Our study, which focused on the retrospective analysis of hospitalization records, was confronted with certain number of difficulties:

- Inaccessibility of patients to imaging and to certain biological analyses, the repetition of which was part of the therapeutic follow-up of patients.

- Poor archiving of files.

- The loading of contact of certain patients.

We collected 57 cases of laryngeal cancer over a period of 11 years and it represented 2.15% of ENT hospitalizations, i.e., an annual frequency of about 6 cases. In our series, the incidence of laryngeal cancer was 0.8 per 100,000 inhabitants in men and 0.5 per 100,000 inhabitants in women. Our results are lower than those of Miss Mohssin Asmae [6], who found 2.4 per 100,000 inhabitants for men and 0.4 per 100,000 inhabitants for women according to the Grand Casablanca cancer registry and according to Clément Gauche [7] in France, the incidence was 2.5 per 100,000 inhabitants in men and 0.2 in women. This could be explained by the difficulties of access to care in our context, and the growing increase in industrial settings in developed countries, but tobacco and alcohol remain clear contributing factors [4].

The predilection age for laryngeal cancer is between 45 and 70 years old with a clear predominance between the fifth and sixth decades of life, whereas it is uncommon before 45 and after 70 years [8], but we observe a recrudescence of cancer in younger and younger subjects in connection with the precocity of alcohol and tobacco intoxication, as is the case in our series. The average age varies according to the series but remains between 55 and 65 years old. In our study, the average age was 52 with extremes ranging from 32 to 74, which agrees with the results found in the series but remains relatively younger [8].

In our study, forty of our patients are chronic smokers, i.e., 70%. In the other non-smoking patients, the notion of passive smoking was clarified in two of our patients. Indeed, the risk is 2 to 12 times higher in smokers compared to non-smokers [9] [10]. Thus, Mrs. Madrare Lamyae [11] found that 85.3% of smokers in a series of 34 cancer cases with an average consumption of 10 to 50 packets per year. Sadek Houda [12] highlighted in his series of 100 cases, 86 chronic smokers, (86%), with an average consumption exceeding 4 to 100 packets per year. The alcohol-tobacco association was found in 10 of our patients, 5 patients consumed it occasionally. In our series, 17.53% consumed alcohol frequently or occasionally. Determining the quantity in our context is difficult. Indeed, when we push the questioning with the patients about their toxic habits, they generally tend to deny their alcoholic habits, unlike smoking, which explains the low percentage of alcoholism in our study.

The consultation period is generally short in developed countries compared to Third World countries or the period can be spread over several years, as follows: we observed in our series an average period of 8.54 months with extremes ranging from 3 to 52 months. Our results are consistent with those of the literature [13], whose average consultation time was 8 months with extremes ranging from one month to 24 months. Several reasons could explain this late delay: The trivialization of certain symptoms (dysphonia, dysphagia) despite their persistence, the absence of initial pain and the difficulty of access to care. The delay in consultation can also be attributed to the first recourse to traditional medicine and the distance from specialized services. Finally, there is the diagnostic delay, which represents the time between the consultation of an ENT specialist and the histological establishment of the diagnosis, as well as the delay in the initiation of treatment. This delay is very long, allowing the evolution and the extension of the tumoral lesions.

The clinical signs evoking laryngeal cancer are classically dysphonia, dysphagia and dyspnea. The clinical signs already mentioned can be supplemented by a dry, irritating but persistent cough, a sensation of a foreign body, reflex otalgia on the side of the tumor lesion, which was found in only one of our patients, more rarely, hemoptoic sputum attracts attention and will lead to consultation [1]. Thus the data on symptoms in national and international series, thus showing a good correlation with the data of our series.

Imaging mainly provides additional information to endoscopy on deep extension. In our series, chest X-ray, abdominal ultrasound and cervico-thoracic CT were systematically used as staging assessments; but CT plays a key role in monitoring treated patients, detecting possible complications of treatment and looking for signs of recurrence (appearance of a mass, thickening of lymphadenopathy, etc.). In the literature [1] [8] in addition to the examinations aroused cervical MRI and PET-scan seem to be more specific and more sensitive to the search for metastasis. These extension assessments are not available from us, but cervico-thoracic CT remains the most useful examination to complete the extension assessment in all series.

Squamous cell carcinoma represents the dominant histological form of malignant tumors of the larynx. This is found in all the series reported in the literature. Diakité [13] in his series of 404 patients, found only one case of adenoid cystic carcinoma; squamous cell carcinoma was found in all the other patients. In our series, squamous cell carcinoma was found in 100% of cases, which agrees with most of the results reported in the literature. The well to moderately differentiated form represented 96%, and the poorly differentiated aspect constituted 4%.

Three methods are available: surgery externally or by endoscopy, radiotherapy and chemotherapy. Total laryngectomy (TL) is indicated when the local extension of the primary tumor contraindicates the performance of a functional partial laryngectomy. Indicated for laryngeal carcinomas with cartilaginous and/or subglottic extension with involvement of the cricoid [1]. In our study, we used LT in 26 patients (46%). The performance of partial surgery stems from the wish of some patients who consent to the resection of part of their larynx, provided that swallowing, breathing and phonation are safeguarded [1] [14]. We did not have recourse since all our patients consulted at a late stage of the disease. The initial lymph node status of patients with squamous cell carcinoma of the upper aerodigestive tract is a factor influencing the prognosis. Patients without lymph node involvement have a favorable prognosis, whereas metastatic lymph node dissemination clearly reduces survival. In our series, 84% of patients had cervical lymph node metastases at the time of diagnosis. After a total laryngectomy, radiotherapy is delivered by two opposite and parallel fields on the tumor excision area and the cervical lymph node areas.

It takes into account the histopathological criteria of the surgical specimen: analysis of resections of the tumor resection area, number of metastatic adenopathies and their capsular rupture, carcinomatous lymphangitis and emboli [1] [14]. In our work, radiotherapy was performed in 37 patients (65% of cases): adjuvant radiotherapy in 12 cases, and exclusive external radiotherapy in 25 cases. Of all the patients treated with radiotherapy, 62% (23 cases) received a combination radio-chemotherapy with weekly cisplatin at a dose of 40 mg/m² and 48% received radiotherapy alone.

Chemotherapy: Considered for a long time as a treatment for recurrent and/or metastatic tumors, it made a strong entry into curative treatments with the appearance, at the end of the 1970s, of platinum salts and their association with 5-fluorouracil. In ENT oncology, systemic treatment now has a validated place in the therapeutic arsenal. Use in induction prior to locoregional treatments with the objective of organ preservation. It was done in 48 patients in our study (84.21%).

In the literature, the overall survival rate (all sexes combined) at 5 years varies between 66 and 87% [1] [2] [14] depending on the tumor location, the therapeutic approach, the stage T, N and M and associated comorbidities. The overall prognosis is the best of that of the various tumors of the upper aerodigestive tract [1] [14]. In our series, the 5-year survival was 26.3%; this result is significantly lower than those of the international series. This low rate could be explained not only by the delay in diagnosis but also by the difficult access to postoperative radio-chemotherapy.