So-called transglottic cancers, involving both supraglottis and subglottis, appear to have a particularly unfavorable biology. However, even advanced glottic cancers have a relatively low incidence of cervical metastases (approximately 10%). In contrast, supraglottic cancers may grow to a considerable size before causing symptoms, and, due to the rich lymphatic drainage, they commonly have nodal metastases at presentation. Thus, most supraglottic cancers present at an advanced Inhibitors,research,lifescience,medical stage, either due to local symptoms from a large tumor, or with a metastatic neck lump. Supraglottic cancers rarely show inferior extension below the level

of the glottis. More problematic is spread to the vallecula Inhibitors,research,lifescience,medical and base of tongue, and extralaryngeal extension in the region of the thyrohyoid membrane. Nodal metastases are common, even in the presence of a clinically negative neck (30%–40%). Lymph nodes in levels 2A and 3 comprise the first echelon

of drainage, and metastatic spread to both sides of the neck is commonly seen. Thus, treatment of early or advanced supraglottic cancer generally Inhibitors,research,lifescience,medical requires simultaneous addressing of both sides of the neck. TREATMENT Definitive treatment options for advanced laryngeal cancer include surgery, radiotherapy, chemoradiotherapy, or a combination of these. Surgical options may range from minimally invasive transoral laser or robotic surgical resection, to open partial laryngectomy, to total laryngectomy. However, for many cases of advanced larynx cancer, the only feasible option is total laryngectomy. In the past, this operation was considered to be the gold standard treatment for advanced laryngeal cancers.15 However, Inhibitors,research,lifescience,medical while it offers excellent local control, it is associated with significant functional and psychological sequelae. More recently, there have been major changes in treatment paradigms for advanced laryngeal cancer. The result has been a major decrease

in the number of patients treated with surgery alone, Inhibitors,research,lifescience,medical and a major increase in the number of patients treated with radiotherapy and chemoradiotherapy. The major driver for these changes has been the publication of clinical trials reporting high rates of larynx preservation after using chemoradiotherapy protocols to of treat advanced laryngeal cancer.14,16 However, simultaneous with this shift in treatment paradigm, new concerns have emerged after the recent publication of data which would appear to show a reduction in larynx cancer survival over recent decades.17 An important factor which facilitates non-surgical treatment of advanced laryngeal cancer is the anatomy of the larynx and the impact of this on the pattern of post-radiotherapy recurrences. Thus, due to the anatomical constraints of the larynx, and the barriers to invasion provided by the laryngeal cartilages and membranes, when cancers which are originally confined to the larynx fail initial treatment with radiotherapy, the this website recurrent cancers also tend to remain confined to the larynx.