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A statistical comparison of the professions of 1119 male patients with malignant laryngeal tumours and the profession of 708 male patients with malignant tumours of stomach, shows the influence of occupational exposures. The quantity of malignant laryngeal tumours is high in the group of steelworks- and foundry workers, workers in the glass-, porcelain-, quartz- and chemical industry and motorists. The inhalation of exogenous cancer-poisons are the probable cause.

At the ENT-Univ. Clinic Halle/Saale 1231 patients suffering from an histological verified cancer of the larynx have been observed over the last 33 years. The numbers of male cases have been trebled within the last 30 years. This trend could not be observed in women. The increase is connected with a remarcable concentration of the supraglottic localisation. Despite of intensive information of the population most of the patients only turn to our clinic in the stage II and III (TNM-system). Only in 9.9% of the cases their fate remained unknown.

Using the anamneses of 1231 patients with laryngeal carcinoma, who were treated in the ORL-clinic at the University om Halle, we investigated the relations among the duration of the anamneses, the place and the stage (TNM-system) of the tumor at the first registration. The causes of the neglection by the patient, the family doctor and the medical specialist are pointed at, and the possibilities for a modern laryngological diagnosis are given. An improvement of the early registration of patients with laryngeal carcinoma cannot be proved in the area of this clinic during the period from 1940 to 1974.

Among 1231 patients with laryngeal carcinoma were 48 women. These were compared with male patients showing laryngeal carcinoma with respect to nine various groups of criteria. There was no significant difference in: Histological Diagnosis, the first symptom, the second tumor. In opposition to male patients with laryngeal carcinoma the number of women's carcinoma has not increased since 1940. Women are relatively more frequently taken ill at a younger age, they show a longer anamnese and relatively more frequently suffer from an inner carcinoma than men. Although the female patients with laryngeal carcinoma were attended relatively frequently at a rather favourable stage, we were not able to notice any better results after the five years' survival in comparison with the male patients.

In 21 cases of laryngeal cancer precursors (diffuse laryngitis chronica; so-called "plain", "verrucous" or "papillary" keratosis circumscripta) a microlaryngoscopy was performed, followed by microsurgical removal of the dysplasia. One part of each tissue specimen was studied histologically, the corresponding other part was observed in the SEM. In comparison of the microlaryngoscopic findings and histologic diagnoses on the one hand to the submicroscopic findings got by SEM on the other hand we may describe interesting characteristic structures of the laryngeal mucous membrane. Chronic laryngitis is represented in two different types: 1. plain parakeratotic type, 2. irregularly elevated hyperkeratotic type. Obviously last of them seems to have a greater tendency of malignant degeneration. The so-called "keratoses" represent specific SEM patterns according to their microlaryngoscopic pictures: - Homogeneous structure including sporadic parakeratotic keratinisation in cases of "plain" keratosis (mostly "leukoplakia"). - Irregularity of cell and tissue surface including cell walls, but also roughness and keratinisation of microvilli in cases of "verrucous" or "papillary" keratoses (mostly "pachydermia" or adult papilloma). - Characteristic SEM picture of cancer (echelon phenomenon) in cases of precancerous lesions, in which signs of atypia were proved histologically. Our SEM results confirm the value of an exact review of the laryngeal mucosa surface for laryngologists. Precancer diagnostics can be completed furthermore by intravital staining for instance. Nevertheless there is no doubt, that also a most careful surface diagnostics cannot replace histologic tissue examination in cases of early cancer detection. Obviously there are the limits of scanning electron microscopy in laryngeal cancer research.

The treatment-surgery and irradiation- of 722 patients with cancer of the larynx in the years 1940-1969 are being statistically evaluated. The classification was done accordingly to localisation, stage (TNM-system) and the kind of therapy. The evaluation of the results only considers the 5-years-healing. Surgical therapy and primary irradiation were confronted. The irradiation ranks equally to surgery only at stages I and II of the carcinoma of the vocal cords. Tumors at other localisation or at a different stage (III and IV) can only be successfully treated by surgery.

Precursors and early symptoms of pharyngeal cancers generally appear without specificity. Mostly they are recognized in the stage of progressive carcinoma, so requiring a more radical therapy. Another situation you will find in laryngeal tumours. The early detection of laryngeal cancers has been mainly influenced by the favourable experiences of gynecologists with portio precancerous diseases. So an essential contribution to early detection of laryngeal cancer was given here by using a system of graduated methods regarding precursors and early stages of laryngeal carcinoma supplied by critical evaluation of early symptoms (hoarseness, disturbances of swallowing). The principle of clinical diagnostics turns out to be an exact observation of laryngeal mucosa surface by means of microscope, occasionally supported and extended by means of further investigations, e.g. exfoliative cytology and supravital staining. Moreover, for instance laryngostroboscopy permits to record vocal folds' movements so enabling a careful registration of laryngeal function. Nevertheless therapy of precancerous epithelial lesions in the larynx can be determined by histology only. Thereto we could demonstrate by means of evaluation of numerous patients' data as by scanning electron microscopic investigations of the laryngeal mucosa, that the rate of malignant transformation of localized (leukoplasia, pachyderma, keratosis) and diffuse epithelial lesions (chronic laryngitis) obviously seems to be greater in cases of verrucous or papillary surface structure of mucosa than in plain one. Finally, general recommendations for diagnostics and therapy of epithelial dysplasias and carcinoma in situ of the larynx according to the ORL society of the GDR are presented now.