Oncological lesions of the throat include various malignant neoplasms that are localized in the area of the pharynx and larynx. This pathology occurs quite often among low-quality tumors. Statistics indicate that this disease occurs 10 times more often in men than in women. Laryngeal cancer at an advanced stage can be fatal, which is why it is so important to diagnose the disease in a timely manner and take all necessary measures. The sooner you start treatment, the better your chances of a full recovery.
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.
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 chemoradiotherapy 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.
Survival prognosis
How long do people live with laryngeal cancer? When a patient is diagnosed with throat cancer, the prognosis directly depends on the location of the tumor and the extent of the cancer process.
Table No. 1. Survival prognosis depending on the location of the laryngeal tumor
| Location of the tumor | Five-year survival forecast |
| Postcricoid region | 20% |
| Posterior wall of the larynx | 21% |
| Pyriform sinus | 50% |
Is throat cancer deadly? If the disease is recognized in a timely manner, there is a high probability that the disease can be defeated. The five-year survival rate for patients with stage 1 throat cancer is 85%. When stage 4 gora cancer is detected, the prognosis is less optimistic. If stage 4 throat cancer is detected, how long do they live? The five-year survival prognosis for patients with stage four laryngeal cancer is 20%. Much depends on whether the patient agrees to surgery to remove the larynx and vocal cords, which could render the person mute.
Long-term survival of patients with throat cancer has remained virtually unchanged over the past 20 years, but the quality of life of cured patients has improved significantly. If radiation therapy does not lead to the expected result, doctors at the Yusupov Hospital use preservation surgery methods that allow the patient to partially preserve speech.
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.
Causes of pharyngeal cancer
The following are the main causes of throat cancer:
| Causes | Description |
| Smoking | Tobacco products containing harmful substances contribute to the development of the disease |
| Alcohol | Alcohol-containing products weaken the body and damage the immune system if abused. |
| Lack of oral hygiene | Lack of care and hygiene increases the risk of developing throat cancer |
| Heredity | If there are people in your family with throat cancer, the likelihood of it occurring in the future generation increases |
| papillomavirus | Infection increases the likelihood of developing cancer. |
How much do you have to smoke to get throat cancer? Studies conducted by scientists have found a connection between the number of cigarettes smoked per day, smoking experience and the likelihood of throat cancer. The higher the first 2 indicators, the higher the risk of cancer. Other forms of tobacco use also increase risk. There is a potential risk of laryngeal cancer in both smokers and those who chew tobacco. In individuals who have both of these habits, the risk of developing throat cancer increases by 3-4 times. Excessive consumption of strong alcoholic beverages is the first reason that increases the risk of developing the disease.
Laryngeal cancer associated with human papillomavirus has characteristic biological features. In its treatment, less aggressive organ-preserving chemotherapy regimens are used. How long does it take for throat cancer to develop? The process of transformation of normal cells into atypical ones is individual for each person. Throat cancer does not develop immediately. It is preceded by long-term precancerous diseases:
- Dyskeratoses of the larynx (leukoplakia, leukokeratosis);
- Pachydermia;
- Fibroma;
- Papillomas;
- Cysts;
- Chronic inflammatory processes in the larynx, which are accompanied by frequent alcohol consumption and smoking;
- Scars of the larynx as a result of illnesses or injuries.
The cause of the development of laryngeal cancer may be exposure to harmful factors at work, a weakened immune system, ionizing radiation, or gastroesophageal reflux disease.
Provoking factors are paints, wood dust, asbestos, sulfuric acid, nickel. How quickly does throat cancer develop? It may take months or years from the appearance of the first changes in the cells of the mucous membrane of the pharynx or larynx to the clinical stage of the disease.
Recently, in Russia there has been an increase in the number of newly diagnosed throat cancers. This is due to the influence of external and internal factors. Around the world, the statistics are no less comforting. Every year 15,000 new cases of pathology are diagnosed. The ratio of sick men to women is 1000:8.
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.
Rehabilitation
Postoperative rehabilitation of patients is a complex and lengthy process, which includes a gentle diet consisting mainly of liquid and pureed dishes without strong flavoring additives. Initially, nutrition is administered through a tube, then the person is able to eat in the usual way.
To strengthen the muscles of the neck and throat, special exercises are prescribed. They allow you to develop diction and at the same time eliminate complications such as bleeding from the throat. In some cases, it is necessary to carry out additional intervention to restore the vocal cords or implant an artificial larynx so that the person is able to speak.
Psychological support is of great importance, since after the operation a person actually learns to use the speech apparatus again, and his voice changes significantly. The modern level of medicine allows even those whose larynx was completely removed due to a tumor to return to normal life.
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.
| Stage | Characteristic |
| I | The formation is limited in size and does not extend beyond the mucous membrane of one anatomical part of the larynx. |
| II | The process completely covers one anatomical part of the larynx (all layers can be involved), does not spread beyond its limits, and does not metastasize. |
| III | a – the tumor extends beyond one anatomical part of the larynx, spreads to adjacent tissues, and causes immobility of half of the larynx. b – in addition to the spread of cancer to neighboring anatomical areas, regional lymph nodes are affected: one fixed or several mobile enlarged nodes are detected. |
| IV | a – spread of the tumor to neighboring organs. b – the formation occupies a significant part of the larynx and penetrates into the underlying tissue. c – fixed metastases are detected in the lymph nodes of the neck. d – tumor of any size, metastasizes to regional lymph nodes and distant organs. |
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.
- poorly differentiated - it is difficult to determine the type of cells and tissues that make up the neoplasm, the tumor is characterized by a high degree of malignancy, grows quickly and metastasizes;
Stages
Oncologists distinguish four main stages of throat cancer, each of which is characterized by certain manifestations.
- A small and clearly localized tumor forms on the mucous membrane, and mild symptoms of malaise are felt. There are no changes in voice, no damage to the lymph nodes.
- The neoplasm spreads to the entire anatomical part of the throat in which it appeared, but practically does not penetrate into other parts.
- Spreading into other anatomical parts is observed, voice changes appear, as half of the larynx becomes motionless. Metastases appear in neighboring tissues.
- The tumor engulfs two anatomical sections or spreads to the entire throat, grows deeper into nearby organs, metastases penetrate the lymph nodes and distant areas of the body.
The process of metastasis in the final stages first covers nearby lymph nodes, then with the help of lymph flow the metastases penetrate into other organs.
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 .
Types of cancer of the larynx
- Most tumors develop from thin, flat cells lining the inside of the larynx and are called squamous cell carcinomas
.
Its earliest form is carcinoma in situ
, or the presence of altered cells in the inner lining of an organ. At this stage, the changed cells are only in the inner lining of the organ, and are not found in the deeper layers and other tissues. This type of cancer is highly treatable, but if left untreated, it can become an invasive tumor that grows into nearby structures and distant parts of the body. It is this disease that will be discussed in this text. - In some parts of the larynx, under the mucous membrane, there are glands that produce mucus and saliva, which are necessary to lubricate food and facilitate its passage through the esophagus into the stomach. Salivary gland cancer
develops in their cells . - Sarcomas
form in the connective tissue contained in cartilage . - Lymphomas
arise in the lymphoid tissue that produces lymphocytes - cells of the immune system that protect us from bacteria, viruses and other diseases .
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.
Anatomical structure
The oropharynx is a continuation of the nasopharynx, the middle section of the larynx. It starts from the hard palate and ends at the entrance to the larynx. The organ is connected to the oral cavity by the pharynx, and is separated by the palatine arches, soft palate and dorsum of the tongue. In this section the digestive and respiratory tracts intersect. The oropharynx contains:
- the back third of the tongue (its root);
- tonsils;
- posterior and lateral walls of the pharynx. The posterior wall is located at the level of the third cervical vertebra. The side walls connect to the eustachian tubes of the ears.
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.
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.
Causes of disease development
Acute and chronic throat diseases can occur for various reasons, among the most common are:
- microorganisms (bacteria, viruses, fungi);
- gastroesophageal reflux disease (GERD);
- allergens;
- adverse environmental impacts;
- voice overstrain;
- injuries;
- hypothermia;
- general decrease in immunity;
- smoking.
A combination of several reasons is possible. Their identification and elimination is an integral part of treatment.
