Throat cancer: causes, stages of development, diagnosis, treatment methods, rehabilitation

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.

Prevention

Cancer can be prevented by following a number of recommendations from experts. First of all, it is important to properly care for your oral cavity and visit the dentist in a timely manner. The doctor keeps your teeth clean and monitors the condition of your gums and soft tissues twice a year.

Since HPV is a significant factor in the development of oropharyngeal cancer, it is important to reduce the risk of infection. To do this, it is necessary to exclude promiscuity and get a vaccine.

Experts recommend giving up bad habits and completely quit smoking. Immediately after eating, you should rinse your mouth and brush your teeth twice a day. A balanced diet is the key to health, so you should consume more vegetables and fruits every day, eat whole grain bread, and it is better to avoid processed meat, legumes and chicken.

Bibliography:

1. American Society of Clinical Oncology. Oral and Oropharyngeal Cancer: Screening. 09/2017. Accessed at www.cancer.net/cancer-types/oral-and-oropharyngeal-cancer/screening on February 21, 2022.
2. National Cancer Institute. Oral Cavity, Pharyngeal, and Laryngeal Cancer Screening (PDQ®)–Health Professional Version. February 9, 2022. Accessed at www.cancer.gov/types/head-and-neck/hp/oral-screening-pdq#section/_1 on February 21, 2022.
3. International Union Against Cancer (UICC). Lip and Oral Cavity. In: UICC TNM Classification of Malignant Tumors, 7th Edition. 2009:328.
4. National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Head and Neck Cancers, Version I. 2022 - February 15, 2022. Accessed at www.nccn.org/professionals/physician_gls/pdf/head-and-neck .pdf on February 21, 2022.
5. American Cancer Society. Facts & Figures 2022. American Cancer Society. Atlanta, Ga. 2022.
6. American Cancer Society. Cancer Facts & Figures 2022. Atlanta, Ga: American Cancer Society; 2022.
7. National Cancer Institute. Cancer Stat Facts: Oral Cavity and Pharynx Cancer. April 2022. Accessed at https://seer.cancer.gov/statfacts/html/oralcav.html on February 22, 2018.
8. National Cancer Institute. Lip and Oral Cavity Cancer Treatment (Adult) (PDQ®)–Patient Version. January 29, 2022. Accessed at www.cancer.gov/types/head-and-neck/patient/adult/lip-mouth-treatment-pdq on February 22, 2022.
9. Squamous cell carcinoma of the head and neck: new avenues of treatment? // Braunschweig1 , A. Lewandrowski1 , D. Smeets1 , MV Bolotin2
10. Bolotina L.V., Vladimirova L.Yu., Dengina N.V., Novik A.V., Romanov I.S. Practical recommendations for the treatment of head and neck tumors. Malignant tumors. 2022.

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.

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.

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.

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.

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

After an examination by an oncologist and a dentist, a number of examinations are prescribed:

• blood test for HPV. The study is carried out using PCR, sequencing or enzyme analysis. Confirmation of human papillomavirus changes tumor treatment tactics;
• endoscopic examination of the larynx and oropharynx using laryngoscopy and pharyngoscopy;
• cytological examination. During laryngoscopy, the doctor takes a scraping from the mucous membrane and sends it for analysis. The cellular composition of the tumor is determined;
• biopsy. The removed area is stained with eosin and hematoxylin, and then a reaction to the drug is observed;
• CT/MRI. Tomography clarifies the location and size of the tumor;
• PAT. Shows the spread of the tumor to surrounding organs, as well as metastasis to the chest organs.

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.

Classification of laryngeal tumors

Traditionally, malignant tumors of the larynx are classified based on their location. There are cancers of the vestibule of the larynx, the middle part of the larynx, and tumors of the subglottic localization. Each of these three cases has its own lymph outflow pathways, a separate TNM classification, depending on the location, treatment methods, approaches, etc. vary.

Upper larynx

• Suprahyoid epiglottis
• Laryngeal surface of arytenoid folds
• Arytenoid cartilages
• Subhyoid part of the epiglottis
• Vestibular folds

Middle part of the larynx

• Vocal fold area
• Anterior commissural division
• Posterior commissural region

Subglottic space

• From the inferior border of the vocal folds to the edge of the cricoid cartilage

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.

Histological variants of laryngeal tumors

Based on their tissue structure, laryngeal tumors are classified as follows:

Laryngeal cancer

• Squamous (predominant variant)
• Adenocarcinoma (rare variant)

Sarcoma of the larynx

• Round cell sarcoma
• Carcinosarcoma
• Myosarcoma
• Chondrosarcoma
• Fibrosarcoma
• Lymphosarcoma

Secondary tumors

• Metastases of cancer and sarcoma of various localizations in the larynx. Mainly contact metastases in cancer of the esophagus, secondary tumor lesions of the mediastinal lymph nodes, lymphoma
• Downward spread of the pharyngeal tumor into the larynx is also possible

Staging of laryngeal cancer using the TNM system

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.