Laryngeal Carcinoma Radiologic Staging and What the Surgeon Wants to Know

Laryngeal cancer accounts for approximately 25% of head and neck cancers and is an extremely morbid malignancy, severely affecting quality of life by impeding the ability to communicate, swallow, and breathe. Patients can present with a myriad of symptoms including hoarseness, pain, dysphagia, and even otalgia. Initial clinical evaluation often includes laryngoscopy, assessing for mucosal lesions and vocal fold mobility. Imaging has a secondary role in laryngeal cancer confined to the mucosal surface, as clinical evaluation is more sensitive for the detection and evaluation of small mucosal lesions. However, T1 and T2 lesions may still be encountered as part of an initial evaluation or incidental presentation. While laryngoscopy can determine the superficial extent and size of a lesion, CT and MRI are central in determining deep tissue extent, invasion into adjacent tissues, and evidence of nodal metastases. Treatment options include surgical resection, chemotherapy, and/or chemoradiation therapy. Surgical options can be as limited as transoral laser microsurgery or as extensive as total laryngopharyngectomy. In this setting, the radiologist plays a vital role, as imaging interpretation will help determine the treatment regimen. Imaging findings largely dictate the T stage based on compartment/subsite location, additional subsite or adjacent tissue invasion, visible involvement of the vocal cord(s), and invasion beyond the larynx. Imaging is also key to the assessment for nodal or metastatic disease. Accurate staging is key, as overstaging could lead to unnecessary total laryngectomy, whereas understaging could contribute to treatment failure.