Throat cancer (larynx): symptoms and signs, treatment, stages
Laryngeal cancer is a fairly common pathology, but we cannot say that the disease is among the leaders in other tumors. The frequency does not exceed eight percent in the population and the most frequent tumor found in elderly men, mostly 60-70 years, and smokers suffering from inflammation of the throat.
In women, throat cancer is much rarer: for every 100 sick men account for only 8 of the fair sex.
The risk of disease increases significantly in smokers, including women Smoking. Moreover, it is noticed that the inhabitants of cities, especially large ones, suffering from malignant tumors of the larynx more often, than inhabitants of villages. This is probably due to bad environment and polluted atmosphere of big cities.
Throat cancer in the early stages of development does not differ in any specific symptoms, so can long time to hide under the mask of inflammatory processes. This leads to delayed diagnosis and difficulties in the subsequent treatment.
Briefly about the larynx
The larynx is a part of the respiratory system involved in sound production. Upper division communicates with the pharynx, the bottom goes into the trachea. In addition to breathing, the most important function of the larynx is a reproduction of the sounds required for articulate speech, and singers of this organ, due to the characteristics of the vocal folds, plays musical sounds. Despite its small size, the larynx is quite complicated, is composed of 3 paired and 3 unpaired cartilage is attached many of the muscles that help to carry out all its functions.
In the structure of the larynx can be divided into three divisions:
- Upper (vestibular) – from the entrance to the larynx to the false folds;
- The average is between the folds of the vestibule and true vocal folds and includes the ventricles of the larynx;
- Lower division subglottic space, passing into the trachea.
Upper and middle division, including the vocal folds are covered by stratified squamous epithelium, the lower ciliated.
From which of the departments within the tumor depends on its flow, structure, characteristics and treatment options, and prognosis.
Risk factors and precancerous changes
As you know, malignant tumors often arise on the background of already existing pathological processes and the impact of adverse environmental factors. Causes of cancer of the larynx consist mostly of external influences.
Thus, among the risk factors of primary importance:
Changes preceding cancer of the larynx, most often presented:
- Chronic laryngitis, especially those with hyperplasia of the mucosa (hyperplastic laryngitis);
- A papilloma of the larynx;
- The leukoplakia (fields appear of keratinization of the mucosa) and other degenerative changes on the background of chronic inflammation;
- Pachydermia (mucosal thickening).
The so-called to obligate precancer, which in most cases goes into a malignant tumor, identify a papilloma of the larynx and dysplasia of the epithelium on the background of other changes in the mucous membrane.
Peculiarities of growth and structure of laryngeal cancer
Among the characteristics of a malignant tumor important its histological structure. Since most of the larynx is lined with stratified squamous epithelium, becoming a source of neoplasia, and the most common form is squamous cell carcinoma of larynx, keratinizing or neorogovevayuschy.
In cases where cancer cells have developed to the extent that allows them to form a Horny substance, talking about keratinizing cancer. It is considered differentiated variant, characterized by slower growth, later metastasis and a relatively favorable prognosis.
When analizirovali malignant cells are not able to do something to secrete, do not form a Horny substance and in structure is far from normal epithelium neorogovevayuschy talking about undifferentiated cancer. This variant is characterized by more rapid growth, early metastasis and poor prognosis.
Tumor of glandular epithelium, adenocarcinoma, occurs in no more than 3% of cases.
Laryngeal cancer can grow as exophytic, that is, into the lumen of the organ and endophytic (infiltrative), delving into the fabric and almost without breaking the surface of the mucosa in the early stages of its development.
Most commonly affects the upper, vestibular Department. This same localization of malignant tumors of the larynx is considered to be most adverse against metastases and the further course. Cancer occurs slightly less often in the middle section and very rarely in the bottom.
Vestibular localization of the tumor is characterized by early and rapid metastasis, because this Department has a large amount of fiber and a well-developed network of lymphatic vessels that cancer cells rapidly reaches the regional lymph nodes. In addition, often these tumors are detected in advanced stage due to scarce and nonspecific symptoms, hiding under the guise of pharyngitis tumor growth.
In the middle section of the larynx the cancer is detected less frequently than the top and this location is considered most favorable. The tumor is most often unilateral in nature, affects the vocal folds, grows as a dense hilly education, prone to ulceration, and secondary inflammation with overlays of fibrin, giving it a whitish tint. It is also possible infiltrative growth.
As you increase the size of the tumor, limited mobility of the affected vocal folds until its immobilization. When exophytic growth of tumor node is able to significantly narrow the lumen of the glottis. The average Department of the larynx is practically devoid of lymphatic apparatus, limited to one or two vessels, so metastases later and rather rare.
In the subglottic space malignant tumors occur very rarely. Cancer grows here more often infiltrative, almost without changing the appearance of the mucosa, as well as downward, in the direction of the trachea. The lower part of the larynx poor ways of lymph drainage, which can spread the cancer cells.
With regard to the metastasis of cancer of the larynx, it occurs more intensively than the younger patient. For malignant tumors of this localization is not typical of a wide disseminirovanne in other organs and tissues, so distant metastases, the liver, the lungs and other organs is very rare and can be observed only in advanced cases of the disease.
Stage of development of the disease
For staging of malignant tumors of the larynx medical oncologists traditionally use the TNM classification, which is complex for the layman, but most accurately and fully describes the features of the tumor. The symbol T means the localization and size of the cancer, N – nodal involvement M – the presence or absence of distant metastases.
Based on the set T, N and M can be determine the stage of the disease:
Signs of cancer of the larynx
As noted above, symptoms of throat cancer do not differ in any specificity and diversity, especially in the initial stages of tumor development, and therefore patients often do not rush to the doctor, writing off painful symptoms of a banal pharyngitis or colds. Changes that are not treatable for a long period of time and even a worsening, forced to go to a specialist.
The most characteristic early symptoms of laryngeal cancer are:
- Dryness in the throat, discomfort when swallowing, a sense of sore;
- Changes in the voice.
These nonspecific signs are often found in patients with chronic pharyngitis or laryngitis, and in elderly smokers with the experience, and for a long time, «masking» the presence of cancer.
Later, these symptoms joins pain that becomes constant and may radiate to the ear, and in the case of the running process symptoms of cancer cachexia and intoxication.
For the initial stage of throat cancer is characterized by the appearance of these early symptoms, and the presence of tumor masses in any part of the larynx, determined by laryngoscopy. All this should alert the physician and prompt further diagnostic measures to confirm the diagnosis.
The symptoms of laryngeal cancer are determined by the localization of neoplasia in any of its parts. So, with the growth of malignant tumors in the vestibular part of the fore pharyngectomy symptoms: dryness in the throat, difficulty swallowing, a tickle in the throat, sensation of presence of a foreign body. This may be followed by ulceration and disintegration of tumor tissue, so this can cause unpleasant putrid breath and blood in sputum.
Growing in the middle section neoplasia most often affects the vocal folds, so the first signs of the disease are disorders of voice function: weakness, fatigue, change in voice, hoarseness and even complete lack of ability to play sounds. In the case of exophytic growth of a malignant tumor is often possible to observe respiratory disorders, and during germination in the upper part or the neck – trouble swallowing food.
Cancer subglottic space is characterized by a rather scanty symptoms, namely coughing and breathing problems. Over time these symptoms intensify and can be mistaken for obstructive lung disease.
With the progression of a malignant tumor of any Department of the larynx, especially with the presence of metastases, growing signs of intoxication, decreased appetite, patients lose weight and become lethargic. To the above symptoms is added the pain associated with tumor ingrowth into the surrounding tissue, damage to blood vessels and nerves, as well as possible secondary inflammation of the cartilages (perichondrium).
The growth of tumors, perhaps growing it into the esophagus, which is accompanied by dysphagia and malnutrition, however, esophageal cancer such tumors have nothing in common.
How to detect a tumor?
Like any other malignant tumor, cancer of the larynx should be identified as early as possible, because only in this case, it is possible to achieve good treatment outcomes.
If you have symptoms of diseases of the throat, you need to visit ENT doctor who will perform the whole range of available surveys.
To determine the presence of a tumor is unlikely, however, the above symptoms, swollen lymph nodes, progressive nature of the disease is not curable must push the patient to the thought of possible malignant nature of the disease.
Already in the clinic, the doctor in detail to find out the nature of complaints, duration of their existence and effectiveness of treatment, if any, already held by the patient. Examination of the pharynx and larynx allows in most cases to establish the presence of any tumors. A try to move the larynx in the presence of a malignant tumor is not accompanied by the characteristic crunch, and patients may feel the pain. Special attention is paid to the lymph nodes of the neck, increasing the already alarming in terms of the development of cancer. Palpation is determined by their size, consistency, mobility. Progression of the tumor, lymph nodes increase, compacted, poorly shifted up to complete their fixation in the surrounding tissue.
The main and most early method of diagnosis of cancer of the larynx is laryngoscopy, which allows you to see the tumor in the vestibular Department and in the vocal folds. The doctor usually alarming unilateral nature of the lesion, the presence of dense hilly education, prone to ulceration. For papillomatosis is characterized by ulceration and growth deep into the tissue, and hyperplastic laryngitis is accompanied by bilateral symmetrical lesions of the vocal folds.
In cases of tumor growth in the subglottic space, it is difficult to detect it with the help of the laryngoscope, and therefore can be used bronchoscope or esophagoscope. With such flexible optics, it becomes possible to examine the lower part of the larynx and to establish the nature of spread of the cancer.
For a more accurate diagnostic laryngoscopy can be supplemented by the use of special microscopes (microlaryngoscopy).
Quite often diagnostic to use radiographic, CT and MRI, allowing to assess the condition of the larynx in different projections and slices.
In all cases, the mandatory component of the diagnostic search is the histological examination. In cases when laryngoscopy determined by the presence of tumors, and the histological conclusion it is not confirmed repeat biopsy. This difference in diagnoses may be associated with surface capture of the material, the presence of pronounced secondary inflammation in the tumor, a combination of it with other disease, like TB.
If after the three biopsies and fails to establish an accurate diagnosis, the patient is the removal of all or part of the tumor with the direction it for urgent histological research. In case of a confirmed cancer diagnosis, the operation continues with the removal of part or all of the larynx in accordance with techniques adopted for the treatment of malignant tumors.
Thus, despite the small range of diagnostic procedures, early detection of the tumor is possible. For this it is necessary to consult the doctor, wasting no time and not waiting until symptoms disappear.
Treatment modalities of laryngeal cancer
Treatment of throat cancer is often quite a difficult task, especially for advanced cases. The larynx difficult by unpaired organ, so removing it implies a serious degree of disability. In such cases, it is important detecting early forms of cancer, allowing you to save not only independent breathing and swallowing, but also the ability to play sounds.
The choice of method of surgical treatment and the need for radiation and chemotherapy depending on the stage, localization and histological structure of tumors.
The main and most effective way of treating cancer remains surgery to remove the tumor. As a rule, such treatment is accompanied by radiotherapy before or after surgery. It should be noted that irradiation before surgery impairs the ability of tissues to heal, the postoperative period can be long and difficult, so often it is administered after removal of the tumor.
Stage of disease determines the amount of interference. So, when cancer stage 1 is sufficient to remove only the tumor, 2 – the affected Department, and if 3 degrees is often necessary to resort to radical methods with the removal of the entire larynx.
Today the main types of surgery for malignant tumors of the larynx are:
- Laryngectomy – removal of the entire organ – the most traumatic and severe types of treatment;
- Resection – removal of part of the larynx;
- Plastic and reconstructive surgery aimed at restoring respiration and swallowing in cases of laryngectomee.
If you have a small size of the tumor on the vocal fold may be deleted along with a fold – chordectomy. Despite the small volume, this operation is very effective, especially when combined with subsequent radiotherapy. Remove half of the larynx is called hemilaryngectomy.
For tumors of stage III and in case of impossibility to resect, doctors are forced to resort to a total laryngectomy with removal of also hyoid bone and root of the tongue. Such intervention is extremely traumatic and leaves the patient a chance for spontaneous breathing and eating, so made a tracheostomy (setting a special device on the neck for breathing) and the introduction of neobisiidae probe.
When involvement of lymph nodes, it is also necessary to remove them along with the tissue of the neck and other affected tissues.
Patients with a history of laryngectomy in need of reconstructive and plastic operations for the restoration of lost functions, which are used as their own skin flaps, and various synthetic materials.
Radiation therapy is also highly relevant in malignant tumors of the larynx, especially in combination with surgical treatment, although in some cases the early cancer can be used alone. Is as external irradiation and internal using various media injected directly into the affected tissue.
With irradiation it is possible to reduce the size of the tumor and slow its growth and prevent recurrence in the postoperative period.
Chemotherapy is only of secondary importance and supplements the operation and radiation therapy. The purpose of chemotherapy is to prevent the possible spread of cancer cells through the lymphatic and blood vessels (metastasis).
In all cases of malignant tumors of the larynx is also appointed painkillers, vitamins and antioxidants, and in the postoperative period is also carried out antibacterial therapy for the prevention of infectious complications.
Folk remedies have no independent value, and can be used only as a component of combination therapy. As a gargle it is possible to use tincture of Valerian, Bay leaf, chamomile, etc. should Not be forgotten that cancer is a herbal tea not to win, so only the traditional medicine is able to give a positive result.
Nutrition for cancer of the throat has the essential features, however, should adhere to a gentle diet with restriction of gross, too hot and too cold food. In addition, you need to completely refuse from alcohol and Smoking.
The prognosis of laryngeal cancer is determined by the timeliness launched treatment, and character of tumor growth. The detection of a malignant tumor in the I or II stage you can expect a favorable outcome in stage III more than half of patients the prognosis is still good and only cancer stage IV allows only to extend the lives of patients.
With regard to prevention of throat cancer, such simple ways as maintaining a healthy lifestyle, elimination of Smoking and alcohol abuse, proper nutrition and timely treatment of inflammatory processes greatly reduce the risk of developing this insidious disease.