Stages of laryngeal cancer, their causes and treatment

Cancer of the larynx is diagnosed in 3% of cases of all human cancer. Most often from malignant tumors of the larynx suffer from smokers with many years of experience, as well as workers in harmful industries. As a rule, this disease is preceded by neglected laryngitis and other diseases of the throat in neglected forms. Unfortunately, even with a pronounced symptomatology, patients often get incorrect diagnoses, so the time for a complete cure can be missed.

Symptoms of laryngeal cancer and vocal cords

This dangerous throat disease, like laryngeal cancer, is promoted by smoking, as well as by alcohol abuse. Causes of cancer of the larynx can also be various chronic inflammatory processes.

Malignant tumors of the larynx are predominantly found in middle-aged and primarily elderly men, but there are cases of illness in young people. Etiodogiya not established definitively. But nevertheless the negative role of various irritating factors of the external environment is undoubted.

In the cancer of the larynx, the cancer of the vestibule( epiglottis, laryngeal ventricles, vestigial folds, arytenoid cartilages and cherpalodnagratonic folds), cancer of the middle section( vocal folds) and lining of the larynx, is isolated depending on the localization. This division is due primarily to a formal anatomical and topographic trait, and anatomical and clinical features peculiar to each of the localizations.

Laryngeal cancer ( vestibular) is more common than others. The vestibule is rich in lymphatic vessels, which are associated with neighboring formations - the root of the tongue, the larynx and the regional lymph nodes of the neck, so this cancer often spreads to neighboring organs and metastases to the lymph nodes of the neck much more often and faster than cancer of other laryngeal regions. In addition, this department is rich in loose fiber, which contributes to the rapid spread of the tumor and connects the vestibule with the pre-glandular space. Cancer of the anterior sections of the vestibule often extends to the pre-glandular space and, because of its anatomically hidden location, remains unrecognized for a long time. Therefore, in cases where removal of the larynx is indicated due to the cancer of the vestibule, it is necessarily produced by a single block with prednadgortannikovym space. This is achieved by resection of the hyoid bone.

Cancer of the vocal folds due to the fact that the lymphatic vessels in it is small and the fiber is loose, develops very slowly and later gives metastases to the lymph nodes of the neck. Cancer lining the larynx is diagnosed less often than the cancer of the middle department. It is characterized by a tendency to prolonged course of submucosal( endophytic) growth, which due to poor visibility of the walls of this department during laryngoscopy leads to late recognition of lesions.

The peculiarity of the submucosal layer of the lining of the larynx consists in the presence of collagen fibers, denser connective tissue, elastic membrane, which, combined with such a factor as the prevalence of infiltrating growth of the tumor at a given site, allows cancer to increase resistance to radiation therapy. Due to the small size of the lining department and its conical structure with the apex that faces the vocal folds, stenosis often develops with cancer. In cancer of such a localization, metastasis is often observed in the cervical lymph nodes( primarily the paratracheal group of lymph nodes).

The photo shows laryngeal cancer of different locations:

Initial and other stages of cancer( with photo)

Symptoms of laryngeal cancer of different stages manifest themselves in different ways. At the initial stage of the larynx cancer there is a tumor or ulcer that is confined to the mucosa or submucosa and does not occupy the entirety of one of the larynx. The mobility of the vocal folds and the arytenoid cartilages of the 1st stage of the laryngeal cancer is preserved, there are no metastases.

When the second stage of laryngeal cancer comes, the tumor or ulcer already occupies any of the laryngeal sections in its entirety, but does not go beyond it. The mobility of the larynx is again preserved, and metastasis is not determined.

In stage 3 of the laryngeal cancer, the tumor also captures other parts of the larynx, or remains only in one, but already leads to immobility of the affected half of the larynx. Or the tumor extends to the organs adjacent to the larynx, as well as to the regional lymph nodes, while the conglomerates of the lymph nodes are not welded to the nerves, vessels and spine.

With the onset of stage 4 of the laryngeal cancer, an extensive tumor occupies most of the larynx and infiltrates into the underlying tissues or sprouts into adjacent organs. At this stage of the larynx cancer, fixed metastases are observed in the lymph nodes of the neck.

Look at the photo of the laryngeal cancer of the initial stage and all the following:

Laryngeal cancer in 98% of cases is squamous, most often keratinizing. Less commonly, warty squamous cell carcinoma, as well as cancer with low malignancy, without metastases: it consists of islets and papillomatous cords from highly differentiated epithelial flat cells. Growth is more crushing than infiltrative, combined with a fairly serious inflammatory reaction in the surrounding tissue. Macrophysically observed exophytic formation of whitish color, papillomatous type, located in most cases on the vocal folds. At the same time, the mobility of the vocal fold is not disturbed.

Lymphoepithelial cancer ( lymphoepithelioma) is a kind of mosaic composed of low-grade( tumor) epithelial cells and lymphocytes.

Undifferentiated( anaplastic) cancer is a highly malignant tumor with early metastasis.

Adenocarcinoma is an atypical cylindrical epithelial cell that forms a glandular structure.

Adenokistozny cancer of ( cylinder) originates from serum glands. Usually metastasizes to the lungs.

Branhyogenic cancer, spindle-shaped cancer( pseudo-sarcoma), giant cell carcinoma( anaplastic giant cell adenocarcinoma), mucoepidermoid cancer, carcinoid, carcinosarcoma and several other species are extremely rare.

Sore throat: symptoms of laryngeal cancer( with photo)

Early signs of cancer of the vestibule of the larynx - a sense of tickling, foreign body, as well as coughing, a feeling of uncomfortable swallowing, which later passes into pain, sometimes giving in the ear. When the disease spreads to the pharynx, pain and dysphagia increase.

When the disease affects the epiglottis, the symptoms are poorly expressed, they are more pronounced when the tumor spreads to the anterior folds: pain may appear, first unsharpened, and then gradually increasing hoarseness and coughing. These symptoms are more pronounced when the cancer of the guttural ventricles is affected.

In case of cancer of the vocal folds, the first symptom is dysphonia. Hoarseness progresses, often combined with a cough. If the tumor spreads to the scaly region, the patient feels a tingling sensation, less often the pain that gives into the ear. These symptoms are present at a later stage. At the second stage of the disease, the fold loses its mobility.

The cancer of the lining department of has been asymptomatic for a long time. The first sign of the disease is hoarseness, which appears due to the germination of the tumor into the vocal fold. At a later stage, there is also difficulty in breathing. Laryngoscopically, the tumor can be identified only when it has already approached the vocal fold. Unfortunately, at the time of diagnosis, the disease is already very common.

Symptoms of late-stage laryngeal cancer: dysphonia and swallowing pain, sometimes sharp, radiating into the ears, getting food with reflex coughing food into the airways, rapidly progressing breathing disorder due to increasing stenosis, and abundant salivation. Laryngoscopy reveals ulceration and necrosis of the tumor, its germination in surrounding tissues and organs.

of Isambera, the symptom of is the increase in the volume of the cartilaginous skeleton of the larynx, characteristic of the late stage of cancer. There is a thickening of the thyroid cartilage, accompanied by a smoothing of its contours due to the germination of the cartilage tumor. At the same time, there is often a limitation of passive and active movements of the larynx.

Duquesne's symptom is the rigidity of the thyrotilaginous membrane due to the germination of the tumor into the tissue of the pre-glandular space.

Moore symptom, or symptom of guttural crepitation , is this: when the larynx moves in the horizontal direction, there is a sensation of crunching, or crepitus. This is explained by the friction of the protrusions of the posterior edge of the thyroid cartilage on the anterior surface of the cervical vertebrae.

In laryngeal cancer, localized in the posterior celiac region, or the circularly growing cancer of the laryngeal part of the pharynx, and also when the larynx cancer grows into the pharynx, primarily with the infiltration of prevertebral tissue( late stage), crepitation disappears.

How to treat laryngeal cancer: radiation therapy and combination therapy

Here you will learn how to treat laryngeal cancer at all stages. Exclusively surgical l is shown only at the first stage of lesion of the vocal fold. In other cases, laryngeal cancer is treated with radiotherapy or combined treatment.

Depending on how the tumor spreads, the larynx either completely removes( laryngectomy), or performs various types of partial resections( removal of the lining of the larynx, one of the voice folds, anterior or anterolateral sections thereof).Partial resection tends to preserve the functions of the larynx. Recently, reconstructive surgeries have been performed that are designed to preserve the functions of swallowing, breathing and phonation after the removal of the larynx completely or most of it. At the same time, natural breathing is immediately restored. Indication for this kind of surgery is mainly cancer of the middle larynx. Also currently, a laser is successfully used to treat laryngeal cancer.

When there are metastases in the cervical lymph nodes, an operation such as Krayla is shown, in which one conglomerate removes the cervical tissue, the internal jugular vein, all the deep cervical lymph nodes, often grasping the sternocleidomastoid muscle. After the operation, irradiation is carried out.

Both radiotherapy and surgical intervention necessarily combine with the appointment of antibiotics, which will prevent the development of infection, primarily radiation perichondritis, as well as vitamin therapy.

Now, together with the main type of treatment, or in the fourth stage of the disease, chemotherapy( methotrexate, cyclophosphamide, thiophosphamide, etc.) is carried out.

If the disease recurs, laryngectomy and subsequent chemotherapy are indicated. Radiation therapy in this case is contraindicated, as it depresses the immune cellular reaction around the tumor and can cause anaplasia or sarcomatous transformation with rapid dissemination.