Laryngeal Cancer
Laryngeal cancer decisions weigh disease control against laryngeal function, which makes precise subsite and stage documentation particularly consequential.
Disease categories
Major disease categories
- Glottic carcinoma
- Supraglottic carcinoma
- Subglottic carcinoma
Molecular
Molecular considerations
TP53, CDKN2A and PIK3CA alterations are described, consistent with head and neck squamous cell carcinoma generally.
Markers commonly discussed in laryngeal cancer
- TP53
- CDKN2A
- PD-L1
Not exhaustive, and not every marker is assessed in every patient. Which of these is relevant depends on the individual case and should be discussed with the treating team.
Testing
Genomic testing considerations
Profiling is discussed in recurrent and metastatic disease.
Germline
Germline considerations
Considered where the clinical picture suggests it.
Molecular monitoring
ctDNA and liquid biopsy considerations
Investigational.
Single-cell & computation
Single-cell and algorithmic approaches
Single-cell sequencing in head and neck cancer is used to characterise immune exclusion and the stromal compartment, both of which vary substantially between tumours that look similar histologically. Single-cell DNA analysis contributes to field-change questions — whether a second lesion is a recurrence or an independent primary, which clonal analysis can often settle. Algorithm work includes HPV integration site analysis, deconvolution of immune composition from bulk expression, and viral circulating-DNA trajectory modelling.
Decisions
Treatment decision questions
Questions worth raising with a treating team when a decision is being made:
- Is the laryngeal subsite documented?
- Are functional considerations recorded alongside oncological staging?
Resistance
Resistance and recurrence questions
- Has the disease been re-staged and re-characterised at recurrence?
Trials
Clinical trial considerations
Function-preservation questions feature prominently in this disease.
When a precision oncology review may help
A review is most useful where the standard pathway has been exhausted or where the picture is more complicated than a protocol accounts for — rare presentations, treatment resistance, complex or apparently contradictory molecular findings, or a decision between several defensible options.
The output is a structured analysis and a set of questions for the treating team. It is not treatment, and it does not replace the treating oncologist.