The incidence rates of laryngeal carcinoma are considerably lower among the female patients [6,7,8,9]. We report 34 female patients—who met the inclusion criteria—with laryngeal carcinoma; 38.2% were in the fifth decade of life, and these results are in accordance with the report of Garham and Palmer [10].
In the majority of cases in this study, the tumor was supraglottic (76.5%), but in 7 patients (20.5%), the tumor was restricted to the glottic area and only 1 patient (3%) had a stage 4 subglottic laryngeal carcinoma. These results are consistent with the study of Kokoska and his colleagues which was conducted on 40 female patients [11] and in discordance to a previous study by Shvero and his colleagues who concluded that the glottic area is the most common laryngeal sub-site affected by the laryngeal carcinoma [12].
In the present report, supraglottic carcinoma constituted the most common site for laryngeal carcinoma in the study population. An epidemiological study conducted by Peller and associates described the demographic distribution of laryngeal carcinoma among the German population. The incidence of laryngeal carcinoma in the female population was 1652 during the period between 1998 and 2011. The main primary subset for tumor origin was the glottis (50%). Their findings come in accordance with the previously reported literature [12]. The incidence remained stable during the study period in contrast to the male population which showed decline starting 2006. This decline reflects the change in the smoking pattern among the German society; however, the relative stability of the disease incidence among female population calls for possible presence of other factors that may contribute to the disease incidence in females [13].
A recent study was conducted over 50 laryngectomy specimens to demonstrate the role of sex hormones in the development of laryngeal caner. This is stemmed from the notion that the larynx is a secondary sex organ that undergoes changes with puberty reflecting the presence of sex hormone receptors which play the role in the physiological changes of puberty. Estrogen receptor B and progesterone receptors were found to be significantly associated with poorly differentiated tumors and malignancies with lymphatic invasion. On the contrary, androgen receptors showed significantly lower expression in poorly differentiated tumors and cancers with lymphatic invasion. Estrogen receptors B and progesterone receptors were thus considered as markers of aggressive tumor biology [14].
Some of the distribution disparity between laryngeal sub-sites could be attributed to differences in smoking and drinking habits between men and women. It is possible that that the greater prevalence of supraglottic tumors in females is due to the influence of steroid hormones, but it is unclear at this time how this effect might be exerted.
Notwithstanding the tendency to high-grade tumors in the supraglottis, 91% of the female patients in this study showed a grade 2 laryngeal squamous cell carcinoma. This is reinforced with the results of Stephenson and his colleagues [3].
In disparity to this study that reported that the majority of female patients with laryngeal carcinoma presented with advanced stage laryngeal carcinoma; 22 patients (64.7%) presented with stage IV and 12 patients (35.5%) presented with stage III; another retrospective study of 96 laryngeal carcinoma female patients showed that 68.8% of the female patients presented in an early stage of the disease [11].
Stell in 1990 found that 50% of affected females developed neck metastasis, but in this study, we found only an 18% incidence, mostly from supraglottic carcinoma [15]. This may be explained by the fact that the majority of our cohort showed well to moderate degree of differentiation (grades 1 and 2).
The main limitation of the present analysis is the small sample size due to the rarity of the disease among women. Another important factor is that we were unable to obtain data regarding the social habits (smoking and alcohol intake) among the study population, highlighting the importance of preoperative documentation. As a consequence, we were also unable to report data about the survival rates and the prognosis.
The main strength of this study is that it reports the largest number of female patients reported in the Egyptian literature. Also, the study was conducted over a relatively adequate time range (7 years). Our population included patients with locally advanced laryngeal tumors only facilitating analysis and future comparison of gender differences affecting only this specified patient population.
