Laryngeal cancer has a better prognosis as compared with that of other cancers and the method of treatment has been virtually established. A recent trend in the treatment of laryngeal cancer is to emphasize the conservative treatment of laryngeal function and also improvement of treatment results has occurred. For a more objective selection of patients for the conservative treatment of laryngeal function, it is most essential to estimate properly the pathological extension of the tumor from the clinical findings. The author observed 100 patients with laryngeal cancer treated in the Departmentof Otorhinolaryngology, Tokyo Medical College, to determine various types of extension. Some findings were obtained concerning the downward extension and also to the vocal cord on the other side, which were very significant in selecting the method of treatment. Classification of 100 subjects according to the site of cancer resulted in 24 cases of supraglottic cancer, 69 cases of glottic cancer and 7 cases of subglottic cancer. In 40 cases, surgery was performed. Large sections were prepared for pathological examination. There were 11 cases of supraglottic cancer. It is well-known that supraglottic cancer rarely involves the subglottic region. With supraglottic cancer it is of ten difficult to clinically identif y the lower limit of the tumor. In two of our cases, the extension of cancer below the glottic region was revealed only of ter pathological examination. These were cases of submucosal extension beside the thyroid cartilage and it was difficult to determine the infiltration from observation of the mucosal surf ace. The limitation and fixation of arytenoid movements were observed in these two cases. Good or poor arytenoid movements in supraglottic cancer might suggest extension under the glottic region.
A study of 24 cases of glottic cancer showed a parallel relationship between poor arytenoid movements and a deeply penetrating extension of cancer. Whether such extension is unilateral or bilateral is as significant in glottic cancer as arytenoid movements. There were two types of extension to the glottis on the other side: extension along the mucosal surface and also submucosal extension. In the latter mode, cancer develops along the thyroid cartilage and it was difficult to estimate this type from the observation of the mucosal surface. It was, however, considered that a comparison between clinical findings and pathological extension enabled prediction to a certain extent.
Infiltration in the cartilage was observed in 11 of 40 cases. A comparison between clinica 1 findings and pathological extension revealed that infiltration in the cartilage was strongly suspected when the following clinical findings were observed: 1) supraglottic cancer extneding to the region below the glottic region, 2) advanced glottic cancer, 3) subglottic cancer with fixed arytenoid movements, and 4) cancer of the anterior commissure with ulceration.
A study of the relationship between clinical findings and pathological extension in 100 cases of laryngeal cancer suggested that pathological extension could be relatively accurately understood by the detailed evaluation of clinical findings.
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