case presentation on laryngeal carcinoma at the mnazi moja hospital, zanzibar, tTan

1.  DEPARTMENT: SURGERY (ENT)
 CASE: LARYNGEAL CARCINOMA
 PRESENTER: DR ALIHUSSEIN KASSAM
 SUPERVISER:DR FEI JIE (ENT SPECIALIST)
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3. NAME: K.K.A
AGE: 77YRS
SEX: MALE
ADDRESS: DUNGA
D0A:17th July 2015
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4.  M/C: DIB 3/12
 Started gradually, progressing in nature,
aggravated by lying supine, no relieving
factors,no chest tightness, no cough, no LL
edema
 Patient also noted change in voice which was
hoarse progressing in nature, there was hx of
loss of significant weight, no hx of night sweats,
no hx of fever, no contact with tb patient
 This patient was treated as TB & pneumonia in
several health facilities including MMH
 ENT was consulted for hoarseness of voice
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5. ROS-NAD
PMHX: no hx of BT, surgery, no chronic illness
(HTN, DM and HIV)
FSHX: Has 4 wives with 20 children, he is a
farmer
Heavy Smoker for nearly 30yrs with
accumulated smoking of 15packyear
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6. General examination:
Ill looking, conscious, , hoarse voice, not jaundiced ,
not pale, no lower limb edema, no cyanosis, no
clubbing, no lymphadenopathy
Oral cavity- Normal
Vital signs:
BP: 130/87mmHg
RR: 30c/m
PR: 96b/m
TEMP: 36 c
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7. Indirect laryngoscopy- left vocal cord fixed
which was pale and had a cauliflower like
lesion noted
Right vocal cord was normal
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8. R/S : STRIDOR
CVS
GI
GU NAD
CNS
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9. Provisional dx: Upper airway obstruction sec to
laryngeal carcinoma
Differential dx: laryngeal polyp
laryngeal TB
laryngeal papilloma
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10. INVESTIGATIONS
FBP-( all parameters under normal range)
CXR-( normal)
PLAN
Emergency tracheotomy + biopsy done
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11. Patient was discharged awaiting biopsy results
And recommended to do CT of the neck with
contrast
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13. Patient came with biopsy results which showed
laryngeal ca stage iii
squamous cell carcinoma
patient was councelled and was prepared for
laryngectomy
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15. Pre-op investigation
CT SCAN OF THE NECK
FBP, BT CT
LFT
RFT
HEPATITIS B & C
ECG
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18. Cricoid
cartilage
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20. Tumour
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24. STAGE TREATMENT OPTION
STAGE 1 RADIOTHERAPY/ ENDOSCOPIC
LASER SURGERY
STAGE 2 RADIOTHERAPY/SURGERY
STAGE 3 SURGERY+ RADIOTHERAPY
STAGE 4 SURGERY+CHEMORADIATION
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30. NIL PER ORAL for 10days (feeding through NGT)
IV Antibiotics : ceftriaxone and metronidazole
for 5days
Inj declofenac 75mg IM 8hrly for 48hrs
Inj pantoprazole 3/12
4days in ICU then the pt was discharged to the
ward where he stayed for ten days then
discharged home
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31. Pt came for follow up and is still under
councelling for radiotherapy
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32. YEAR CASES
2007 0
2008 0
2009 0
2010 0
2011 0
2012 5
2013 0
2014 2
2015 1
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33.  From May 2007 to February 2016 a total of
number of 8 cases
 A rare condition by itself
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34.  A hoarse voice more than 2/52 and on
antibiotics needs a referral to an ENT
specialist
 Associating factors may lead to a good
diagnosis
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35. Definition:
are mostly, squamous cell carcinoma reflecting
their origin from the mucosa of the larynx.
Most laryngeal cancers originate in the glottis.
Supraglottic cancers are less common, and
subglottic tumours are least frequent
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36.  Hoarseness or other voice changes
 A mass in the neck
 A sore throat or feeling that something is
stuck in the throat
 Persistent cough
 Stridor - a high-pitched wheezing sound
indicative of a narrowed or obstructed
airway
 Bad breath
 Earache ("referred")
 Difficulty swallowing
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37.  Male sex
 Cigarette smoking
 Alcohol
 Age
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38.  Hx and physical examination
 biopsy
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39.  Discussion?
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