Cancer of the pharynx and cervical esophagus

By /

Cancer of the pharynx and cervical esophagus

Anatomy

    • Borders
    • Upper – a plane passing along the upper edge of the free section of the epiglottis perpendicular to the back wall of the pharynx
    • Inferior – a plane passing along the lower edge of the cricoid cartilage perpendicular to the back wall of the pharynx
    • With the larynx – a plane passing along the free edge of the epiglottis, the edge of the arytenoid folds to the tops of the arytenoid cartilages
    • With the oropharynx – a horizontal plane passing on

the level of the pits of the epiglottis to the posterior wall of the pharynx. It includes the pear-shaped pockets, the area behind the cricoid cartilage, and the posterior pharyngeal wall.

    • Lymphatic drainage
    • Lymph from the pear-shaped pockets flows into the jugular and middle jugular lymph nodes
    • Lymph from the posterior pharyngeal wall flows into the pharyngeal lymph nodes
    • The lower parts of the laryngopharynx drain the paratracheal and lower jugular lymph nodes. Classification and etiology
    • In 95% of cases, the tumor of this localization is squamous cell carcinoma.
    • Approximately 60-75% of tumors occur in pear-shaped pockets and 20-25% on the posterior pharyngeal wall. Less often, the tumor originates from the retrocricoid region.
    • Smoking, alcohol, radiation predispose to tumor growth. Stages (see also Tumor, stages)
    • Tjs – carcinoma in situ
    •  T, -carcinoma is limited to the primary focus
    • T2 – tumor spread to adjacent areas without fixation of half of the larynx (vocal cord)
    • T3 – spread of the tumor to adjacent areas with fixation of half of the larynx
    • T4 – massive tumor growth in the bone, soft tissues of the neck.

Clinical assessment

    • The triad is characteristic (more than 50% of cases): sore throat, earache, dysphagia
    • Hoarseness of voice and impaired airway patency are signs of larynx involvement in the process
    • Subjective sensation of a lump in the throat, the need to clear the throat
    • Cervical metastases (hidden in 41% of cases) are found in 75% of patients with cancer of the pear-shaped pocket and in 83% of patients with cancer of the laryngeal wall (66% hidden)
    • The diagnosis is confirmed by fluoroscopy with contrast and laryngopharyngoscopy with biopsy.

Treatment

    • Treatment depends on the stage of the process
    • If at stages T, /T, the apex of the piriform pocket is not affected, it is possible to perform a laryngectomy above the level of the glottis
    • For small stage T tumors, external beam radiation therapy or resection through the lateral pharyngotomy is indicated
    • The majority of T3~T4 lesions require laryngopharyngectomy with radical cervical lymphadenectomy followed by radiotherapy.
    • The presence of a tumor of the cervical esophagus may be an indication for the removal of the pharynx, esophagus and larynx.
    • Reconstruction of circular defects of the laryngopharynx and cervical esophagus is necessary to restore swallowing. The question of the need for surgery is decided individually. Types of reconstructive surgeries
    • Use of local skin flaps (cervical or deltopectoral)
    • The use of musculoskeletal flaps on the feeding leg (from the pectoralis major muscle, the latissimus dorsi muscle)
    • Esophagectomy followed by stomach or colon plasty to replace the esophagus
    • Transplantation of a free section of the intestine or soft tissue flap with the imposition of microvascular anastomoses.

The prognosis is unfavorable, which is associated with intensive infiltrative growth of tumors and a high frequency of metastases.

    • The 5-year survival rate for laryngopharyngeal tumors is within 30%
    • It increases to 50% in cases of probable laryngectomy above the level of the glottis.

See also Tumor, radiotherapy, Tumor, markers; Tumor, methods of treatment; Tumor, stages

ICD

    • C32 Malignant neoplasms of the larynx
    • C15 Malignant neoplasm of esophagus