The etiology and pathogenesis of laryngeal carcinoma

Abstract

Squamous cell carcinoma (SCC) is the predominant type of laryngeal cancer, accounting for over 90% of cases, and laryngeal SCC accounts for 26% of all cases of head and neck SCC. Most patients who develop laryngeal SCC are men, and the overall male-to-female ratio for this disease is approximately 5:1; however, since the 1950's, an increasing incidence of laryngeal SCC has been observed in female patients. This increase in women is particularly significant, and it may relate to the increased use of tobacco and ethanol by women during that period. Changing patterns of disease with time and exposure to comparable risk factors in different countries of the world have helped elucidate a group of common carcinogenic variables that are now being associated with a broader, more multifactorial hypothesis of laryngeal carcinogenesis. Although many of the presumed carcinogenic influences have been shown to alter the internal (mucosal) environment, not one has been proved to cause carcinoma. Virtually all of the available data is associative, that is, epidemiologic. This is even true for well-established causes of head and neck carcinoma, such as tobacco and ethanol. In addition to tobacco and ethanol, it now appears that other risk factors may influence the carcinogenic process, and that identification of specific factors in susceptible patients with laryngeal SCC may influence both management and outcome.