John A. H. Waterhouse

Introduction and Methods

Of the many varieties of cancer which affect man, cancer of the larynx has an importance which is quite disproportionate to its frequency. In Great Britain it is not common, and indeed by world standards the incidence is relatively low. In men it amounts to approximately 1% of all cancers, but it is significantly less common in women, a feature which summons up thoughts of possible occupation based aetiology. It is not a homogeneous cancer, by which is meant it does not affect the larynx uniformly. The larynx is a complex organ, and its various discrete parts are affected with unequal frequency (again, by international comparisons, in a manner differing from some other parts of the world). Cancers of the subsections of the larynx — supraglottis, glottis and subglottis, show variations in behaviour and in their tendency to metastasise. Some remarkable differences in metastasising capacity are portrayed.

Malignancy in Crohn's Disease

In a series of 295 patients with Crohns disease, observed malignancy of the gastrointestinal tract was in excess of expectation. The small intestine and the pancreas were the sites where the excess was statistically very significant.

Cancer of the large bowel

Epidemiology histology presentation and investigation treatment and survival stages appendix and anal canal lymphoma and sarcoma. Appendices: standardized rates census populations.

MORTALITY IN CROHN'S DISEASE

A series of 513 patients with Crohns disease, who were followed for 1 to more than 35 yr by one unit, experienced a twofold increased risk of dying compared with a matched group drawn from the general population (102 observed; 51.8 expected; p < 0.001). The overall risk was similar for men and women and was greatest in the younger patients within a few years of diagnosis. The relative risk of dying decreased as the age at diagnosis of their Crohns disease increased and also fell as the period of time from diagnosis increased. There was a small but significant excess of death from tumors of the digestive organs (9 observed; 4 expected; p < 0.05). There was also a significant excess of deaths from suicide in women (3 observed; 0.4 expected; p < 0.01). The major burden of mortality lay in causes directly attributable to Crohns disease or to associated complications within the digestive system (46 observed; 1.41 expected; p < 0.001).

Sequelae of Neonatal Jaundice

A total of 371 newborn infants falling into 3 groups, non-haemolytic jaundice, haemolytic jaundice, and non-jaundiced controls, have been reassessed in the 6th year of life as regards neurological, audiological, and psychological function. Neurological handicap was concentrated among the infants of low birth weight and was not related to jaundice, apart from one case of athetoid cerebral palsy with deafness. No other cases of perceptive deafness were discovered. Intelligence testing on the Stanford Binet scale showed no relation between depth of jaundice and I.Q. These findings support the majority of reports in the literature that reduction in intelligence does not occur in non-haemolytic jaundiced babies with serum bilirubin below about 20 mg./100 ml. In haemolytic jaundice slight doubt remains. There is no indication for changing present standards for exchange transfusion.

Malignancy in relatives of patients with coeliac disease.

A survey of 1329 relatives of 139 patients with coeliac disease demonstrated an overall increase of cancer deaths particularly in women, but this did not quite reach 5 percent significance in men. Evidence is insufficient to determine whether this was due to the occurrence of cancer in relatives with undetected coeliac disease or to the operation of independent factors.

Cancer of the Larynx

Introduction and methods epidemiology - demographic aspects multiple primaries, social class and occupation histology incidence by sub-site stage - supraglottis, glottis, subglottis survival - larynx, treatment survival related to treatment second treatments. Appendices: Birmingham and West Midlands Regional Cancer Registry standarized rates census and inter-censal populations TNM classification of malignant tumours - larynx.

Extent of Disease

Unfortunately Dukes staging was only available for the period 1977–81, so the results for the entire 25 years could only be analysed on a broad grouping of node negative cases (equivalent to Dukes AB) or node positive cases (equivalent to Dukes C).

Palliative or No Treatment

For the sake of completeness an analysis of various palliative treatments has been undertaken and the results of these are presented in this Chapter. Some of the information, is perforce, incomplete and certain subgroups are too small to permit valid statistical conclusions to be drawn.

Survival Related to Treatment

This chapter examines the results of different treatment regimes and relates them to survival. The treatment given first (the primary treatment) is the one designated. Many cases will have suffered from recurrences and undergone successful second or even third treatments, for larynx is a site where this is both feasible and useful.