Medical Imaging In Laryngeal Carcinoma

1. Medical Imaging In Laryngeal Carcinoma C24

2. Navigation Click the HOME button to return to table of contents. Use the arrows to navigate through the slides.

3. Table of contents

4. Objectives

5. Introduction The population of America are discovering faults in their personal habits contributing to laryngeal carcinoma, and with the ever-advancing medical imaging capabilities. We can use multiple modalities to help lead us to an accurate diagnosis and treatment plan for this cancer with fluoroscopy, CT, MRI, and PET scans based off presented signs and symptoms.

6. Laryngeal Carcinoma • Laryngeal carcinoma is easily understood as malignant cancer of the neck, more specifically the larynx. The larynx which is also commonly known as the “voice box” is shown in the image to the right. 1 IMAGE 1.1

7. Did You Know? Approximately 9,500 people in the United States receive the diagnosis of cancer in the larynx.1

8. Risk factors Individuals are at a higher risk for laryngeal carcinoma with the following factors: • Tobacco use (number one cause of laryngeal carcinoma) • Excessive alcohol consumption • Large quantities of processed food • Lack of fruit and vegetables • Exposure to asbestos • Family history3

9. Signs and Symptoms • Hoarse voice • Breathing difficulties • Excessive coughing • Hemoptysis (coughing up blood) • Neck pain • Trouble swallowing food • Neck swelling • Neck lumps • Sudden weight loss • Sore throat3 Sign: any objective problem of a disease that can be recognized by the patient, physician or any medical personnel. Symptom: any subjective problem of a disease that cannot be measured. An individual with laryngeal carcinoma may experience:

10. Did You Know? The National Cancer Institute tells us that throat/head cancer makes up for about 3% of the cancer in the US. 1 HOME

11. Diagnosis Through Imaging The following modalities are utilized in the diagnosis process: • Fluoroscopy • Computed tomography • Magnetic resonance imaging • Positron emission tomography • Dual modality CT SCANNER PET SCANNER

12. Fluoroscopy Fluoroscopy is a live imaging system that uses x-rays to visualize anatomical structures in real-time video images. This dynamic study is most often utilized in the early steps to diagnose laryngeal carcinoma.

13. Fluoroscopy • One major health risk that is associated with throat abnormalities are trouble swallowing and trouble getting food down, which can lead to aspiration. • Swallow studies are one of the better ways to diagnosis aspiration because it gives a live film feed of a patient swallowing different thicknesses and consistencies of liquids mixed. 3 • This type of exam visualizes the possible carcinoma that could be present. FLUOROSCOPY UNIT

14. Fluoroscopy Image IMAGE 2.3 HOME A filling defect is shown with contrast in this fluoroscopic image. The expanding carcinoma creates a new space for contrast to get trapped.

15. Did you know? The early stages of laryngeal carcinoma are curable with an 80%-95% survival rate within the first 5 years. Advanced stages of throat cancer have a 5 year survival rate of 25%-50%.3 HOME

16. Computed Tomography CT uses thin beams of x-rays that rotate around the patients stationary body to produce cross sectional images of the targeted anatomy. 3 CT SCANNER

17. PUNCH BIOPSY NEEDLE Computed Tomography • CT’s for laryngeal carcinoma demonstrates size, location, shape and adjacent tissues. • Provides an axial set of images of the larynx which focuses on the anatomy instead of function. • A contrast CT of the neck will give the best evaluation of the carcinoma. • Two types of biopsies in CT include: • Punch: A small piece of round tissue about the size of a pencil eraser is punched out using a sharp circular instrument. • Trucut: Utilizes a needle that has a notched rod to obtain a specimen.2 TRUCUT BIOPSY NEEDLE

18. CT Image • Image 3 demonstrates a mass on the vocal cords which is shown with the white arrows. The black arrows display sclerosis of the thyroid lamina. 2 IMAGE 3.2 HOME

19. Did You Know? Cancers of the larynx constitute about 25% of all head and neck malignancies.2

20. Magnetic Resonance imaging An MRI uses an intense magnet that aligns the human body’s hydrogen atoms along the magnetic field lines of the scanner. A radio wave, enhanced by coils is sent through the patient causing the protons to flip direction, releasing energy.

21. Magnetic Resonance Imaging

22. MRI Image • This picture shows a sagittal T1W MR image through the larynx. A sagittal T1W MRI shows the epiglottis (thin arrow) and the pre-epiglottic fat space (thick arrow). 3 • Images are also utilized to see if the carcinoma is growing or spreading. IMAGE 4.2 HOME

23. Positron Emission Tomography

24. PET Image • This picture depicts the region of interest, which is where the radioisotope is most concentrated. This brightly colored area is where the laryngeal carcinoma resides.3 Image 5.2 IMAGE 5.2 HOME

25. STAGING • Cancer staging is the method of defining how much cancer is in the body and where it is located. • Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.  • Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required.4 *Laryngoscope which utilizes a small scope or series of mirrors that give a clear up-close video to examine the larynx. *Laryngoscope which utilizes a small scope or series of mirrors that give a clear up-close video to examine the larynx. IMAGE 6.4

26. Staging HOME

27. Stage I Cancer is in one or both vocal cords, and the vocal cords can move normally.4

28. Stage II Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally.4

29. Stage III Cancer is in the larynx only, and the vocal cords cannot move and/or cancer is in tissues next to the larynx. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is three centimeters or smaller.4

30. Stage Iv Stage IV is divided into three stages: • Stage IVA- cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus. • Stage IVB- Cancer has spread to the space in front of the spinal column, surrounds the carotid artery, or has spread to parts of the chest. • Stage IVC- Cancer has spread to other parts of the body such as the lungs, liver or bone.4

31. Treatment • Depending on the stage of the cancer and your overall health, different treatment options may be used alone or in combination. In creating your treatment plan, the most important factors to consider are the site and the stage of the cancer.3 • Surgery- In the early stages (I, II), patients can be treated successfully without totally removing their larynx (partial laryngectomy). In late stages, total removal of the larynx occurs. • Radiation Therapy- Affects healthy cells and the carcinoma. However the healthy cells will grow back, whereas the cancer cells will not. • Chemotherapy- Used to directly treat the carcinoma. • Targeted Therapy- Utilizes a combination of both radiation therapy and chemotherapy.

32. Conclusion In conclusion, laryngeal carcinoma is very relevant in today’s society because of lifestyle choices. There are many risk factors that lead to the various signs and symptoms that coincide with laryngeal carcinoma. Multiple imaging modalities are used to diagnostically stage and treat this cancer. No two patients are the same, which is why having multiple modalities with varying capabilities plays a critical role in the diagnosis process. These modalities include: fluoroscopy, computed tomography, magnetic resonance imaging, and positron emission tomography. The tool of imaging aides medical professionals in providing an efficient and effective treatment plan.

33. What is the leading cause for Laryngeal Carcinoma? CLICK HERE TO SEE THE ANSWER

34. Smoking

35. What type of treatment uses both radiation therapy and chemotherapy? CLICK HERE TO SEE THE ANSWER

36. Targeted therapy

37. Which imaging modality gives a better visualization of soft tissue? CLICK HERE TO SEE THE ANSWER

38. MRI

39. references • Jager EA, Kasperts N, Caldas-Magalhaes J, et al. GTV delineation in supraglottic laryngeal carcinoma: interobserver agreement of CT versus CT-MR delineation. Radiation oncology (London, England). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4327804/. Published January 23, 2015. Accessed March 22, 2019. • Joshi VM, Wadhwa V, Mukherji SK. Imaging in laryngeal cancers. The Indian journal of radiology & imaging. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624744/. Published 2012. Accessed March 22, 2019. • Tests for Laryngeal and Hypopharyngeal Cancers. American Cancer Society. https://www.cancer.org/cancer/laryngeal-and-hypopharyngeal-cancer/detection-diagnosis-staging/how-diagnosed.html. Accessed March 22, 2019. • Stages of Laryngeal Cancer. Cancer Support Community, So that No One Faces Cancer Alone. https://www.cancersupportcommunity.org/stages-laryngeal-cancer. Accessed March 22, 2019. • Qi X, Yu D, Zhao X, et al. Clinical experiences of NBI laryngoscope in diagnosis of laryngeal lesions. International journal of clinical and experimental medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238487/. Published October 15, 2014. Accessed March 22, 2019.

40. Image references • North Wby 30 D. Overview of Laryngeal Cancer. Arizona Oncology - The US Oncology Network. https://arizonaoncology.com/disease-drug-information/types-of-cancer/laryngeal-cancer/. Accessed March 22, 2019. • Joshi VM, Wadhwa V, Mukherji SK. Imaging in laryngeal cancers. The Indian journal of radiology & imaging. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3624744/. Published 2012. Accessed March 22, 2019. • Laryngeal Cancer - Ear, Nose, and Throat Disorders. Merck Manuals Professional Edition. https://www.merckmanuals.com/en-pr/professional/ear,-nose,-and-throat-disorders/tumors-of-the-head-and-neck/laryngeal-cancer. Accessed March 22, 2019 • Manager. Home. Diagnostic Imaging Pathways. http://www.imagingpathways.health.wa.gov.au/index.php/imaging-pathways/ear-nose-throat/staging-of-laryngeal-cancer#pathway. Published August 15, 2017. Accessed March 22, 2019