Throat cancer: signs, symptoms, diagnosis,causes, treatment

Update: November 2018

Malignant neoplasms are a direct threat to life.
No exception and laryngeal cancer. Currently,
There are effective treatments that can reduce
tumor growth activity or completely get rid of
diseases. However, despite this, the success of treatment is somewhat
decreased, compared with the end of the last century. If a в 80-х годах
every fifth cancer patient died, today the percentage
recovery is more than 60%, according to Dr. V.V.
Bryuzgin.

What is the reason? The success of treatment depends directly on
timeliness of treatment to the doctor and the choice of diagnosis. Because
patients often come to the doctor already in the late stages of the disease,
therapy and surgery become ineffective.
Also, the lack of regular
preventive examinations and insufficient coverage
medical examination.

Therefore, it is important that knowledge of the causes, signs of throat cancer,
principles of adequate treatment were widespread among
population.

Causes of development and predisposing factors

The main reasons for the formation of malignant tumors are only two
– it is a long inflammatory process (more than 5-10 years, in
depending on its intensity) and perverted recovery
tissue, during which appear “wrong”, atypical
cells There is a group of diseases that are immediate
precursors of laryngeal cancer. If a они имеют место – рано или
late in their place will malignant formation. To them
relate:

  • Excessive formation of keratin protein in the laryngeal mucosa
    (dyskeratosis). There are two variants of this disease: –
    leukoplakia: determined in the form of a spot of irregular shape, which
    has a rough surface. As a rule, there are several
    above the vocal cords. – leucokeratosis: more pronounced
    pathological process. With it, the mucosal surface is covered.
    �”Scales” gray-white. She looks like an ordinary
    skin
  • Thickening of a limited area of ​​the mucous on the inside
    surface of the larynx (pachydermia). Putting this diagnosis is enough
    difficult, because for this you need to study the fabric under a microscope.
    Important отметить, что рак при этом заболевании возникает только в
    the only case is when the pachidermia is located next to
    vocal cords. With another localization of this disease,
    according to the research works of Professor MI Davydov,
    malignant process never develops;
  • Laryngeal papillomas (only in adulthood) are
    quite common disease that can
    transform into cancer. The term “malignancy” is enough
    uncertain. They are supposed to depend on the availability of other
    predisposing factors.

With adequate treatment of the above diseases,
the probability of developing laryngeal cancer is reduced by 60-80%.

In national guidelines, among the risk factors
marked by:

  • smoking and occupational hazards – tobacco smoke, dusty
    air, work with high air temperature, aggressive
    substances: benzene, phenolic resins, petroleum products, carbon black, etc.
  • increased voice load (constant cry)
  • scars on the mucous larynx, they may occur after
    some specific infections (syphilis, tuberculosis, scleroma)
    or burns.
  • alcohol – part of the ethyl enters the upper parts of the larynx
    alcohol, causing irritation and mucosal damage
  • hot, spicy foods
  • chronic inflammation of the larynx (laryngitis).

Classification

It should be noted that the term “cancer
throat. ” It is incorrect – according to the international
classification of diseases, it is correct to say “laryngeal cancer” and
indicate the localization of the pathological process.

Symptoms of laryngeal cancer vary significantly, depending on
location level. This principle became the basis
classification of the disease. In accordance with the ICD tenth revision
The following groups of malignant neoplasms are distinguished:

  • proper vocal apparatus (vocal cords);
  • над голосовыми связками (преддверия larynx);
  • under the voice apparatus;
  • laryngeal cartilage;
  • several listed areas of the larynx.

In addition to separation by topography, there is
TNM-classification, which determines the severity of tumor
growth, lymph node damage and the presence of metastases (tumor cells,
which spread throughout the body, settling in other tissues). She is
necessarily indicated in the diagnosis, with cancer of the throat.

The principle of its decryption is quite simple. Every letter in
the abbreviation TNM is a clinical sign, and the number is a severity
process:

  • T (0-4) – Tumor size (tumor);
  • N (0-3) – The degree of damage to the lymph nodes (nodus);
  • M (0-1) – The presence or absence of metastases in organs
    (metastasis).

The most favorable prognosis for the patient is diagnosed with
designation N0M0. In this case, the symptoms of laryngeal cancer will be worn.
local character.

Because клиническая картина significantly different in cancer
different departments of the larynx, it will be better to consider these options
separately from each other.

Cancer of the vestibule of the larynx (above the vocal cords)

60% of patients with this form go to doctors already in the late
stages of laryngeal cancer. Because анатомическая область над голосовыми
the ligaments are the widest, the small tumor does not
manifests. Only after its significant growth appear
initial symptoms in the form of:

  • constant discomfort in the throat, feeling of “foreign
    bodies “;
  • difficulty breathing;
  • frequent gagging;
  • pain during swallowing, due to pressure of the esophagus on
    tumor;
  • mixed dyspnea that does not pass at rest or after taking
    bronchodilator drugs (Salbutamol, Berodual and so
    Further);
  • dry cough. Distinctive feature – it does not have
    the influence of antitussives (Libeksin, Sinekod, Bronholitin) and
    mucolytic drugs (Ambroxol, Lasolvan, Bromhexin);

Due to the erased clinical picture, these patients are often treated by
About a sore throat at the local therapist.

Cancer of the vocal cords

Detecting this form in the early stages is much easier than
others. The first symptoms of throat cancer appear early and fairly.
characteristic are hoarseness and change in timbre, which
persist for a long time. Conventional treatment
antibiotics, NSAIDs, hormones have no effect.

With the narrowing of the airways, the symptoms join,
characteristic of the vestibular tumor.

Cancer of the sub-vocal region of the larynx

The first complaint of patients, which forces them to see a doctor
– это difficulty breathing. This area of ​​the larynx is narrow enough
therefore, even a small tumor causes discomfort in the patient.
The symptom cannot be removed by bronchodilator drugs and
antispasmodics (Drotaverine, No-shpa, Spazmalgon), which is
typical sign of laryngeal cancer, which allows you to distinguish it from
other diseases.

Common symptoms of laryngeal cancer

As the disease progresses, symptoms of damage
different departments become indistinguishable. Characteristic:

  • wet cough with profuse sputum, accompanied by stabbing
    pain. As a rule, there is a small admixture of scarlet blood.
    colors;
  • general weakness, malaise, loss of appetite. Sick often
    lose weight in a relatively short time;
  • bad breath;
  • mixed dyspnea – it is equally difficult for a patient to inhale and
    exhale

If a рак гортани отдает метастазы в другие органы, возникает
clinic related to their damage. Most often, the “target”
become lungs, spleen or liver. Late symptoms of cancer
throat women may have damage to the ovaries or dairy
glands.

Diagnostics

First of all, you must carefully probe the entire area.
neck. With a tumor of considerable size, its deformity occurs and
displacement of cartilage. A round formation may be determined, dense
consistency, with smooth edges, somewhat painful.

There is a simple test that can be carried out by any patient.
houses:

  • consistently push the thyroid cartilage to the right and left, and
    move it a few centimeters;
  • Normally, a characteristic “crunch” due to friction should appear
    cartilage;
  • its absence indirectly indicates the presence of a tumor
    larynx

Laboratory research methods are practically uninformative.
Slight increase in ESR and white blood cell count (general analysis
blood) and C-reactive protein (biochemical blood test)
indicate only the presence of inflammation. For differential
diagnostics these analyzes do not give anything.

The main instrumental methods of examination for cancer of the larynx
presented in the table:

Survey method pros Minuses
Indirect laryngoscopy – examination of the larynx with a mirror
  • Rapidity;
  • No need for patient preparation, except
    one situation – pronounced gag reflex in a patient. In that
    case, the uvula and soft palate are sprayed with a solution of lidocaine that
    removes unpleasant sensations.
  • Limited review – can only detect vestibular cancer
    department or vocal cords (if the tumor is large enough);
  • You can explore the mucous only superficially.
Direct laryngoscopy – a method of inspection using a special
device (laryngoscope). This is a hard elongated object with
light bulb, which is introduced directly into the larynx.
  • Provides a better overview than the indirect method;
  • It is performed under local anesthesia (Lidocaine spray), which
    allows you to reduce patient discomfort.
  • The sub-vocal department is rarely available for inspection;
  • A special posture is required from the patient (lying down
    head);
  • Superficial examination of the mucous membrane;
  • Possible complication – spasm of the vocal cords and violation
    speech.
Fibrolaryngoscopy – examination of the larynx using a flexible
optical device (equipped with a video camera and a source
Sveta)
  • You can see all three parts of the larynx;
  • Allows you to do a biopsy (pick up a small piece of mucous
    for research under a microscope);
  • Held after irrigation spray Lidocaine (under the local
    anesthesia).
It is possible to touch the vocal cords and call them
spasm.
Straight microlaryngoscopy – study of the mucous membrane with
using a special microscope inserted in the larynx.
  • Possibility of microscopic examination of the laryngeal mucosa on
    any level (most often found squamous cell carcinoma
    larynx);
  • No discomfort during the survey.
Anesthesia can provoke the development of a number of complications (violation
consciousness, headache, atony of the digestive tract or bladder and so
Further);
Radiography of the neck in two standard projections
(side and straight)
  • Rapidity;
  • Lack of patient discomfort;
  • The ability to assess the severity of tumor growth.
  • Only indirect signs of throat cancer are found;
  • The presence of a small irradiation.
Neck CTgram
  • Speed;
  • Excellent visualization and accuracy;
  • No discomfort to the patient.
  • High radiation exposure;
  • The high cost of research (on average – 2000 rubles).
MRI of the neck
  • The gold standard for diagnosing tumors (the best
    visualization);
  • The complete absence of side effects.
The high cost of the survey (from 4000 rubles).

All of these methods have diagnostic value, but the diagnosis
�”Cancer of the larynx” can be put only after a biopsy.

Differential diagnostics

Unfortunately, there are no absolutely accurate symptoms that
indicate cancer of the larynx. Therefore, the disease can be confused with
along with other pathologies:

  • laryngitis (inflammation of the larynx) – the clinical picture is very
    similar to cancer in the vocal cords. When it is observed:
    hoarseness, shortness of breath (due to laryngeal edema), general weakness,
    possible low temperature. The main difference is pain or
    �”Tickling” in the throat, which, as a rule, does not happen on the initial
    stages of throat cancer;
  • tuberculous process in the larynx – it is accompanied by similar
    symptoms: general weakness, weight loss, voice disorders,
    difficulty breathing. It is important to remember that this disease develops.
    only after pulmonary tuberculosis. Therefore, to distinguish it from
    laryngeal cancer is enough to carry out the usual fluorography;
  • most diseases of the bronchi and lung tissue (bronchial
    asthma, pneumonia, bronchitis, COPD, etc.) – difficulty breathing and
    dyspnea, accompanying podgolosis cancer in the first stage,
    also observed in these pathologies. Enough to distinguish
    perform auscultation (listen to the phonendoscope) chest
    cells

Additional examination, which is necessarily conducted
allows the patient to easily draw a line between cancer of the larynx and
the above diseases.

Treatment

To determine the correct tactics of the patient can only
qualified oncologist. In clinical practice, now
There are four main ways to treat laryngeal cancer:

  • tumor destruction by laser – effective only with a tumor
    T1;
  • surgical – preference is given to this method if
    the tumor has not yet metastasized or sprouted into neighboring organs.
    There are two large groups of surgical interventions: –
    organ-preserving: when a tumor is excised or one of
    parts of the larynx (denoted by the term resection); – radical:
    the larynx is completely removed along with the neoplasm, and on its
    place place the graft.
  • beam – there are a huge number of variations and schemes
    radiation that only a specialist can choose. Important
    note that with laryngeal cancer, ionizing radiation
    affect a fairly wide area – from the clavicle to the bottom
    jaws. In the case of the spread of metastases, the amount of radiation therapy
    determined individually;
  • combined – combination of ray and operational methods,
    the interval between which should be no more than 2 weeks, for
    achieve optimal effect.

Scientists are constantly working on new ways of therapeutic
and operational impacts. Even 40 years ago, cancer
was a sentence for the patient, but now, the percentage
recovery is constantly increasing. Now he is approaching
63%.

Forecast

The course of laryngeal cancer depends largely on the location of the process.
In the predoor and sub-vocal sections there is a very rich lymph and
circulation. Therefore, the tumor, having excellent nutrition, quickly
grows and begins to metastasize early (usually during
several years). Localization of cancer in the vocal cords has more
favorable prognosis.

With timely diagnosis and adequate treatment, 5 year old
life expectancy for cancer of the larynx is about 90%. If a
the same tumor is detected in the third stage (according to TNM), the survival rate of five
years is not more than 67%, according to Professor Sh.H. Gantsev.

Frequently asked questions of patients with laryngeal cancer

What will happen to the voice after treatment?

Answer this question definitely can not. It all depends on
tumor localization and treatment options. Cancer voice
apparatus or traumatic operations are often accompanied by a complete
loss of voice. However, you should be aware that it is better – voice or
a life?

Will it be difficult for me to breathe after removing the tumor?

No, breathing difficulties in patients after successful treatment
practically never arise. Even after removing the entire larynx,
it is replaced by a graft, which allows you to fully breathe.
Рак горла

Will the appearance of the neck change?

Unfortunately yes. Radical operations always leave their mark.
on the body. However, with the help of plastic surgery, it is easy to return
imagine the old look.

Can cancer come back?

Yes. The probability of recurrence is always preserved. Even one is cancerous
a cell that has not been destroyed may cause
formation of a new tumor.

Will I be able to swallow normally after removing the tumor?

As a rule, yes. The functions of the esophagus and pharynx do not suffer when
T1 or T2 tumors. If a же рак начал прорастать в пищевод, вы
you may feel some discomfort due to scarring of the mucous, even
after successful chemotherapy.

Can cancer start in another organ?

There is such a probability, but laryngeal cancer will not affect it.
In clinical practice, there are cases when one patient
begin to grow, independently of one another, several malignant
tumors. They are extremely rare, unlike the distribution
metastasis.

How much damage does chemotherapy do?

Significant. The bone marrow suffers most of all.
leads to anemia. In second place is the skin and its derivatives.
(hair, nails and so on). Damage to other tissues is also possible.
However, it should be remembered that such treatment can save you
a life. In other words, a tumor kills a person significantly.
faster and better than radiation therapy.

Where is the best treatment: in Russia or abroad?

The qualifications of Russian doctors are no worse than foreign ones. the main thing
the difference is in price. Treatment за рубежом будет гораздо более
costly but hardly more efficient.

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