Pharynx, Larynx and Neck
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Malignant tumours of the hypopharynx are almost exclusively squamous cell carcinomas and typically behave aggressively. The tumours are usually classified according to their probable anatomical site of origin from the piriform fossa, postcricoid region or posterior pharyngeal wall. Marked differences in the incidence of these tumours occur globally because of factors such as iron-deficiency anaemia (see Sideropenic dysphagia, page 740). They may be associated with marked submucosal spread, which further complicates evaluation. Tumours arising from the piriform fossa and posterior pharyngeal wall may spread to upper or lower cervical nodes. Tumours arising in the postcricoid area typically metastasise to paratracheal and paraoesophageal nodes, which may not be palpable. As with other non-HPV head and neck cancers, alcohol and tobacco are two principal carcinogens. Postcricoid carcinoma, though rare, is more common in women than men.
Epidemiology
John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie in Basic Sciences Endocrine Surgery Rhinology, 2018
For descriptive studies, concepts such as null hypothesis, effect size, alpha level and power do not apply. Instead, descriptive statistics, such as means and proportions, are presented. The sample size of descriptive studies depends on how precise the investigator wants these descriptive statistics to be. Confidence intervals, such as 95% or 99% confidence intervals, are commonly used to represent the precision of the estimates. For example, a study of the 5-year survival after surgical treatment in 228 patients with hypopharynx carcinoma found that the survival was 27.2% with a 95% confidence interval ranging from 21.5% to 33.5%.21 This interval indicates that we can be 95% confident (which can be considered more or less the same as saying that there is 95% chance) that the ‘true’ 5-year survival probability lies within this interval. When estimating the sample size for descriptive studies, the investigator specifies the desired width of the confidence interval, and the sample size derives from that and can be read from tables or obtained from statistical software packages. This approach can be followed for any type of descriptive variable for which confidence intervals can be calculated.
Tumours of the oral cavity and pharynx
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
Head and neck cancer is the ninth commonest cancer worldwide, although there is geographical variation due to environmental and genetic factors (9). Globally, lip, oral cavity, and pharyngeal cancers accounted for approximately 530,000 new cancer cases and 230,000 deaths in 2012, representing 3.8% of all cancer cases and 3.6% of cancer deaths. The age-adjusted incidence for men is between 0.4 and 1.4:100,000/year, and it is 2–4 times lower in women. In Western Europe, about one-quarter each of head and neck cancers arise in the larynx, oral cavity, and pharynx, with the remainder in the thyroid gland, salivary glands, and other sites. In India, oral cancer is the commonest cancer of any type. SCC typically affects middle-aged persons, with a rising incidence up to the age of 70–80 years, although the incidence is rising in younger adults because of shifts in risk factor exposure. Prognosis is dependent on site and stage, equating to 65% at 5 years for the oropharynx compared with 28% for the hypopharynx (10).
High pretreatment platelet-to-lymphocyte ratio is related to poor prognosis in the squamous cell carcinoma of the larynx and hypopharynx in male patients
Published in Acta Oto-Laryngologica, 2021
Han Zhou, Panpan Song, Yajun Gu, Junguo Wang, Hui Li, Xia Gao, Xiaoyun Qian
Larynx and hypopharynx are neighboring structures that are functionally integrated and surgically related. According to the GLOBOCAN 2018 report by the International Agency for Research on Cancer, worldwide incidence of the laryngeal and hypopharyngeal cancers is about 1% and 0.4% of all sites, respectively [1]. As the most common pathological type, the squamous cell carcinoma (SCC) has a poor overall survival (OS) rate [2]. Compared to females, male patients have a circa sevenfold cumulative risk [3]. Fully assimilate the nature of laryngeal/hypopharyngeal SCC (LHSCC) mainly relies on pathology of the surgical specimen including tumor invasion, nodal involvement, perineural and lymphovascular invasion, and distant metastases. However, the main drawback is that these indexes can only be assessed after surgery.
Video laryngeal masks in airway management
Published in Expert Review of Medical Devices, 2022
Manuel Á. Gómez-Ríos, Teresa López, José Alfonso Sastre, Tomasz Gaszyński, André A. J. Van Zundert
When Archie Brain introduced the LMA-Classic in the 1980s, it revolutionized the airway armamentarium of anesthetists. It meant the start of a large group of SADs, which primarily act as a passageway for delivery of oxygen and anesthetic gases, allowing spontaneous and positive pressure ventilation. The aim is to insert the airway device into the hypopharynx, forming an airtight seal enclosing the larynx inlet. The popularity of SADs results from a handsfree approach to airway management that does not involve the insertion of a tracheal tube, while avoiding hand fatigue of the operator holding a facemask. Originally targeted for simple surgical procedures, SADs gradually gained more widespread use and are currently the most used airway device in the world. Advanced models with specific designs for better performance and higher patient safety were developed by a large group of competitive manufacturers, each producing their own specific SAD, although many ‘me-too’ devices came on the market.
Value of extranodal extension detected by computed tomography for predicting clinical response after chemoradiotherapy in head and neck squamous cell cancer
Published in Acta Oto-Laryngologica, 2018
Hyun Moon, Young Jun Choi, Yoon Se Lee, Sang Wook Lee, Sung Bae Kim, Jong-Lyel Roh, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim
US, MRI, 18F-FDG PET/CT, and combined functional imaging studies with MRI and 18F-FDG PET are effective for prognosticating in HNSCC. Despite recent advances in various radiological techniques, CT remains the study of choice when evaluating the extent of disease and the response to treatment and it continues to be used routinely for these purposes at our tertiary hospital. This allowed us to use the pretreatment contrast-enhanced CT data to evaluate not only the primary tumor but also the rENE status. Many studies have investigated the relationship between pENE and rENE, using various imaging modalities, with CT and US often used to identify the relationship between pENE, rENE, and neck node status [17]. Notably, we demonstrated that the rENE was directly related to the response to CCRT without knowing the pENE status. Thus, a positive rENE status on a pretreatment CT scan may be considered an independent prognostic factor for poor distant control and survival in advanced oropharyngeal carcinoma [17]. We observed similar results in cancers of the hypopharynx, larynx, and oropharynx.