Head and Neck Imaging

Supraglottic cancer

malignant tumour in the supraglottic larynx.

Clinical background

Squamous cell carcinoma head and neck is the most frequent malignant tumour of the supraglottic larynx. Supraglottic cancer is less common than glottic cancer. There is a strong association with cigarette smoking. The presenting symptoms are dysphagia, pain and/or hoarseness. Tumoral involvement of the different laryngeal subsites and impairment of vocal mobility (as visible during clinical examination) determine the T-staging (see also TNM classification head and neck). The number, location and degree of fixation of lymphadenopathies determine the N-staging.

Diagnostic imaging

Essentially, the radiological signs are similar to those in glottic cancer (see glottic cancer), but supraglottic cancers often show a larger tumour volume at first presentation. Clinically visible tumour extension and radiological tumour volume are not always correlated, due to submucosal spread in the pre epiglottic space or paraglottic space (Fig.1). Laryngeal cartilage invasion is rarely seen in supraglottic cancer. Supraglottic cancer may spread to the adjacent pyriform sinus. Extension to the tongue base may occur subclinically through the pre-epiglottic space, but is revealed by CT or MRI (Fig.2). Large supraglottic cancers may spread to the glottic larynx and are then called transglottic cancers. Lymphadenopathy head and neck is frequently present in supraglottic cancer. The imaging findings are helpful in arriving to a correct TNM-staging.

Treatment

Small-volume supraglottic cancers may be treated by radiation therapy or supraglottic laryngectomy, provided they do not extend to the level of the true vocal cord as this excludes the possibility of this surgical procedure (laryngectomy (VI:2), Fig. 1). Bulky supraglottic cancers are considered unfavourable for radiation therapy; they will often cause vocal cord fixation or airway compromise and partial (if feasible) or total laryngectomy is recommended in these patients. CT (or MRI) is helpful for assigning patients to various treatment options. Also, see TNM classification head and neck, radiation therapy tissue changes and baseline study.R

RH

To view high resolution images,
please register first.

Click  here to register.

Already registered? Enter your e-mail in the window below.
Re-register

Fig.2

Recurrent supraglottic carcinoma after radiation treatment, clinically limited to the larynx. a. Axial contrast-enhanced CT image through supraglottis. Large enhancing mass lesion is seen within the pre-epiglottic and left paraglottic space (arrows). The tumour mass is growing over the superior edge of the thyroid cartilage (arrowheads). b. The tissues at the level of the base of the tongue and floor of the mouth appear inhomogeneously (arrowheads), suggesting tumoural invasion. c. Sagittal contrast-enhanced T1-weighted spin-echo image confirms the large mass lesion within the supraglottis (arrows). There is obvious tumour extension into the base of the tongue and floor of the mouth (arrowheads).
Supraglottic cancer, Fig.1 (a)
Supraglottic cancer, Fig.1 (b)
Supraglottic cancer, Fig.2 (a)
Supraglottic cancer, Fig.2 (b)
Supraglottic cancer, Fig.2 (c)