How does throat cancer develop (photo of the initial stage)

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.

Treatment

The objectives of the treatment procedures are to remove the tumor and restore the basic functions of the larynx, respiratory and voice-forming.

The choice of treatment program is made taking into account the localization of the tumor focus, the prevalence of the disease, the presence/absence of metastases, the sensitivity of pathogenic cells to drugs, etc.

Treatment methods:

• Surgical intervention;
• Radiation therapy;
• Chemotherapy.

To maintain the patient's quality of life, it is very important to restore his voice function after treatment. Here, a voice prosthesis and subsequent sessions with a phoniatrist can help.

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.

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

The main reasons contributing to the occurrence and development of the disease are the following:

• Smoking;
• Consumption of alcohol in large quantities;
• Poor oral hygiene;
• Hereditary predisposition;
• Infection with papilloma virus.

In addition to the above reasons, there are so-called precancerous diseases, which can also affect the occurrence of throat cancer. So, throat cancer can be caused by:

• Chronic inflammation in the larynx;
• Leukoplakia;
• Leukokeratosis;
• Pachyderma;
• Fibroma;
• Papillomas;
• Cysts;
• Laryngeal injuries.

Provoking factors may be weakened immunity and harmful production factors.

In addition, throat cancer can develop from some benign tumors.

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.

What are the first signs of throat cancer?

The first signs of throat and larynx cancer are very varied. They depend on the shape and location of tumor growth and the degree of its spread. The initial stage of throat cancer is hidden. The first symptoms of throat cancer are mild. If they are present, you must immediately make an appointment with an otolaryngologist.

What does throat cancer look like in its early stages? Initially, the tumor can be in the form of a nodular or papillomatous formation, a polyp, or diffuse infiltration. The surface of the tumor is usually uneven and may be gray, red or dark. Cancer of the laryngeal ventricle first appears as a small, gradually increasing upward bulge of the ventricular ligament. Cancer of the epiglottis appears in the form of a limited infiltration or a lumpy, mushroom-shaped mass on its laryngeal surface, spreading into the preepiglottic space.

The first signs of laryngeal cancer depend on the location of the tumor. In the early stages of cancer of the middle part of the larynx, where the vocal cords are located, the first symptoms of throat cancer are hoarseness and other voice changes. The sensation of a lump or foreign body in the throat intensifies while eating or swallowing water.

Swallowing dysfunction occurs when the tumor is localized in the epiglottis. First, a sore throat appears, radiating into the ear on the affected side when chewing, and then there is a constant feeling of a foreign body in the throat. Because of the pain, the patient begins to eat less, which leads to weight loss and exhaustion of the patient.

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.

Leukoplakia, erythroplakia and dysplasia

Leukoplakia and erythroplakia are terms denoting various changes in the mucous membrane of the oral cavity and pharynx due to smoking, chewing tobacco, trauma to the oral mucosa with a denture

The appearance of a changed white mucous membrane may indicate the presence of leukoplakia in the patient. With erythroplakia, the altered mucous membrane is red in color, may protrude somewhat above the surface and bleed easily.

The severity of the resulting changes in the mucous membrane of the oral cavity and pharynx can only be clarified with the help of a biopsy (taking a piece of tissue for microscopic examination) or scraping of individual cells.

These changes may be harmless and disappear after the cessation of exposure to the causative factor, but may precede the onset of cancer.

This precancerous condition is called dysplasia.

There are minor, moderate and severe degrees of dysplasia. Knowing the degree of dysplasia, it is possible to predict (predict) the likelihood of self-healing, disappearing after treatment, or turning into a malignant tumor.

Without proper treatment, 5% of leukoplakia develop into cancer over a 10-year period.

Erythroplakia is a more serious condition in which almost 50% of cases are diagnosed as cancer after biopsy.

More than 90% of tumors of the oral cavity and oropharynx are squamous cell carcinoma, developing from integumentary (epithelial) cells.

Verrucous (warty) carcinoma is a type of squamous cell carcinoma and accounts for 5% of all oral tumors. This type of cancer is a low-grade tumor that rarely metastasizes, but can spread deeply into surrounding tissues. In this regard, wide removal of the tumor within healthy tissue is recommended.

The minor salivary glands, located in the oral and pharyngeal mucosa, can give rise to various types of cancer, such as adenoid cystic carcinoma, mucoepidermoid carcinoma and low-grade polymorphic adenocarcinoma.

The tonsils and base of the tongue contain lymphoid tissue from which lymphomas (non-Hodgkin's lymphoma/lymphosarcoma and Hodgkin's disease/lymphogranulomatosis) can develop.

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 .

Diagnostics

Early diagnosis plays a key role in the prognosis and effectiveness of treatment for throat cancer.

If symptoms such as cough and hoarseness persist for 2-3 weeks, then laryngoscopy is used for preliminary diagnosis of throat cancer.

Additional diagnostic methods:

• Stroboscopy;
• Electroglottography;
• Phonetography.

The prevalence of the disease can be assessed using radiography and MSCT.

Metastasis is determined using ultrasound and biopsy.

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.

Life expectancy of people with throat cancer at different stages

A person's life expectancy is directly related to the stage of cancer. Stage zero of throat cancer is one of the forms in which neoplasms appear on the mucous membrane. How long do people live with this type of throat cancer? With timely intervention, 95% of patients can live more than 5 years.

Stage 1 throat cancer

If a patient has stage 1 throat cancer, then in 80% of cases he can live 5 years. Stage 1 of throat cancer is the stage when pathologically changed tissues affect both the mucous layers and neighboring tissues. But at the same time, if a person has stage 1 throat cancer, then the metastases do not spread to the lymph nodes. At this stage of throat cancer, it is still possible to operate on the patient and remove the tumor.

Throat cancer stage 2

If a patient has stage 2 throat cancer, then in the next 5 years the survival rate is up to 70%. The tumor can reach its maximum size in stage 2 throat cancer. It makes it difficult to breathe and swallow food.

Throat cancer stage 3

If a person has stage 3 throat cancer, then the tumor will gradually develop metastases. At this stage of throat cancer, they enter the bloodstream and spread to the mucous layers of the throat. At stage 3 of throat cancer, a person may lose their voice. It is also possible that the swallowing reflex will begin to weaken. Only 50% of all patients with stage 3 throat cancer live 5 years, but only with proper therapy and rehabilitation.

Throat cancer stage 4

At stage 4 of throat cancer, the disease affects tissues and organs adjacent to the tumor. Metastases can be found in the lymphatic system. At this stage of throat cancer, the process of development of the tumor and the disease in general only accelerates. At stage 4 of throat cancer, cancer cells appear throughout the body through the blood. This form of the disease is considered the most advanced. At stage 4 throat cancer, no more than 20% of patients survive the next 5 years.

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.

Prevention of cancer of the oral cavity and oropharynx

Most oral and oropharyngeal cancers can be prevented by avoiding known risk factors.

Tobacco and smoking are the most important risk factors in the development of cancer of the oral cavity and oropharynx. The best solution for all people is not to start smoking, not to drink alcohol, or to sharply limit their consumption.

If you smoke and drink alcohol, even for a long time, then giving up these habits will significantly reduce the risk of cancer in these locations.

Avoiding sun exposure during the middle of the day, when exposure to ultraviolet radiation is greatest, will reduce your risk of developing lip and skin cancer.

A nutritious diet including plenty of vegetables and fruits several times a day and whole grain products will help reduce the incidence of cancer of the oral cavity and oropharynx.