Supraglottis Cancer

Kylee McConnell
Dr. Evans
RadSci 3672
Case Study
1. Throatcancersymptoms.net. Supraglottic Throat Cancer.
http://www.throatcancersymptoms.net/supraglottic-throat-cancer.html. Accessed February 28,
2014.
2. Hackworth, R. Larynx and Hypopharynx. [PowerPoint]. The Ohio State University Radiation
Therapy Program; 2014.
3. Hornig J. Supraglottic Cancer. Medscape. http://emedicine.medscape.com/article/852908overview#a0102. Updated October 30, 2013. Accessed February 28, 2014.
4. Hackworth, R. Head and Neck Intro to CA. [PowerPoint]. The Ohio State University
Radiation Therapy Program; 2014.
5. Kumar N., et al. Squamous Cell Carcinoma of Supraglottic Larynx with Metastasis to All Five
Distal Phalanges of Left Hand. PMC. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221229/.
Accessed February 28, 2014.
6. American Cancer Society. Survival Rates for Laryngeal and Hypopharyngeal Cancer By
Stage.
http://www.cancer.org/cancer/laryngealandhypopharyngealcancer/detailedguide/laryngeal-andhypopharyngeal-cancer-survival-rates. Accessed February 28, 2014.

At the SBRT machine in the radiation oncology department at the James Cancer Hospital,
there was a patient treated there with cancer of the supraglottis. This patient was a Caucasian
male who was 59 years of age. Before being diagnosed with cancer, his past medical history
included hypoglycemia, hard of hearing, tooth extraction, tonsillectomy, exploratory laparotomy,
and appendectomy. He also underwent a laryngoscopy with excisional biopsy on November 18,
2013, a colonoscopy on December 11, 2013, a tracheostomy and an EGD with placement of a
PEG tube on December 30, 2013. So before his cancer, he experienced quite a few problems.

His social history involves him not drinking alcohol. He mentioned he had not drank
alcohol in years. He also used to smoke one and a half packs of cigarettes a day for 45 years, but
he quit on March 2 of 2013. He did not use drugs, and he was sexually active with his wife. His
mother experienced kidney failure, colorectal cancer, and lung cancer. His father had a stroke,
coronary artery disease, and heart disease. His brother has hypertension and dysrhythmia.
The most common signs and symptoms of supraglottic cancer are throat discomfort or
sore throat, disturbance in eating or swallowing, hemoptysis, and breathing difficulties. This
patient experienced disturbance in swallowing, breathing difficulties, and chronic laryngitis.1
Supraglottic cancer is the most common cancer of the head and neck region. It is the 11th
most common in men, and there are about 12,500 new cases found a year. Men have a 30 times
more chance of getting it. About half of the patients will have involvement in their lymph nodes
once their cancer is diagnosed.2,3 Common causes of this cancer are alcohol, tobacco (including
chewing tobacco), dietary deficiencies, radiation exposure, HPV, and GERD. The only one of
these that could contribute to the cause of this patients cancer is his use of tobacco.3
The supraglottis is superior to the glottis, or the true vocal chords. The hyoid bone starts
the epiglottis. The supraglottis contains the suprahyoid and infrahyoid epiglottis, false chords,
ventricles, aryepiglottic fold, and arytenoid cartilage. The lymph node drainage includes the
superior, deep, and mid jugular lymph nodes, which are also known as level II-IV nodes. The
Rouvieres node is also another common node that can be involved.2
This patients tumor was histologically squamous cell carcinoma. This is an epithelial
cell cancer most commonly found in areas with air exposure. It was a stage III tumor with a
grade of T3, N1, M0. By T3, it means the tumor was limited to the larynx with vocal chord

fixation. N1 means there was a single lymph node involved that was up to 3 centimeters in
dimension. M0 just means that there was no distant metastasis.2
Possible treatment methods for this type of cancer are surgery with pre of post-op
radiation therapy and post-op chemo for positive margins. The chemotherapy agents that could
be used are 5-FU or Cisplatin. More superficial tumors may only be treated with external beam
radiation therapy alone. The supraclavicular region may be involved in the treatment field if
there are positive lymph nodes. Doses can vary from 5000-7000 cGy using 200 cGy per fraction.
This patient received surgery, post-op radiation therapy, and post-op chemo of Cisplatin. He was
treated with 6 MV for 35 fractions.2
There are many critical structures in the head and neck region that need to be avoided, or
at least receive lesser dose. The left and right parotid and submandibular glands are something to
keep dose down on. The oral cavity, mandible, spinal cord, proximal esophagus, brachial plexus,
and brainstem all need to be carefully planned around to not receive too much dose.4
The side effects this patient experienced are very common ones. These include mucositis,
pain, xerostomia, thick mucus, and erythema. Chronic side effects may include dysphagia,
hypothyroidism, xerostomia, osteoradionecrosis, mild skin atrophy, and permanent hair loss.4
Metastasis form the supraglottic region is very rare. Although it is rare, it could possibly
metastasis to the lung, liver, or other head and neck regions.5 The five-year survival rate for his
cancer is 53%. The other stages of supraglottic cancer are similar in survival rates, as well.6