Signs, symptoms, stages and treatment of throat cancer. Symptoms of the initial stage

To date, statistics show that 65-70% of malignant tumors are accounted for by cancer of the larynx. Today, as we see, this is one of the most common diseases of the throat. It especially affects men aged 40 and over. over years. Women may also be at risk. About 60% of all patients are cured completely. Most often, this disease affects the townspeople, villager in this case, they are less affected by 1.5 - 2 times.

ICD-10 code

C14.1 Malignant neoplasm of laryngopharynx

Causes of throat cancer

The most common cause is smoking. How more people smoked in his life, the higher his risk of developing cancer of the larynx.

With complex interaction tobacco smoke and alcohol risk appeared malignancy almost doubles. It is also worth noting that the symptoms of throat cancer appear not only due to smoking and alcohol abuse.

Drinking alcohol, all kinds infectious diseases in the oral cavity, as well as contamination environment can also cause cancer of the larynx. The human papillomavirus can also lead to cancer of the larynx.

Risk factors

In addition to the above, risk factors include:

• lack of B and A vitamins, which can also cause throat cancer;
• weak immune system, congenital diseases or HIV infected;
• men working in crowded places chemical substances or constant contact with harmful chemical elements. These include wood dust, paints, varnishes, etc.
• African Americans.

If a person:

• consumes large quantities of salted meat;
• does not follow oral hygiene;
• often breathes air high content asbestos or coal dust;
• has a number of genetic predispositions to this disease,
• then they may also be at risk of developing laryngeal cancer.

throat cancer symptoms

Laryngeal cancer occurs in such a way that healthy cells suddenly begin to actively divide, grow and touch neighboring organs. Moreover, cancer cells can metastasize. Cancer foci can appear even where it is impossible to expect, in very remote places from the tumor itself. This can be explained by the fact that the cells of this tumor can spread throughout the lymphatic and blood vessels.

Laryngeal cancer may require surgery to remove malignant tumor, namely the larynx. As a result, a person completely loses the ability to speak independently. There is hope for the artificial larynx that scientists have created in our time. This is the so-called "voice prosthesis", which is able to restore up to 80% of speech.

This is a small box-implant device that is inserted into the space formed after the operation between the trachea and the esophagus, which is very unpleasant and unusual for a person.

Symptoms of cancer of the throat and larynx to identify in this case is not difficult. early form laryngeal cancer can be detected by hoarse voice. But if a person notices the following signs, then it is also important for him to see a doctor as soon as possible.

So if a man:

• for no reason feels a noticeable weight loss,
• for a long period of time, the cough does not leave him alone,
• feels discomfort when swallowing, namely, he has difficulty breathing and pain appears,
• feels constant pain in the throat or in the ear,
• feels for a visible swelling or swelling in the neck,

These are the main symptoms of cancer of the throat and larynx, no matter how regrettable it may sound.

When the symptoms described appear, if they do not disappear for more than two weeks, it is better to consult a doctor as soon as possible. Usually, in 80% of cases, the 1st stage of laryngeal cancer is asymptomatic. Therefore, it is better if the patient nevertheless notices unpleasant and unusual sensations or painful sensations in time.

It should be said that the symptoms of throat cancer can be different for each patient. We have listed the most common ones above. But they can be and vary depending on the localization of the tumor, the characteristics of its development, from any pathological influences on others. human organs. For example, if the tumor is located in the region of the epiglottic cartilage or in the place of the arytenoid-epiglottic fold, then the person has a feeling like a coma in the throat. This factor can also be attributed to the first symptoms of throat cancer. If the vocal folds are damaged as a result of the disease, then hoarse voice eventually it may disappear altogether. If the tumor grows in the subglottic region, then it will provoke difficulty breathing, can lead to suffocation and endless coughing.

If the patient, when swallowing, feels, as we wrote earlier, a foreign body, then this is one of the first tumors of the larynx, which is caused by compaction of the epiglottic cartilage. The symptom of pain in the ear may appear at a later stage in the development of larynx cancer and usually this is due to the tumor growing into the nerves or growing metastases. A symptom such as hoarseness occurs due to the fact that the tumor allows the vocal cords to close tightly and, as a rule, in the process of cancer development, this hoarseness increases until the complete disappearance of the voice. If breathing is difficult, then this is directly related to the germination of the tumor in the lumen of the larynx. They can be considered among the most late symptoms throat cancer. In the future, it can grow into neighboring organs, for example, in the tissue of the cervical region, trachea. In the neck area, metastases can get most quickly. In the same way and with the same speed, they can appear in the root of the tongue, in the lungs and other organs. Metastatic tumors have the same structure as the main tumor. Therefore, if it passes into the lungs, then it has the name "metastatic tumor of the larynx in the lungs", but not lung cancer. These signs of throat cancer alone are not enough for a doctor. He fails to diagnose throat cancer. For this, the patient needs to pass quite a few more tests, to be tested. One of the most common tests used to diagnose a disease is a biopsy. Using a thin needle, the doctor takes a sample of tumor tissue in order to determine in a medical laboratory whether there are cancer cells in the tissue or not. A biopsy can help determine the presence of the disease, and other diagnostic tests can determine the size and shape of the tumor and pinpoint its location. If malignant cells are present, then the patient must undergo computed tomography, thanks to which it is possible to detect a three-dimensional image of the tumor.

The first symptoms of throat cancer

We have already talked about the symptoms in general, now we will talk about the first symptoms of throat cancer. The first signs of laryngeal cancer appear as follows.

The initial stage of throat cancer, as it is also called, is accompanied by a change in the timbre of the voice, hoarseness, up to the complete disappearance of the voice. After that, a person simply cannot swallow saliva, or even swallow food at all due to tormenting him. pain. The sensation of the presence in the throat of some foreign or foreign bodies may still be one of the first symptoms of throat cancer. Well, the last thing that may appear at first is shortness of breath.

For more late stages throat cancer can occur:

• difficulty in getting food through the esophagus.
• constant pain, which practically no longer disappears even when treating the throat with all sorts of methods and means.
• paroxysmal or cough that does not even go away.
• the appearance of pain in the ears.
• not small swelling on the neck due to the fact that there was an increase in size lymph nodes.
• in some cases, rapid weight loss.

At advanced 3-4 stages of throat cancer, sputum appears with pus, with blood impurities and with bad smell from the oral cavity. It's getting harder to breathe every day.

Treatment for this disease is possible, but it must begin in a timely manner. It depends only on the degree of complication whether it will end simply with treatment or the human larynx will be subjected to surgical intervention.

The main thing is to understand one thing than earlier man examines his body, the sooner the diagnosis is made, the more likely it is to receive help without harm to health, which will help not to start the disease. Do not bring the disease to the deadline, so that even the most radical methods will no longer be able to help.

On the preventive examination a dentist or an otolaryngologist can detect the presence of ulcers on the mucous membrane of the larynx, if any. However, more accurate diagnosis patient receive only when special survey. Ultrasound procedure, x-ray, helps to determine the location of the tumor and its size, shape. During the treatment period, quite often a specialist may prescribe magnetic resonance imaging. A mandatory examination in diagnostics is the delivery laboratory tests, in which, as a result of obtaining a piece of tissue or a smear taken from the larynx, experiments are carried out under a microscope. Such an analysis is extremely necessary, since it can be used to identify atypical cells - dead or with deviations.

If the treatment is carried out correctly, especially in the early stages of the development of the disease, a favorable prognosis can be safely achieved. The situation worsens, as a rule, growth cancerous ulcers to neighboring organs and tissues, some complications, in particular distant metastases, which is a sign of the generalization process.

stages

Medicine is familiar with various forms throat cancer. The most common among them is squamous cell carcinoma larynx. Most often, malignant tumors of the larynx are located in the middle section, where the vocal cords are located.

How can you determine for yourself whether you are a carrier of laryngeal cancer or not?

As mentioned earlier, certain symptoms may arise as a result of exactly where the tumor is located. If it is present in the upper parts of the pharynx, then pain occurs in the throat. This pain is very similar to the pain of a sore throat.

With the localization of the tumor in the pharynx when swallowing food appears painful sensation in the throat. It happens that the pain may begin in the teeth or they may begin to fall out suddenly.

If cancer has formed on the vocal cords, in the places of the larynx, then, first of all, the patient cannot help but notice the hoarseness of the voice, to the point that it can completely disappear. And as we have already said, shortness of breath, difficulty breathing, feeling the presence of something out of the ordinary in the throat are another symptoms of cancer of the throat and larynx.

Like any other malignant tumor, laryngeal cancer has several stages:

Stage zero, in which the biopsy detects the presence of abnormal cells in the mucosal area that do not cross the border of the mucosa.

• Stage 1 - a tumor in the form of a small sore located in the mucosal area. This may be a part of the larynx, which is not reflected in the hoarseness of the voice.
• Stage 2 - the tumor can develop on the entire larynx. Symptoms of throat cancer are the initial hoarseness of the voice, but metastasis in the lymph nodes is not observed.
• Stage 3 - the tumor of the larynx already passes to the neighboring tissues of the larynx, which may cause a change in voice and an increase in lymph nodes up to 3 cm.
• Stage 4 - the tumor grows in large sizes and over the entire larynx, while sprouting into neighboring tissues: the esophagus, lungs, thyroid gland. Metastases can also be in distant organs.

It is important that before treatment, the doctor properly examines the symptoms of throat cancer and determines the patient's stage of development of his disease.

Throat cancer is a very serious disease that is not to be trifled with. Therefore, when the first signs and symptoms occur, do not delay seeing a doctor. It is better to contact a specialist as soon as possible than to suffer from all the bitter consequences later.

Throat Cancer Treatment

Laryngeal cancer can be cured in two ways: conservatively and through surgery. Today, the quality of life of the patient is given enough attention. Therefore, in the early stages of the development of cancer of the middle and supraglottic region, treatment begins with conservative methods- radiation and chemotherapy. It is on a par with the surgical one in terms of quality and result. This therapy does not disrupt the function of the larynx, and patients can continue to work.

What is included in the concept Combined treatment"? This is usually a combination of surgery and radiation therapy. It is carried out in patients with large tumors, as a rule, and the development of a cancerous process. Preoperative radiation therapy makes it possible to reduce the size of the tumor and helps to reduce the development cancer cells. However, if the doses of radiation therapy are large, then the wound may heal even worse.

Radiation therapy

With this therapy, laryngeal cancer is irradiated from the side fields and covers the entire larynx and the area of ​​regional metastasis. Common reactions include weakness, headaches, and nausea. Local reactions may occur in the larynx and on the skin of the neck. Patients may experience pain when swallowing, swelling of the tissues of the neck. With changes in the larynx, inflammation and swelling of the mucous membrane and vocal cords. This can lead to the fact that hoarseness will increase even more, and the lumen of the larynx will decrease even more. Therefore, if a patient has a tumor big size, then he needs to impose a tracheostomy (in a place that is located below the tumor itself, a tube is inserted into the trachea through which the patient can breathe calmly, it is removed after treatment). With radiation therapy, the function of sound formation does not change for the worse, and after the person has been treated, the sonorous voice is completely restored.

Chemotherapy

It is carried out only in conjunction with radiation therapy and surgical treatment. For this, platinum preparations, mainly cisplatin, are used. It is necessary to be checked by a specialist: in the first year - monthly, in the second year - 1 time in 3 months, from 3 to 5 years - 1 time in 6 months, and after 5 - 1 time per year.

Application Based Chemotherapy medications helps fight cancer. Chemotherapy - part complex treatment laryngeal cancer, which is prescribed in 2 cases:

1. Before surgery or before radiation therapy. As a result of its use in this case, the size of the tumor can decrease significantly.
2. After surgery or after radiation therapy. Its main goal is the final destruction of possibly preserved cancer cells.

But both are very cruel methods of treatment, which can give their complications in the future. All this affects not only malignant cells, but also other healthy organs person. Chemotherapy releases drugs into the blood. When radiation therapy is aimed at damaging cancer cells, it can also affect healthy cells, which can adversely affect the body as a whole.

In order to reduce the risk of laryngeal cancer, you need to do some doctor's wishes.

1. Each method of treatment, whichever the patient chooses, involves a difficult course, periodic prevention of the disease.
2. The main causative factors of throat cancer and many other oncological diseases, such as cancer of the lips, mouth, esophagus, are alcohol and smoking, their increased use. Therefore, first of all, you need to abandon the harmful ones. This will reduce the risk of the appearance and development of cancers.
3. It is necessary to exclude the use of spicy, salty and very hot dishes from your diet. Instead, eat more fruits and vegetables. Every day you need to take care of the oral cavity, reduce exposure to the sun, apply means personal protection in the presence of diseases of the throat.

Forecast

Throat cancer symptoms develop slowly. As a rule, metastases, if they develop, then in remote areas. and that is very rare. Therefore, in the initial stages of laryngeal cancer, the prognosis is relatively successful.

Throat cancer is oncological disease, which is accompanied by mutation and atypical division cells. The combination of these elements forms a tumor. depend on the degree of damage to the oropharynx, tonsils, pharynx or vocal cords.

The concept of "throat cancer" grouped two types of diseases:

1. Cancer of the pharynx (the tumor is located in the gap from the nose to the upper respiratory tract).
2. (zone of the vocal cords).

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Causes and risk factors for throat cancer in women

Malignant lesions of the throat in women are most susceptible to individuals over the age of 50 years. Key Factors risk include:

• tobacco smoking and frequent use hard liquor.
• Hypovitaminosis or vitamin A deficiency.
• Carcinogenic effects of asbestos fumes.
• Unsatisfactory condition of the oral cavity.

Some scientists point to the connection of a cancerous lesion of the throat in women and papillomatous infection, which is spread through sexual contact. Also, in 20% of cases it can be a secondary lesion in metastases of internal organs.

Reliable signs of throat cancer in women

It is often very difficult to determine the oncology of this area in the initial stages of the disease. General signs and symptoms of throat cancer in women include:

1. Changes in the timbre of the voice.
2. Difficulty swallowing food.
3. Sudden weight loss.
4. Periodic bouts of coughing, which may be accompanied by bloody discharge.
5. Enlarged cervical lymph nodes.
6. Pain syndrome, which is diffuse in nature.
7. Hoarseness in voice and rattling during breathing.

If the first symptoms of throat cancer in women detected, seek immediate medical attention.

Diagnostics

After clarifying the patient's complaints, the doctor proceeds to an instrumental examination. There are two main diagnostic methods:

• Laryngoscopy :

Before the procedure, the patient is anesthetized the mucous membrane of the throat. After local anesthesia through oral cavity a long and flexible hose is introduced, which is equipped with a backlight and a video camera at the working end. If during the visual examination there is a suspicion of, then the specialist removes a small part of the tumor tissues.

• Biopsy :

This technique determines final diagnosis based on histological and cytological analyzes biopsy.

Establishing diagnosis

The detection of cancer cells in the throat determines the stage of the cancer process.

• Stage 0 - the tumor does not extend beyond the throat.
• Stage 1 - a malignant neoplasm less than 7 cm in diameter and limited to the tissues of the nasopharynx.
• Stage 2 - the pathology exceeds 7 cm and still does not spread to neighboring structures of the throat.
• Stage 3 - cancerous tissues reach a significant size and affect nearby organs and systems.
• Stage 4 - observed with metastases in the lymph nodes and internal organs.

To clarify the size malignant neoplasm and the degree of spread of pathological tissues, the doctor prescribes computed and magnetic resonance imaging. These examinations are X-ray scans of organs and systems.

Throat cancer in women - photo:

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Treatment of throat cancer in women

Exist various options throat cancer therapy. The choice of an adequate method of treatment depends on the stage oncological process and prevalence of pathology.

Surgery

If the tumor is detected in the initial stages of growth, then the specialist may suggest that the patient undergo prompt removal mutated tissues. This operation is usually performed under local anesthesia.

Some patients may experience the following complications after surgery:

• difficulty swallowing solid food;
• asymmetry of the neck and face;
• lack of conversational function;
• labored breathing;
• skin scars, folds in the neck.

Radiation therapy

may also occur several years after treatment. To prevent recurrence of the disease, many oncologists recommend that their patients undergo regular medical examinations. The frequency of visits to a specialist should be at least once a year. At such an appointment, the oncologist performs palpation, analysis for tumor markers and radiography.

When it comes to throat cancer, in most cases, this malignant neoplasm develops in one of the parts of the larynx, less often in the pharynx (see photo).

Laryngeal cancer accounts for about 3-8% of all malignant neoplasms and is the most common tumor in the practice of an ENT doctor. Consider the main aspects of this problem and its treatment.

Laryngeal cancer, what is it?

Throat cancer is a malignant tumor that can affect different departments laryngopharynx. It is capable of exophytic (outward) and infiltrative (inward) growth, and in the process of its development gives distant and regional metastases. Cancer of the larynx is a lesion of a tumor of one of the sections of the throat - the larynx.

Usually this formation is detected in elderly patients and old age, but it can also appear in a child. Throat cancer is several times more common in men than in women.

Women who smoke are several times more susceptible to the disease than their non-smoking neighbors. The disease is more common among urban residents than among rural residents.

Among the factors that contribute to the development of this pathology, smoking is in the first place. Give a certain importance occupational hazards(dust, inhalation of gases, etc.), alcohol, increased load voice (singers, teachers, etc.).

Often, a cancerous tumor develops against the background of existing pathological conditions laryngopharynx. So, in about half of the patients, throat cancer developed against the background of chronic laryngitis (hyperplastic form).

Important! Other risk factors include gastroesophageal reflux, since the acidic contents of the stomach and esophagus constantly irritate the laryngopharynx, which can lead to malignant cell degeneration, as well as juvenile papillomatosis.

A throat tumor can be formed as a mature (keratinizing, differentiated) or immature (more malignant, poorly differentiated) form.

A mature tumor develops more slowly, it metastasizes less often and takes longer. later dates. Immature poorly differentiated cancer grows much faster and metastasizes early to other organs and tissues.

Important! Metastases are a secondary focus of growth tumor cells. Those. from the primary tumor, cancer cells spread to other organs and tissues, giving rise to other neoplasms.

Depending on which area the tumor affects, there are:

1. Cancer of the pharynx. It is rare and mostly found in males. Carcinomas and sarcomas usually develop in this area. Early symptoms very poor, but this department is easier to examine, so there are many chances to identify a tumor on early stages.

2. Cancer upper division larynx. One of the most unfavorable tumor locations in terms of patient survival. Occurs in 15-20% of cases. This area is well supplied with blood, therefore, with the development tumor process extensive and early metastasis occurs.

The first signs of laryngeal cancer are very mild and often patients confuse them with inflammation and infection. This leads to the fact that the pathology is diagnosed already in the later stages.

3. Tumor of the middle part of the larynx. Occurs in more than half of patients, it is a prognostically "favorable" form of cancer.

The neoplasm usually appears on the vocal folds - this area has few lymph nodes, so metastases are either not observed at all or develop at a very late date. Clinically, patients notice it much earlier due to the appearance of voice problems.

4. Cancer of the lower larynx. Occurs rarely. This department is rich in lymphatic vessels and well supplied with blood, so the tumor metastasizes early.

the first signs of cancer are nonspecific

One of the unpleasant features of such neoplasms is their meager symptoms in the early stages. The first signs of throat cancer either do not appear at all or are simply ignored by the patient, who writes them off for a cold or other pathology.

Consider the symptoms of laryngeal cancer in the early stages:

1. Dryness, discomfort, burning in the throat.
2. feeling of coma and foreign body.
3. Difficulty swallowing saliva, solid food.
4. Pain in the neck and ears.
5. Hoarseness of voice, change in its timbre.

Such scanty symptoms lead to the fact that laryngeal cancer is detected in the later stages or during a random scheduled examination by an ENT doctor. The symptoms of throat cancer in women and men do not differ from each other, except that women are more attentive to their health and the process is detected in them earlier - but this depends rather not on gender, but on the patient's personal qualities.

Signs and symptoms of laryngeal cancer

symptoms of laryngeal cancer, photo

Symptoms of laryngeal cancer depend on the stage, the presence of metastases and the type of cancer. At different stages, the patient may be disturbed by the following symptoms:

1. Throat discomfort. Pain in throat cancer appears in the later stages, when the formation compresses the nerve endings. Such pains are very pronounced and are not stopped by taking conventional analgesics.
2. Difficulty in swallowing. At first there are problems with the use of solid food, then the tumor grows and the patient has difficulty swallowing saliva and water.
3. Fatigue, deafness of voice.
4. Cough.
5. Swelling in the neck.
6. Enlargement of regional lymph nodes.
7. Violation general condition: weakness, loss of appetite, weight loss and others.

The disease is manifested by other symptoms, especially when the tumor metastasizes to other organs, therefore clinical picture largely determined by the type and stage of neoplasm.

Throat cancer grades

Almost all tumors can be classified according to the international TNM system, where T is the size of the primary tumor itself, N is regional metastases, and M is distant metastases. According to this classification, the larynx is schematically divided into separate zones so that the prevalence of the pathological process can be assessed.

The size of the primary tumor is estimated as follows:

• T1 means that the tumor has spread to one of the anatomical elements of the larynx and does not go beyond it;
• T2 - the tumor completely occupied one of the anatomical elements of the larynx;
• T3 - the pathological process has gone beyond one anatomical element of the larynx;
• T4 indicates that the tumor has already spread beyond the larynx and there are distant metastases.

This is how the degree of damage to regional (nearby) lymph nodes is assessed:

• N0 - lymph nodes are not enlarged and cannot be felt;
• N1 - palpable unilateral lymph nodes;
• N2 - large lymph nodes are palpable, soldered together.

Based on these criteria, throat cancer is divided into 4 stages. The first includes T1N0M0, which should be understood as a tumor of one of the anatomical elements of the larynx, there are no metastases, nearby lymph nodes are not affected. Stage 4 can be written as T2N3M0. This information is needed for selection efficient scheme treatment of laryngeal cancer at stage 4.

Early diagnosis is based on subtle symptoms that suggest the presence of a tumor. So, constant dryness, perspiration and discomfort in the throat should alert both the patient and the specialist in relation to laryngeal cancer.

Important! common cause diagnostic errors in the early stages is the similarity of manifestations with and (inflammatory processes in the laryngopharynx), so it is important to remain vigilant.

Regular routine examination of the larynx with the help of special instruments and an endoscope will help to recognize the tumor in the early stages.

The final diagnosis can only be made on the basis of histological examination. To do this, remove a small piece of suspicious tissue (biopsy) and examine it under a microscope.

CT, ultrasound and x-rays are used after confirming the diagnosis of throat cancer to clarify the prevalence of the process and the presence of regional or distant metastases.

There are several approaches to the treatment of laryngeal cancer, depending on the stage, cellular structure and area of ​​​​its location. The main methods of treatment are radiation therapy, surgical intervention and chemotherapy.

1. At the first stage, radiation treatment is usually chosen. In addition, they can surgical intervention, remove the tumor and then conduct a course of radiation therapy.
2. At the second stage, a combination of radiation and surgical methods is chosen. First, a cancerous tumor is removed, and then the lymphatic vessels and nodes are irradiated.
3. At the third stage, the treatment is approximately the same: the tumor is removed and the lymph drainage pathways are irradiated.
4. In the fourth stage, chemotherapy is used, since surgical and radiation treatments are no longer effective. In addition, they are engaged in palliative therapy: they relieve pain and maintain the quality of life of the patient.

How long do people live with throat cancer (prognosis)

Survival for throat cancer depends on the type of tumor and the stage at which it was noticed and treated.

The most favorable prognosis for cancer of the middle part of the larynx, detected at stage 1. Here, the five-year survival of the patient is more than 80%. As for tumors of other localizations and stages, the figures are correspondingly lower.

There is no definite answer to the question of how long they live with grade 4 throat cancer. Survival depends on the type of tumor, as well as the treatment that the patient can afford.

Cancer of the throat (larynx) is severe diagnosis, both for the patient and for his relatives, but this is not a sentence. Determining the disease in the early stages and appropriate treatment allows you to cope with this problem. To do this, do not neglect the planned examinations of a specialist and, if possible, eliminate the risk factors for this disease.

Laryngeal cancer is a fairly common pathology, but it cannot be said that the disease is among the leaders among other tumors. Its frequency does not exceed eight percent among the population, and most often the tumor is found in older men, mostly 60-70 years old, smokers and those suffering from inflammation of the throat.

In women, throat cancer is much less common: for 100 sick men, there are only 8 representatives of the fair sex.

The risk of the disease is significantly increased in smokers, including smoking women. In addition, it has been noted that residents of cities, especially large ones, suffer from malignant tumors of the larynx more often than residents of villages. This is probably due to the unfavorable environmental situation and gas pollution of the atmosphere of megacities.

Throat cancer in the initial stages of development does not differ in any specific symptoms, so maybe for a long time hide behind a mask inflammatory processes. This leads to delayed diagnosis and difficulties in subsequent treatment.

Briefly about the larynx

The larynx is part respiratory system involved in sound production. Its upper section communicates with the pharynx, the lower passes into the trachea. In addition to respiratory essential function the larynx is the reproduction of sounds necessary for articulate speech, and in singers this organ, due to the peculiarities of the vocal folds, reproduces musical sounds. Despite its small size, the larynx is quite complex, it has 3 paired and 3 unpaired cartilage, is attached by many muscles that help to carry out all its functions.

In the structure of the larynx, three sections can be distinguished:

• Upper (vestibular) - from the entrance to the larynx to false folds;
• Middle - located between the folds of the vestibule and the true vocal folds and also includes the ventricles of the larynx;
• The lower section is the subglottic space, passing into the trachea.

From which of the departments the tumor is located, its course, structure, features and possibilities of treatment, as well as the prognosis, depend.

Risk factors and precancerous changes

As you know, malignant tumors most often arise against the background of already existing pathological processes, and also as a result of the impact adverse factors environment. The causes of laryngeal cancer consist largely of external influences.

So, Among the risk factors of paramount importance are:

1. Smoking, which increases the risk of a tumor several times;
2. Work in harmful working conditions (dust, gas pollution, high or low temperatures);
3. The use of alcohol, the vapors of which irritate the mucous membrane of the respiratory tract;
4. Excessive voice load, characteristic of singers, teachers.

The changes that precede laryngeal cancer are most often represented by:

• Chronic laryngitis, especially with mucosal hyperplasia ( hyperplastic laryngitis);
• Papilloma of the larynx;
• Leukoplakia (the appearance of fields of keratinization of the mucosa) and others dystrophic changes against the background of chronic inflammation;
• Pachydermia (thickening of the mucous membrane).

The so-called obligate precancer, which in most cases turns into a malignant tumor, includes laryngeal papilloma and epithelial dysplasia against the background of other changes in the mucous membrane.

Features of the growth and structure of laryngeal cancer

Among the characteristics of a malignant tumor importance assigned to its histological structure. Since most of the larynx is lined with multi-layered squamous epithelium, which becomes a source of neoplasia, then most common form- squamous cell carcinoma of the larynx, keratinizing or non-keratinizing.

In cases where the cells cancerous tumor developed to the extent that allows them to form a horny substance, they speak of keratinizing cancer. It is considered a differentiated variant, characterized by slower growth, later metastasis, and a relatively favorable prognosis.

When anaplastic malignant cells are not able to secrete anything, do not form a horny substance and are far from normal epithelium in structure, they speak of undifferentiated non-keratinizing cancer. This option is more rapid growth, early metastasis and poor prognosis.

Tumor of glandular epithelium adenocarcinoma occurs in less than 3% of cases.

Laryngeal cancer can grow both exophytically, that is, into the lumen of the organ, and endophytically (infiltratively), deepening into tissues and practically without disturbing the surface of the mucosa in the early stages of its development.

The upper, vestibular, department is most often affected. The same localization of a malignant tumor of the larynx is also considered the most unfavorable in terms of metastasis and further course. Somewhat less often, cancer occurs in the middle section and very rarely - in the lower.

Vestibular localization of the tumor characterized by early and rapid metastasis, since this department has a large amount of fiber and a well-developed network lymphatic vessels through which cancer cells quickly reach the regional lymph nodes. In addition, often such tumors are found in an advanced stage, which is associated with poor and non-specific symptoms that hide tumor growth under the guise of pharyngitis.

In the middle section of the larynx cancer is found less frequently than in the upper one, and this location is considered the most favorable. The tumor is more often unilateral, affects the vocal folds, grows in the form of a dense tuberous formation, prone to ulceration, secondary inflammation with fibrin overlays, giving it a whitish tint. Infiltrative growth is also possible.

As the size of the tumor increases, the mobility of the affected vocal fold is limited up to its complete immobilization. With exophytic growth, the tumor node can significantly narrow the lumen of the glottis. middle department The larynx is practically devoid of a lymphatic apparatus, limited to one or two vessels, so metastasis is later and rather rare.

In the underlayment space malignant tumors are very rare. Cancer here grows more often infiltratively, practically without changing appearance mucosa, as well as downward, towards the trachea. The lower part of the larynx is poor in lymphatic drainage pathways through which cancer cells can spread.

As for the metastasis of cancer of the larynx, it occurs the more intense, the younger the patient. For malignant tumors of this localization, widespread dissemination to other organs and tissues is not typical, therefore, distant metastases, damage to the liver, lungs and other organs are very rare and can be observed only in advanced cases of the disease.

Stages of development of the disease

For staging of malignant tumors of the larynx, oncologists traditionally use TNM classification, which is difficult for the layman, but most accurately and fully characterizes the features of the tumor process. The symbol T means the location and size of cancer, N - damage to the lymph nodes, M - the presence or absence of distant metastases.

Based on the established T, N and M, you can determine the stage of the disease:

1. So, first stage characterizes a small tumor that does not reach the borders anatomical department larynx in the absence of metastasis.
2. In second stages the tumor can occupy the entire department and reach its borders, but metastases are still not detected.
3. On the third stages the tumor is able to go beyond the anatomical region and grow into the surrounding tissues, while enlarged regional lymph nodes and, in some cases, distant metastases are found.
4. Fourthstage The disease is manifested by the presence of distant metastases, regardless of the size of the primary tumor and the nature of the lesion of regional lymph nodes.

Signs of cancer of the larynx

As noted above, the symptoms of throat cancer do not differ in any specificity and diversity, especially in the initial stages of tumor development, so patients often do not rush to the doctor, attributing painful manifestations to banal pharyngitis or a cold. Changes that are not amenable to treatment for a long period of time and even worsening, make you still turn to a specialist.

The most typical early symptoms of laryngeal cancer are:

• Dryness in the throat, awkwardness when swallowing, a feeling of perspiration;
• Voice changes.

Such nonspecific signs are often found in patients suffering from chronic pharyngitis or laryngitis, as well as in older smokers with experience, and can “mask” the presence of cancer for a long time.

Later, these symptoms are accompanied by pain, which becomes constant and can radiate to the ear, and in the case of a running process, manifestations of cancer cachexia and intoxication are observed.

For initial stage throat cancer is characterized by the appearance of these early symptoms, as well as the presence of a tumor-like formation in one or another part of the larynx, determined by laryngoscopy. All this should alert the doctor and encourage further diagnostic measures in order to confirm the diagnosis.

Symptoms of laryngeal cancer are determined by the localization of neoplasia in any of its parts. So, with the growth of a malignant neoplasm in the vestibular part, pharyngitis-like manifestations come to the fore: dryness in the throat, difficulty in swallowing, perspiration, a feeling of the presence of a foreign body. Subsequently, ulceration and disintegration of the tumor tissue is possible, so an unpleasant putrid odor from the mouth and blood in the sputum.

Neoplasia growing in the middle section most often affects the vocal folds, Therefore, the first signs of the disease are violations voice function: weakness, fatigue, change in the timbre of the voice, hoarseness, and even the complete inability to reproduce sounds. In the case of exophytic growth of a malignant tumor, it is often possible to observe respiratory disorders, and with germination in upper part or neck - difficulty in swallowing food.

Subglottic cancer is characterized by rather poor symptoms, consisting in attacks of coughing and respiratory failure. Over time, these manifestations increase and may be mistaken for obstructive pulmonary disease.

With the progression of a malignant tumor of any part of the larynx, especially with the presence of metastases, signs of intoxication increase, appetite decreases, patients lose weight and become lethargic. The above symptoms are accompanied by pain associated with tumor growth into surrounding tissues, damage to blood vessels and nerves, as well as possible secondary inflammation of the cartilage (perichondritis).

As the neoplasm grows, it may grow into the esophagus, which is accompanied by dysphagia and malnutrition, however, such tumors have nothing in common with esophageal cancer.

How to detect a tumor?

Like any other malignant tumor, laryngeal cancer should be detected as early as possible, because only in this case it is possible to achieve good results treatment.

If symptoms of a sore throat appear, it is necessary to visit an ENT doctor who will perform the full range of necessary examinations.

It is hardly possible to independently determine the presence of a tumor, however, the symptoms described above, an increase in lymph nodes, the progressive nature of the disease that cannot be treated, should prompt the patient himself to think about the possible malignant nature of the disease.

Already in the clinic, the doctor will find out in detail the nature of the complaints, the duration of their existence and the effectiveness of the treatment, if it has already been carried out by the patient on his own. Inspection pharynx and larynx allows in most cases to establish the fact of the presence of some kind of neoplasm. An attempt to displace the larynx in the presence of a malignant tumor is not accompanied by a characteristic crunch, and patients may feel pain. Special attention is given to the state of the lymph nodes of the neck, the increase in which is already alarming in terms of the development of cancer. At palpation their size, consistency, mobility are determined. As the tumor progresses, the lymph nodes increase, thicken, poorly displaced until they are completely fixed in the surrounding tissues.

The main and most early method diagnosis of laryngeal cancer is laryngoscopy, which allows you to see tumors in the vestibular region and on the vocal folds. The doctor is usually alarmed by the unilateral nature of the lesion, the presence of a dense, bumpy formation prone to ulceration. Papillomatosis is not characterized by ulceration and growth deep into the tissues, and hyperplastic laryngitis is accompanied by a bilateral symmetrical lesion of the vocal folds.

In cases of tumor growth in the subglottic space, it is quite difficult to detect it with a laryngoscope, so a bronchoscope or esophagoscope can be used. With the help of such flexible optics, it becomes possible to inspect lower section larynx and establish the nature of the spread of cancer.

For more accurate diagnosis laryngoscopy can be supplemented by the use of special microscopes ( microlaryngoscopy).

Quite often in diagnostic purposes use radiological methods research, CT and MRI, allowing to assess the state of the larynx in different projections and sections.

In all cases mandatory component diagnostic search is histological examination. In cases where the presence of a neoplasm is determined during laryngoscopy, and the histological conclusion does not confirm it, repeated biopsies are performed. Such a difference in diagnoses may be associated with a superficial sampling of the material, the presence of a pronounced secondary inflammation in a tumor, its combination with another disease, for example, tuberculosis.

If after three biopsies it is not possible to establish an accurate diagnosis, the patient is removed all or part of the tumor with its direction for urgent histological examination. If the diagnosis of cancer is confirmed, the operation continues with the removal of part or all of the larynx in accordance with the techniques adopted for the treatment of malignant tumors.

Thus, despite the small range of diagnostic procedures used, early detection of the tumor is quite possible. To do this, it is necessary to consult a doctor in a timely manner, without wasting time and without waiting for the symptoms to disappear on their own.

Treatment options for laryngeal cancer

Treatment of throat cancer is often a rather difficult task, especially for advanced cases. The larynx is a complex unpaired organ, so its removal entails a serious degree of disability in patients. In such cases, it is more important than ever to find initial forms cancer, allowing you to save not only independent breathing and swallowing, but also the ability to reproduce sounds.

The choice of the method of surgical treatment, as well as the need for radiation and chemotherapy, are determined by the stage, localization and histological structure of the neoplasm.

The main and most effective way cancer treatment remains conducting surgical operation to remove the tumor. As a rule, such treatment is accompanied by radiation therapy before or after surgery. It should be noted that irradiation before surgery impairs the ability of tissues to heal, and the postoperative period can be long and difficult, so it is most often prescribed after removal of the neoplasm.

The stage of the disease determines the scope of the intervention. So, with stage 1 cancer, it is sufficient to remove only the tumor itself, with stage 2 - the affected section, and with stage 3 it is often necessary to resort to radical methods with the removal of the entire larynx.

To date The main types of operations for malignant tumors of the larynx are:

• Laryngectomy - removal of the entire organ - the most traumatic and difficult type of treatment;
• Resection - removal of part of the larynx;
• plastic and reconstructive surgery- is aimed at restoring breathing and swallowing in cases of laryngectomy.

If the tumor is small in size, vocal cord it is possible to remove it along with the fold - chordectomy. Despite the small volume, such an operation is very effective, especially when combined with subsequent radiation therapy. Removal of half of the larynx is called hemilaryngectomy.

In case of stage III tumors and if it is impossible to perform a resection, doctors are forced to resort to total laryngectomy also removed hyoid bone and the root of the tongue. Such an intervention is extremely traumatic and does not leave the patient a chance for spontaneous breathing and eating, so a tracheostomy is performed (installation special device on the neck for breathing) and the introduction of a nasoesophageal probe.

When lymph nodes are involved in the process, they must also be removed along with the tissue of the neck and other affected tissues.

Patients who have undergone laryngectomy need reconstructive and plastic surgeries to restore lost functions, for which both their own skin flaps and various synthetic materials are used.

Radiation therapy is also very relevant for a malignant tumor of the larynx, especially in combination with surgical treatment, although in some cases early cancer can be used on its own. Both external irradiation and internal irradiation are performed using various carriers injected directly into the affected tissue.

With the help of irradiation, it is possible to achieve a reduction in the size of the tumor and slow its growth, as well as to prevent recurrence in the postoperative period.

Radiation therapy

Chemotherapy has only an auxiliary value and complements the operation and radiation therapy. The purpose of chemotherapy is to prevent possible spread cancer cells in the lymphatic and blood vessels (metastasis).

In all cases of malignant tumors of the larynx, painkillers, vitamins and antioxidants are prescribed, and in the postoperative period, it is also carried out antibiotic therapy in order to prevent infectious complications.

Folk remedies do not have independent significance, but can only be used as one of the components combination therapy. As a rinse, you can use tincture of valerian, bay leaf, chamomile, etc. It should not be forgotten that cancer cannot be defeated with a decoction of herbs, therefore only traditional medicine able to give a positive result.

Nutrition for throat cancer does not have significant features, but it is worth adhering to a sparing diet with a restriction of rough, too hot and too cold food. In addition, you need to completely abandon the use of alcohol and smoking.

The prognosis for laryngeal cancer is determined by the timeliness of the treatment started and the nature of tumor growth. If a malignant tumor is detected in stage I or II, one can expect favorable outcome, in stage III, in more than half of patients, the prognosis is still good, and only stage IV cancer can only prolong the lives of patients.

As far as throat cancer prevention is concerned, such simple measures as maintaining a healthy lifestyle, avoiding smoking and alcohol abuse, proper nutrition, as well as timely treatment inflammatory processes significantly reduce the risk of contracting this insidious disease.

Video: throat cancer - symptoms and treatment

The author selectively answers adequate questions from readers within his competence and only within the resource of OncoLib.ru. Face-to-face consultations and assistance in organizing treatment in this moment, unfortunately, do not appear.