Cancer of the larynx
Laryngeal cancer is a widespread cancerous tumor, accounting for less than 1% of all malignant neoplasms. Among malignant lesions of the larynx, squamous cell carcinoma is 95-98%, less than 2% of all cancerous tumors. By the time of diagnosis, 62% of patients have local lesions, 26% with regional metastases, and 8% with distant lung, liver, and/or bone metastases. Risk factors – smoking, alcohol abuse. Frequency – 5 per 100,000 population; 12,500 new cases per year; more often recorded in persons 60-70 years old; less than 1% of cases occur in people under 30; men get sick more often (1:5), but the incidence increases among women who smoke. Anatomy
- Upper – a closed line running along the free edge of the epiglottis, the upper edge of the aryepiglottic folds and the tops of the arytenoid cartilages. Anatomical formations located anterior, lateral and posterior to this line belong to the lower pharynx
- Inferior – a horizontal plane passing along the lower edge of the cricoid cartilage
- Departments. The larynx is divided into 3 sections
- The vestibule of the larynx starts from the end of the epiglottis, includes the false vocal cords and the floor of the ventricles of the larynx (blinking ventricle)
- The interventricular region is located approximately 1 cm below the free edges of the true vocal cords.
- The subvocal cavity extends to the lower edge of the cricoid cartilage
- Lymphatic drainage
- The vestibule of the larynx has a rich network of lymphatic vessels leading to the deep jugular lymph nodes.
- At the glottis, the lymphatic system is poorly developed
- From the subvocal cavity, lymph flows into the prelaryngeal and pretracheal lymph nodes. Stages (see also Tumor, stages)
- TV — carcinoma in situ
- T, – the tumor is limited to the primary focus
- T 2 – the tumor spreads to adjacent areas of the larynx
- T3 – the tumor is limited to the larynx with fixation of its half
- T4 Tumor with cartilage destruction or extension below the larynx.
- Persistent hoarseness in middle-aged and elderly smokers
- Shortness of breath and stridor
- Pain in the ear on the affected side
- Persistent cough
- Weight loss stimulated by reduced nutrition
- Bad breath due to tumor decay
- Change in the shape of the neck associated with metastasis to the cervical lymph nodes (volumetric formations on the neck are not often visually determined)
- Soreness in the larynx associated with the decay and suppuration of the tumor
- Feeling of a lump in the throat
- On palpation, the larynx is dilated, crepitus is less pronounced
- Thickening of the cricothyroid membrane.
- Laryngoscopy reveals mushroom-shaped tumors of a loose consistency with expanded edges, a granular surface and foci of necrosis in the center, exudation. The affected areas are surrounded by fields of hyperemia.
- MRI / CT is used to detect metastases in the chest, liver or brain (according to individual indications)
- Indirect and / or direct laryngoscopy with biopsy and subsequent morphological examination to determine the stage of the disease.
- Carcinoma in situ is treated by excision of the affected vocal cord mucosa.
- Most lesions are in stage T (subject to radiation therapy
- Some authors recommend vaporizing the tumor with a laser.
- If one of the vocal cords is involved or grows into the subglottic cavity, a hemilaryngectomy (vertical laryngectomy) is used
- Small lesions of the apex of the epiglottis can also be treated with limited resection
- Removal of the vestibule (horizontal laryngectomy) is used for large tumors of the upper larynx
- During the operation, the epiglottis, aryepiglottic and false vocal cords are removed. The true vocal cords are preserved
- Tumors of the vestibule extending to the true vocal cords may require supralaryngectomy
- For all lesions of stages T3 and T4, total laryngectomy is indicated in combination with radical cervical lymphadenectomy and postoperative radiation therapy.
- Warty carcinoma is treated with surgery.
Tactics of conducting
- Repeat indirect laryngoscopy and complete head and neck examination at least 5 years after treatment to detect early recurrence or development of a tumor lesion from another source
- Annual chest x-ray and liver function test
- Patients with dysphagia undergo an X-ray contrast study with barium and / or FEGDS to exclude a secondary tumor lesion of the esophagus
- With changes in mental status, a CT scan of the skull is indicated to exclude metastatic lesions.
methods of treatment, Tumor, stages
ICD. C32 Malignant neoplasms of the larynx