Differential dx: laryngeal polyp laryngeal TB laryngeal papilloma

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INVESTIGATIONSFBP-( all parameters under normal range)CXR-( normal)PLANEmergency tracheotomy + biopsy done

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Patient was discharged awaiting biopsy results

And recommended to do CT of the neck with contrast

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READMISSION14/12/2015Patient came with biopsy results which

showed laryngeal ca stage iii squamous cell carcinomapatient was councelled and was prepared

for laryngectomy

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Pre-op investigationCT SCAN OF THE NECKFBP, BT CTLFTRFTHEPATITIS B & CECG

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Cricoid cartilage

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Tumour

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MANAGEMENT OF LARYNGEAL CARCINOMASTAGE TREATMENT OPTION

STAGE 1 RADIOTHERAPY/ ENDOSCOPIC LASER SURGERY

STAGE 2 RADIOTHERAPY/SURGERY

STAGE 3 SURGERY+ RADIOTHERAPY

STAGE 4 SURGERY+CHEMORADIATION

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INTRAOPERATIVE

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POST OPERATIVE ORDERSNIL PER ORAL for 10days (feeding through

NGT)IV Antibiotics : ceftriaxone and

metronidazole for 5daysInj declofenac 75mg IM 8hrly for 48hrsInj pantoprazole 3/12

4days in ICU then the pt was discharged to the ward where he stayed for ten days then discharged home

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Pt came for follow up and is still under councelling for radiotherapy

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STATISTICS AT MMHYEAR CASES2007 02008 02009 02010 02011 02012 52013 02014 22015 1

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From May 2007 to February 2016 a total of number of 8 cases

A rare condition by itself

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TAKE HOME MESSAGE A hoarse voice more than 2/52 and on

antibiotics needs a referral to an ENT specialist

Associating factors may lead to a good diagnosis

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LITERATURE REVIEW

Definition:are mostly, squamous cell carcinoma

reflectingtheir origin from the mucosa of the larynx.

Most laryngeal cancers originate in the glottis. Supraglottic cancers are less common, and subglottic tumours are least frequent

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SIGNS AND SYMPTOMS Hoarseness or other voice changes A mass in the neck A sore throat or feeling that something is

stuck in the throat Persistent cough Stridor - a high-pitched wheezing sound

indicative of a narrowed or obstructed airway

Bad breath Earache ("referred") Difficulty swallowing

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RISK FACTORS Male sex Cigarette smoking Alcohol Age

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DIAGNOSIS AND MANAGEMENT Hx and physical examination

biopsy

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TREATMENT OPTIONS Discussion?