Throat cancer in the early stages: symptoms, diagnosis and treatment

Throat cancer is a malignant tumor that forms from the tissue of the larynx and is squamous cell in nature. The larynx is an organ consisting of a cartilaginous skeleton connected by fibrous ligaments and lined with mucous membrane. The upper 2/3 of the epiglottis and the area of ​​the vocal folds are covered with stratified squamous epithelium, the rest of the mucous membrane is covered with stratified ciliated epithelium. The lamina propria of the mucous membrane is represented by loose fibrous tissue. All cartilages of the larynx, with the exception of the epiglottis, are hyaline. The epiglottis consists of elastic cartilage. All muscles of the larynx are striated; they can contract both voluntarily and reflexively. At the top, the larynx is attached by the median and lateral thyroid ligaments to the hyoid bone, which serves as a support for all the external muscles of the larynx.

Men get laryngeal cancer more often than women. The average age of patients in whom pathology is detected is 40–60 years. Factors that provoke the development of neoplasms are smoking, including passive smoking, and alcohol abuse. An additional risk factor is working in hazardous industries, where you have to inhale coal, asbestos, tobacco dust, as well as benzene or phenolic resins.

The Oncology Clinic of the Yusupov Hospital offers thorough oncological diagnostics using modern medical equipment. Competent doctors will select the most effective treatment for you, taking into account the individual nature of the tumor process and all associated diseases. You will receive advice not only from an oncologist or chemotherapy doctor, but also from other related specialists: surgeon, therapist, endocrinologist, neurologist, etc. The hospital provides both surgical and palliative treatment of severe cancer diseases.

Anatomy of the larynx

In an adult, the larynx is located at the level of the IV-VI cervical vertebrae along the midline of the neck. At the top it comes into contact with the hyoid bone, at the bottom it passes into the trachea, at the back it is covered with fiber and communicates with the pharynx. The anterior surface of the larynx is covered with muscles, fascia and skin.

The organ has a complex anatomical structure - it contains cartilage, ligaments, many muscles and joints. The large thyroid cartilage, also called the Adam's apple, is palpated on the neck and protrudes significantly forward in men.

Functions of the larynx:

• respiratory – regulation of external respiration, its depth and rhythm;
• insulating (protective) - protection of the respiratory tract from food entering during swallowing, harmful impurities from the air (for this, a spasm of the larynx occurs), evacuation of foreign particles trapped in the respiratory tract by coughing;
• vocal (phonatory) - the formation of vowels and parts of consonant sounds when air passes through the glottis.

Laryngeal cancer is a malignant neoplasm, most often developing from squamous epithelium.
Localized in all parts of the organ.

The first is the voice, the second is the melody

A person’s ability to produce sounds of different strength, pitch and timbre is associated with the movement of the vocal cords under the influence of a stream of exhaled air. The strength of the sound produced depends on the width of the glottis: the wider it is, the louder the sound. The width of the glottis is regulated by at least five muscles of the larynx. Of course, the force of exhalation itself, caused by the work of the corresponding muscles of the chest and abdomen, also plays a role. The pitch of the sound is determined by the number of vibrations of the vocal cords in 1 second. The more frequent the vibrations, the higher the sound, and vice versa. As you know, tightly stretched ligaments vibrate more often (remember a guitar string). The muscles of the larynx, in particular the vocal muscle, provide the necessary tension to the vocal cords. Its fibers are woven into the vocal cord along its entire length and can contract either as a whole or in separate parts. Contraction of the vocal muscles causes the vocal cords to relax, causing the pitch of the sound they produce to decrease.

Having the ability to vibrate not only as a whole, but also in individual parts, the vocal cords produce additional sounds to the main tone, the so-called overtones. It is the combination of overtones that characterizes the timbre of the human voice, the individual characteristics of which also depend on the condition of the pharynx, oral cavity and nose, movements of the lips, tongue, and lower jaw. The airways located above the glottis act as resonators. Therefore, when their condition changes (for example, when the mucous membrane of the nasal cavity and paranasal sinuses swells during a runny nose), the timbre of the voice also changes.

Despite the similarities in the structure of the larynx of humans and apes, the latter are not able to speak. Only gibbons are capable of producing sounds that are vaguely reminiscent of musical sounds. Only a person can consciously regulate the force of exhaled air, the width of the glottis and the tension of the vocal cords, which is necessary for singing and speech. The medical science that studies the voice is called phoniatry.

Even in the time of Hippocrates, it was known that the human voice is produced by the larynx, but only 20 centuries later Vesalius (16th century) expressed the opinion that sound is produced by the vocal cords. Even now, there are various theories of voice formation, based on individual aspects of the regulation of vocal cord vibrations. Two theories can be cited as extreme forms.

According to the first (aerodynamic) theory, voice formation is the result of vibrational movements of the vocal folds in the vertical direction under the influence of an air stream during exhalation. The decisive role here belongs to the muscles involved in the exhalation phase and the muscles of the larynx, which bring the vocal cords together and resist the pressure of the air stream. Adjustment of muscle function occurs reflexively when the mucous membrane of the larynx is irritated by air.

According to another theory, the movements of the vocal folds do not occur passively under the influence of an air stream, but are active movements of the vocal muscles, carried out by command from the brain, which is transmitted along the corresponding nerves. The pitch of the sound, associated with the frequency of vibration of the vocal cords, thus depends on the ability of the nerves to conduct motor impulses.

Some theories cannot fully explain such a complex process as voice formation. In a person who has speech, the function of voice formation is associated with the activity of the cerebral cortex, as well as lower levels of regulation, and is a very complex, consciously coordinated motor act.

Morbidity statistics

Laryngeal cancer accounts for 2.6% of all cancers. It is in first place in terms of incidence among head and neck tumors. In 95% of cases, malignant lesions of the larynx are squamous cell carcinoma, 2% each are glandular cancer and basal cell carcinoma, and 1% are rare types of cancer.

Men are more susceptible to the disease - they are diagnosed 9-10 times more often than women. 80-95% of patients are men from 40 to 60 years old. Most of them are heavy smokers.

The survival prognosis directly depends on the stage at which the cancer is detected and its location. If the tumor is detected at stage I, the five-year survival rate is 85%, at stage II – 70%, at stage III – 60%, at stage IV it decreases to 20%.

When chemoradiation therapy is started in the early stages, stable remission is achieved in 85-95% of cases, in late stages - in 30-40%.

Neoplasms of the upper part of the larynx give metastases to regional lymph nodes in 35-45% of cases, of the lower part - in 15-20%. In the area of ​​the vocal cords, the lymphatic network is less developed, so the tumor in this area metastasizes rarely and late.

What is tonsillitis?

Tonsillitis is an inflammatory process in the tonsils. The disease can be acute or chronic. The acute form is better known as tonsillitis. In chronic cases, periods of exacerbation (inflammation of the tonsils) are replaced by a period of remission (calm). Most often, the disease occurs in children 5-15 years old, although adults are also susceptible to the disease. The tonsils in children are larger than in adults. The palatine tonsils reach their maximum size by the age of 7, and then begin to shrink. Constant viral attacks on the tonsils lead to tonsillitis. Chronic tonsillitis most often acts as a complication after an infectious disease (sore throat, caries, etc.). The chronic form of the disease, according to statistics, occurs in 5% of adults and 11% of children. That is, chronic tonsillitis is a common disease. Tonsillitis plugs on the tonsils often appear with chronic tonsillitis.

Causes and risk factors

Laryngeal cancer, like other cancers, develops from mutated cells of normal tissues or benign tumors. Cell malignancy, or malignancy, occurs under the influence of external factors; there are also diseases that have a high risk of degeneration.

External factors that provoke the occurrence of laryngeal cancer:

• smoking and chewing tobacco;
• drinking alcohol;
• occupational hazards - dust, high and low temperatures, benzene vapors, petroleum products, phenol resins.

Diseases prone to malignancy:

• long-standing papillomatosis;
• fibroma with a wide base;
• leukoplakia;
• pachydermia;
• dyskeratosis;
• ventricular cysts;
• chronic inflammatory processes.

Device principle

The throat is a highly complex organ responsible for breathing, speaking, and moving food.

In short, its structure is based, as we said earlier, on the pharynx (pharynx) and larynx (larynx). Since this organ is a conducting channel, it is very important that all its muscles work harmoniously and correctly. Inconsistency in their activities will lead to the fact that food can enter the respiratory system and create a dangerous situation, even leading to death.

The structure of a child's throat is the same as that of adults. But children have narrower cavities and tubes. As a result, any disease in which swelling of these tissues occurs can be extremely dangerous. It is advisable for a person to know the structure of such an organ, as this can be useful in caring for it and during treatment. In the pharynx, the nasopharynx and oropharynx are distinguished.

The pharynx (pharynx) is a cone-shaped structure turned upside down. It is located behind the mouth and goes down to the neck. The cone is wider at the top. It is located near the base of the skull, which gives it more strength. The lower part is united with the larynx. The layer of tissue covering the outside of the pharynx is a continuation of the layer of oral tissue lying outside. It has many glands that produce mucus, which is involved in the processes of moistening the throat when eating and talking.

Symptoms of laryngeal cancer

The first signs of a tumor are nonspecific, they are similar to the symptoms of many inflammatory diseases, and it is difficult to suspect an oncological process from them and, even more so, to determine its location.

Early symptoms:

• low-grade fever;
• weakness, fatigue, general malaise;
• drowsiness.

Late signs vary depending on where the neoplasm develops.

Supraglottic cancer is characterized by:

• dryness and sore throat;
• discomfort and pain when swallowing, radiating to the ear on the side of the tumor, choking;
• sensation of a foreign body in the larynx;
• dull voice.

Symptoms of a neoplasm on the vocal cords:

• change in voice, loss of sonority and melody;
• hoarseness and hoarseness.
• When a tumor develops in the subglottic region, patients complain of:
• paroxysmal dry cough;
• voice disorders.

In the late period, when cancer of any localization grows into the lumen of the larynx, difficulty breathing, attacks of suffocation, putrid breath, and cough with blood clots appear. Due to discomfort when swallowing, the patient limits food intake, and exhaustion develops.

The sooner a person seeks help, the more effective the treatment will be. Even early signs (weakness, fatigue) should be a reason to visit a doctor. In this case, it is possible to diagnose the tumor at an early stage. If you experience coughing or difficulty swallowing, you should consult a doctor immediately.

The oropharynx is...

Another element in the structure of the human throat and larynx is the oropharynx.

This fragment is located behind the oral cavity. Its main function is to conduct air flow from the mouth to the respiratory organs. This part is more mobile compared to the nasopharynx. Thanks to this, when the muscle tissue of the oral cavity contracts, a person can speak.

We already know that the structure of the throat has certain components, but they will also include other, even smaller components. Among them is the tongue, which helps, by contracting the muscular systems, move food into the esophagus. There are also tonsils, which are very often involved in throat diseases.

Classification

Classification of laryngeal cancer is carried out according to different criteria.

Localization of education

There are three anatomical sections of the organ:

• supraglottic (vestibular);
• middle (vocal cords);
• subglottic

Cancer of the supraglottic region develops most often - from 65% to 70% of all laryngeal tumors. It appears on one side and quickly spreads to the other. Neoplasms in this area are characterized by aggressive growth and rapid appearance of metastases.

A tumor of the middle section is diagnosed in 25-30% of cases. Usually develops on one vocal cord. Less aggressive than in the supraglottic. Voice disorders force patients to see a doctor quickly, which is why ligament tumors are often detected in the early stages. Localization of the formation facilitates surgical access to it.

Neoplasms of the subglottic region are the rarest - approximately 2% of cases. At the same time, they are characterized by fairly rapid infiltrative growth, and their location complicates surgical access and increases the risk of injury to the vocal cords during surgery.

Stages of laryngeal cancer, Russian classification

According to the prevalence of the process, malignant lesions of the larynx are divided into four stages - I, II, III and IV, stage III has substages a, b, IV - a, b, c, d.

Growth pattern

Exophytic cancer - grows into the lumen of the organ or outward. The formation usually occurs on the wall of the larynx and grows outward, blocking the lumen of the upper respiratory tract. It has no clear boundaries, the surface of the tumor is lumpy, with papillary growths.

Endophytic (infiltrative) cancer - grows inward, into the tissue of the organ. It looks like an infiltrate with ulcerations, without clear contours. Penetrates into the thickness of adjacent tissues.

Mixed - combines the features of exo- and endophytic growth.

Histological structure

Most often, laryngeal cancer arises from squamous epithelial cells. Glandular cancer, basal cell carcinoma and other rare types of tumor are diagnosed much less frequently. Some types are further subdivided:

• Squamous cell carcinoma : non-keratinizing – arises from non-keratinizing epithelium, grows quickly, has a high risk of metastases;
• keratinizing – develops slowly, metastases appear after a long period of time.

Diagnosis of laryngeal cancer

During the initial visit, the doctor collects an anamnesis of the patient’s life and illness, asks him about the presence of provoking factors, conducts a visual examination, palpation of the neck, indirect laryngoscopy - examination of the larynx with a mirror on a long curved handle.

If there is still suspicion of a tumor formation, the patient is prescribed direct laryngoscopy . This is an invasive diagnostic procedure during which the larynx, trachea, and bronchi are examined using a laryngoscope (rigid method) or a flexible fiberscope. As a rule, during direct laryngoscopy, a biopsy of the neoplasm is performed - biomaterial is taken for cytological and histological analysis.

of tumor markers SCC and CYFRA 21-1 is considered an effective diagnostic method . To analyze tumor markers, venous blood is taken from the patient.

To assess the degree of tumor invasion, damage to the lymph nodes, and the presence of metastases in distant organs and tissues, additional procedures are used: CT or MRI , PET scan , biopsy of sentinel lymph nodes , scintigraphy , radiography .

What are the contraindications for MRI?

Compared to X-ray methods of scanning the body, magnetic resonance imaging has no limitations associated with the danger of radiation. For example, MRI without contrast can be done on children and breastfeeding women. Pregnancy is a relative contraindication only during the first trimester - during this period, doctors prefer not to expose the developing fetus to electromagnetic pulses.

However, there are limitations related specifically to the essence of the procedure. For example, a magnetic resonance imaging scanner and fixed metal prostheses, wires, implants, valves, clamps, as well as electrical devices such as pacemakers, in most cases, are incompatible. If such parts are present in the human body, MRI is questionable.

The fact is that metal parts, prostheses or implants, when exposed to a magnetic field, heat up and can even come out. In addition, the reason for the limitation associated with the presence of metal parts in the body is that they cause interference in the operation of the equipment and distort the information content of the resulting images. As for pacemakers, doctors clearly recommend that people who have such a device not undergo an MRI procedure.

Due to exposure to the magnetic field, the pacemaker may fail, thereby putting the patient's life at serious risk. Exposing a person to such a risk, even for the sake of very accurate diagnostic results, is unacceptable.

However, recently, manufacturers of both metal implants and pacemakers have paid attention to this problem, so such products have begun to appear on the medical market, manufactured taking into account the requirements of compatibility with the magnetic field of tomographs.

In addition, patients with tattoos should inquire whether the pigment placed under the skin contains metallic compounds. If the answer is yes, then diagnostics using a magnetic resonance imaging scanner is not performed.

The presence of excess weight in the patient is considered a relative contraindication. Many tomographs are not designed for a weight of more than 120-160 kilograms, but there is still a possibility of performing tomography in this case - an open tomograph will cope with this task.

Treatment methods

For laryngeal cancer , radiation chemotherapy (rarely), targeted therapy , and surgery . A single method or an integrated approach can be used, depending on the stage of the tumor, its location, degree of aggressiveness, growth pattern, and extent of the process.

Conservative therapy

Almost always, the first stage of treatment is radiation therapy . It is used to treat cancer of the middle section of the larynx, which is highly radiosensitive, as well as for tumors of the upper and lower regions of the larynx of stages I-II. Radiation is sometimes combined with hyperbaric oxygenation - saturating the blood with oxygen in a special chamber. This procedure enhances the effect of rays on degenerated cells and reduces damage to healthy tissue.

Treatment of stage III-IV laryngeal cancer, localized in the upper region of the organ, begins with chemotherapy . Chemotherapy is ineffective for the lower and middle parts of the larynx.

Radiation and chemotherapy can be used in combination.

Targeted therapy is the directed effect of a drug on the epidermal growth factor receptor. In laryngeal cancer, a large amount of the EGFR receptor protein is often found on the surface of tumor cells, which stimulates cell division. The drug Cetuximab, used for targeted therapy of the disease, suppresses the activity of this receptor. The drug is administered intravenously, usually used in combination with radiation, and in later stages - together with chemotherapy.

Surgical treatment

Sometimes, for stages I-II of laryngeal cancer, conservative therapy is sufficient. If it turns out to be ineffective, as well as for tumors detected at stages III-IV, surgical intervention is recommended. Before surgery, radiation therapy is always indicated to reduce the size of the tumor.

For stage I-II tumors, doctors try to perform organ-preserving resection: hemilaryngectomy - removal of one vocal cord, supraglottic laryngectomy - removal of part of the larynx above the ligamentous apparatus.

In the early stages, laser removal of the tumor using an endoscope can be used. The advantage of this method is that it is less traumatic; the disadvantage is that it is not possible to take a tissue sample for histological examination.

In later stages of the disease, it is necessary to resort to radical operations: chordectomy - complete removal of the vocal cords, total laryngectomy. In this case, the patient completely loses his voice.

Auxiliary Operations

In addition to direct removal of the malignant tumor, other surgical operations are performed. When laryngeal cancer metastasizes to regional lymph nodes or there is a high risk of metastases, these nodes are excised along with the surrounding tissue. The operation is called a cervical dissection .

When the larynx is completely removed, the patient needs a tracheostomy , a surgically created hole in the trachea. When creating a tracheostomy, the upper end of the trachea is sutured to the skin of the neck.

If laryngeal cancer makes it difficult to eat, the patient will have gastrostomy tube placed directly into the stomach.

If necessary, after extensive surgery, reconstructive plastic - operations that allow at least partially restoring the functions of the removed organs.

Forecast

The prognosis of the disease depends on how early the tumor is detected. Unfortunately, laryngeal tumors are often diagnosed late due to the nonspecificity of early symptoms.

Newly diagnosed stage III laryngeal cancer is 46.8%, stage IV – 17.0%. The mortality rate in the first year from the moment of diagnosis for lesions of the larynx is 24.2%.

A large number of patients develop resistance to radiation and chemotherapy. When conservative therapy is used, recurrent tumors occur in 20-40% of cases, the treatment of which is only possible through surgery.

Without treatment, laryngeal cancer lasts from one to three years. The prognosis of 85-90% of cases of complete recovery is given only if the tumor is detected early, treatment is started in a timely manner and completely completed.

Hemorrhage

The result of the work of the arterial structure of the body is the blood supply, which fills with blood and ensures the complete function of the organ of interest to us.

The responsible systemic part occurs when the procedure is initiated, not without the active activity of the vagus nerve, which comes to the rescue and performs motor functions.

Between the left and right hemispheres of the brain, behind the frontal gyrus, there is a center that is responsible for the process of coordinating the formation of voice. If disturbances in the functioning of the center occur due to early hearing loss, this is fraught with muteness and loss of the motor reflex.

Prevention of laryngeal cancer

Quitting smoking cigarettes, pipes, hookahs, and chewing tobacco is the basis for preventing the disease. Eliminating alcoholic beverages or reducing their consumption will help prevent not only laryngeal cancer, but also other pathologies.

There is an opinion that red meat and smoked meats increase the risk of cancer. You should reduce their number in the menu, eat fresh vegetables and fruits more often.

It is important to undergo medical examinations on time - medical examinations, medical examinations at enterprises. If you suspect a disease of the larynx, even if general symptoms appear, you should consult a doctor.

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.