Patients with multiple malignant primary tumours are often described, based on their chronology of presentation, as simultaneous, synchronous or metachronous tumours. Lung malignancies presenting in association with head and neck tumours are well documented while there have been small series of thyroid synchronous cancers presenting with laryngeal lesions in literature. No cases, to our knowledge, have been reported in literature of a single patient with all three laryngeal, lung and thyroid malignancies. We report one such case of a 71-year-old Chinese man who had undergone a total laryngectomy for a recurrent cancer of the larynx only to be found to have tumours of the lung and thyroid in the post-operative period and he eventually died of post-operative complications. We also discuss screening for lung and thyroid malignancies in patients with head and neck squamous cell carcinoma (SCC).
Radiotherapy is the accepted treatment for early laryngeal carcinomas with the advantage of voice preservation. It is however, not without complications. We report a case of bilateral vocal cord immobility 15 years after radiotherapy. This appears to be due to ankylosis of cricoarytenoid joint and fibrosis of the larynx.
A retrospective study of cases with carcinoma of the larynx seen in the Universiti Kebangsaan Malaysia (UKM) and General Hospital Kuala Lumpur (GHKL) between 1981 to 1988 was performed. The aim was to document the distribution and the pattern of behaviour of this tumour amongst our patients. There were 137 cases, the majority of whom were Chinese (54%). The peak incidence was in the seventh decade and the male to female ratio was 7.6:1. The most common symptom at presentation was hoarseness (90%). The most common histological type was squamous cell carcinoma (87%) whilst by site, transglottic involvement was commonest (55%). The overall 3 year survival rate was 68%. Supraglottic carcinoma behaved differently in that a significantly large number presented with dysphagia (33.3%) and neck nodes (42%). Compared to tumours of other sites of the larynx, they had the poorest 3 year survival rate of 50%. Amongst the T2 and T3 tumours, the results of surgery appeared better than primary radiotherapy. Considering that 26% of patients presented with stridor, 20% with neck nodes and 55% with multiple site involvement, it can be concluded that our patients present themselves late.