Head and Neck Pathology Case Studies


CASE 5: Squamous Cell Carcinoma of the Larynx


Clinical History:

A 60-year-old man has increasing hoarseness over the last 6 months. He has smoked 2 packs of cigarettes per day for the past 45 years, and has had a chronic cough for may years. However, yesterday he noted some blood streaking of his sputum. Endoscopy reveals a mass invoving the vocal cords, right more than left. He has some enlarged non-tender cervical lymph nodes.

Radiologic, Gross, and Microscopic Pathology:

The lesion is arising in the neck, in the region of the larynx, and extending into surrounding soft tissues. The gross appearance is that of an exophytic lesion that partially occludes the airway and can interfere with phonation to produce the symptom of hoarseness. Microscopicall, there are atypical cells with hyperchromatic nuclei, pink cytoplasm, and distinct cell borders.

Questions:

  1. What is the diagnosis?

    2. Squamous cell carcinoma of the larynx

  2. What is the risk factor for this condition?

    3. Smoking is the most important factor.

  3. What is the prognosis?

    4. The findings are those of local invasion and lymph node metastases. Radiation therapy can be utilized.

  4. What is palliative care?

    5. Palliative care has to do with taking care of symptoms even though you are not extending life. Hence the term 'palliative surgery' for example. The patient may have a debulking procedure as palliative surgery, or radiation therapy to shrink the size of the tumor. It might enable him to eat food by mouth a little longer, for example. And even taking in a little of your favorite food can be a wonderful feeling, once you've lost that ability. Even if it is only a few spoonfulls of a favorite hot soup in the winter, or of ice cream or ice tea in the summer, it can make someone happy. (That is why they're also called 'comfort foods.' Do not belittle it: the parts of the brain that control taste and smell are very deep, primitive, and primordial; many little worries can seem soothed by stimulating these centers.)

    As the disease progresses there will be more palliative options, and then hospice for the last few months. Hospice at least will provide better pain control, whether it is at home (the most popular hospice option) or in a hospice center. And it usually provides much more than that: psychological and/or spiritual counseling for the patient and the family, for example.