1. Demographics
   1. gender bias...
      1. M>W by 3.5x
   2. avg age of onset...
      1. 60-62 y/o
2. Risk Factors
   1. Smoking - dose-dependant risk - 20x risk of non-smokers - 7x risk if ex-smoker - <5% of laryngeal cancers have no h/o smoking
   2. Drinking - synergistic with smoking
   3. Less important RFs: - GERD - radiation - laryngocele - h/o juvenile papillomatosis
3. Incidence
   1. most common head & neck cancer (after skin)
   2. 5% of all malignancies
   3. overall 1/3 die
4. Presentation
   1. all can present with...
      1. - hoarseness - dysphagia - odynophagia - globus sensation - sore throat - referred otalgia - weight loss - neck mass
   2. presentations suggesting a specific lesion...
      1. Supraglottic - sore throat - hemoptysis - hoarseness - otalgia - neck mass
      2. Glottic - hoarseness (mechanical obstruction, neural involvement) - stridor & hemoptysis are late findings
      3. Subglottic - presents late with signs of airway obstruction (biphasic stridor)
5. Types of Cancer
   1. SCC (>95%)
   2. Verrucous carcinoma (Ackerman's tumor) (2-4%) slow-growing, locally destructive tumor that rarely mets --> excellent prognosis
   3. Adenocarcinoma (1%) - more aggressive than SCC
6. Frequency based on Location in Larynx
   1. Supraglottic (1/3) superior tip of epiglottis ---> floor of ventricular fold
   2. Glottic (2/3) floor of ventricular fold ---> horizontal plane 5mm inferior to vocal cord
      1. 95% arise from true cords
   3. Subglottic (2%): horizontal plane 5mm inferior to vocal cord ---> inferior border of cricoid cartilage
7. Lymphatic Drainage
   1. Supraglottic...
      1. can have bilateral drainage --> nodes on either/both sides
   2. Glottic...
      1. glottis is without notable drainage (regional node spread <10%)
      2. can invade through the pre-epiglottic space via pits in the epiglottic cartilage
   3. Sub-glottic
      1. often silent and poorly differentiated
      2. extends through the cricothyroid membrane to involve the LATERAL PARATRACHEAL lymphatics, CERVICAL lymphatics, and MEDIAL PRE-LARYNGEAL (DELPHIAN) node
8. Grade & Stage
   1. Grading
      1. 239-240
9. Treatment
   1. T1-T2...
      1. either excision or primary radiation (similar cure rates)
   2. T3-T4...
      1. surgery + post-op rads vs. organ preservation therapy