The natural history of early vocal cord cancer.

Pure "early cancer" is an intramucosal lesion, but does not include carcinoma in situ or dysplasia in which the malignant cells have not penetrated the basement membrane and therefore have no metastatic potential. The term is often erratically used to describe lesions with invasion of the muscle or cartilage structures and such a careless terminology adds confusion to the nomenclature for these neoplastic lesions. Malignant tumour development involves complex interactions between several factors, both environmental (or exogenous) and endogenous (i.e. genetic, hormonal, etc.). The natural history of neoplastic disease coincides with three chronologically distinct stages: initiation and promotion (the sub-clinical latency period), and progression (when the tumour usually becomes clinically visible). Early vocal cord cancer may be asymptomatic and more advanced than it seems. It has a high cure rate with various treatments: there is no treatment of choice for early cancer, but a choice of treatments. As it is obviously difficult, or even impossible, to control far-advanced laryngeal cancer, it is essential to concentrate efforts on study the initial steps in tumour development to facilitate early detection and timely therapy.