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

Malignant neoplasms in the throat affect 10,000 people every year, of whom 4,000 die. The insidiousness of the pathology is that throat cancer (symptoms in men) does not occur so often; local therapists and other doctors in the general medical network know little about it. It is easy to confuse the symptoms of oncology with a seasonal cold. Therefore, it is important for everyone, especially the stronger sex, to know the symptoms of laryngeal cancer in men. After all, oncology “loves” them very much.

Why is there such gender injustice? Doctors explain that men are more often exposed to provoking factors and neglect their health. Although early detection of the disease, modern drug correction guarantees a survival rate of up to 95% in the first stage . In the final stages of the disease, the rate drops to 25%.

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Symptoms

The initial manifestations of the disease resemble a common cold:

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• sore throat that makes it difficult to speak or swallow food;
• feeling of the presence of a foreign body in the throat;
• swelling of the tonsils;
• change in voice - hoarseness or nasality;
• frequent headaches;
• general weakness, decreased performance;
• slight increase in body temperature;
• enlargement of the submandibular lymph nodes.

However, unlike a cold, the first symptoms of throat cancer do not go away within a week. The listed signs intensify, and over time they are added:

• light spots on the mucous membrane;
• small bleeding ulcers;
• chronic cough;
• ear pain without signs of otitis media;
• weight loss for no apparent reason;
• the appearance of a tumor in the neck;
• difficulties in pronouncing words due to decreased mobility of the tongue;
• labored breathing;
• nose bleeding

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.

Causes and risk factors

The mechanism that causes pathological changes in cells, due to which they begin to divide uncontrollably and uncontrollably, has not yet been precisely identified. However, today the factors contributing to the appearance of throat cancer have already been well studied. The main reasons are heavy tobacco smoking and alcohol consumption. In addition, the situation is aggravated by:

• being male;
• age over 40 years;
• living in a city with an unfavorable environmental situation;
• work in hazardous production;
• lack of vitamins and the predominance of meat in the diet;
• inherited predisposition to cancer;
• heartburn (gastroesophageal reflux);
• papillomavirus infection.

About 90% of patients with throat cancer are men aged 40-60 years, living in large cities and smoking at least a pack of cigarettes daily.

Stages

The appearance of symptoms of laryngeal cancer is often preceded by a precancerous condition - dysplasia of the mucous membrane, which develops with constant irritation from cigarette smoke, strong alcohol or pollutants. If the irritating factor is eliminated, this condition often disappears on its own, otherwise a transition to the so-called zero stage of cancer is possible - in situ, or “in situ”, when pathological cells remain within the epithelial tissue. Subsequently, rapid growth and spread of the tumor occurs.

Otolaryngologists and oncologists distinguish four main stages of the disease.

1. The pathological formation remains within the original part of the larynx, spreading into the mucous membrane and submucosal layer. Symptoms are absent or subtle.
2. The tumor grows into all layers of throat tissue, but remains within the original region. Sore throat and voice changes appear.
3. The neoplasm penetrates into the tissues adjacent to the throat and regional lymph nodes. The sore throat intensifies, cough, ulcers and other characteristic symptoms appear.
4. The tumor grows so much that it becomes clearly visible on the neck. It grows into all surrounding tissues and metastasizes to nearby and distant organs. The patient's condition deteriorates sharply, and he is tormented by constant pain.

Types

This form of cancer of the throat and larynx can have several main varieties, which differ in manifestation and approaches to their treatment.

Let's take a closer look at the types of laryngeal cancer:

1. Squamous cell non-keratinizing cancer of the larynx.
2. Squamous cell keratinizing.
3. Highly differentiated squamous cell.

What are the stages of development of this disease and what are their external manifestations?

• Stage 0, 1, 2, 3, 4 of throat cancer, stage classification according to the TNM system, symptoms, diagnosis, treatment and life prognosis

Diagnostics

If cold symptoms do not disappear within two to three weeks, you should visit an otolaryngologist as soon as possible and be diagnosed with throat cancer. The examination includes:

• laryngoscopy - examination of all parts of the larynx using an endoscope to detect pathological changes;
• biopsy of tumors for subsequent histological examination of cells to identify laryngeal cancer;
• X-ray of the esophagus and larynx to determine how deep the tumor has spread;
• Ultrasound of the neck to detect metastases;
• MRI of the larynx to clarify the size and topology of the tumor;
• immunological blood test to identify tumor markers.

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Doctor's second opinion

The larynx, nasopharynx and esophagus are not organs that can be correctly assessed by any doctor. Thus, a thorough and attentive analysis of CT or MRI images is extremely important because it allows you to answer questions that are important when choosing treatment methods. For example, is the tumor located in the subglottic space or supraglottic? What is its stage, is there any germination of the surrounding tissue? Is there damage to regional lymph nodes? In order not to make a mistake in diagnosis, you can resort to a Second Opinion and send the research results for consultation with a highly specialized diagnostician. Otherwise, analysis of CT or MRI images may be fraught with errors. Today you can send images for consultation using various medical services, such as the National Teleradiological Network.

Treatment

Treatment methods for throat cancer are selected according to the size of the tumor, the degree of involvement of neighboring organs in the oncological process, the presence of metastases, and the general condition of the patient.

• Surgery is a radical and most effective method, which involves removing malignant tissue. In the early stages, surgery is used as an independent method of combating the tumor, in later stages it is used in combination with radiation and chemical therapy. Depending on the size of the tumor, the surgeon removes part of the larynx or the entire organ. In some cases, lymph nodes, cervical tissue and other anatomical structures affected by metastases are simultaneously removed.
• Radiation therapy is used after surgery to destroy residual cancerous lesions, and if intervention is not possible, as the main method of treatment. In some cases, radiation can destroy a small tumor without surgery.
• Chemotherapy is used before surgery to shrink the tumor, and in combination with radiation therapy to prevent recurrence after surgery. In advanced stages of cancer, chemoradiotherapy is used as the primary treatment to control tumor growth and symptoms.
• Targeted therapy in the early stages is used in combination with radiation therapy, in later stages - in combination with chemotherapy.

What should be the care for a patient diagnosed with throat cancer?

How long people live with throat cancer depends not only on proper treatment and the stage of the disease, but also on providing proper care. Already at the first stage of throat cancer, it is recommended to immediately switch to a diet. Products that contain carcinogens, sugar, and cholesterol are prohibited. It is useful to eat fresh vegetables and fruits, as well as lean dishes that have been steamed. Minimize meat consumption, take purified water in large quantities.

It is imperative to observe all hygiene measures, as well as take medications prescribed by the doctor. Psychological support is also important. It is necessary to pay more attention to patients, especially their emotional state. Walking in the fresh air is beneficial.

Rehabilitation

Recovery after surgery to remove the larynx or part of it is a difficult and lengthy process. The patient cannot eat normally and is forced to take food through a tube, and cannot speak. After a certain time, when it becomes clear that the operation was successful, the patient’s larynx is restored and plastic surgery of the vocal cords is performed. To restore voice function, it is necessary to undergo a rehabilitation course, which includes special physical procedures, exercise therapy exercises, sessions with a psychotherapist, and training in new speech skills.

Questions and answers

What does throat cancer look like?

In the initial stages, cancerous growths may appear as small bumps located on the mucous membrane of the throat. Subsequently, as the pathologically altered tissue disintegrates, ulcers form in their place. Increasing in size, the tumor becomes noticeable from the outside, forming a characteristic bulge under the skin of the neck.

How do you know if you have throat cancer?

The presence of a cancerous tumor in the throat should be suspected when:

• voice changes - hoarseness, distortion of intonation, roughness;
• sensation of a foreign body in the throat;
• pain that worsens when swallowing;
• frequent nosebleeds.

If your throat hurts for more than two weeks and does not go away, you should immediately visit an otolaryngologist.

Is there a cure for throat cancer?

If detected early, throat cancer is completely curable in 85-90% of cases. Even in the most advanced cases, at least 20% of patients live more than five years. The earlier treatment is started, the higher the patient's chances of recovery.

Attention! You can cure this disease for free and receive medical care at JSC "Medicine" (clinic of Academician Roitberg) under the State Guarantees program of Compulsory Medical Insurance (Compulsory Medical Insurance) and High-Tech Medical Care. To find out more, please call +7(495) 775-73-60, or on the VMP page for compulsory medical insurance

Classification

Tumors in the oropharynx are divided into three types:

Figure 1. Leukoplakia

Figure 2.1. Erythroplakia

Figure 2.2. Erythroplakia

List of sources

• Kaprin A.D., Starinsky V.V. Malignant neoplasms in Russia in 2015 (morbidity and mortality) - M.: MNIOI im. P.A. Herzen branch of the Federal State Budgetary Institution "NMRRC" of the Ministry of Health of Russia, 2022.
• Malignant tumors of the head and neck. edited by Kropotova M.A.., Podvyaznikova S.O., Alieva S.B., Mudunova A.M. Clinical guidelines for the treatment of head and neck tumors of the National Oncology Network (USA) - M.: ABV-Press LLC, 2011.
• A.I. Paches, E.G. Matyakin. Tumors of the larynx. Tumors of the head and neck: hands / A.I. Paches. – 5th ed., add. and processed – M.: Practical Medicine, 2013.

Precancerous diseases are a pathological process that determines the tissue’s readiness for malignant transformation. There are obligate and facultative precancerous diseases. Processes with a high degree of probability of developing malignancy are called obligate. Optional ones can undergo malignancy, but much less frequently.

Current state of the issue

Irina Shlyaga, head of the department of otorhinolaryngology with a course of ophthalmology at GomSMU, candidate of medical sciences. Sciences, Associate Professor. Among benign neoplasms, papillomas, fibromas, fibropapillomas, and dyskeratosis are more often subject to malignancy processes. Much less often, with the least degree of probability, tumor-like formations such as polyps, granulomas, cysts, and infiltrates. In many cases, the development of malignant processes in the larynx is preceded by benign diseases that last many months and sometimes years, which include chronic hyperplastic laryngitis (CHL).

Laryngeal papillomas are the most common formations among benign tumors. It is an exophytic epithelial tumor with a finely tuberous surface and slow growth. Occasionally, rapid growth of papillomas or diffuse damage to the laryngeal mucosa (papillomatosis) is observed, both in children and adults.

Dyskeratosis of the larynx is also often found and is a collective concept that includes several clinical forms: dyskeratosis proper, pachydermia, desquamative laryngitis, leukoplakia, keratosis, hyperkeratosis, leukokeratosis.

From a morphological point of view, it is a focus of pathological keratinization, and clinicians distinguish the above formations into separate ones, since they all differ in color, shape, size and have a favorite localization. They are often formed against the background of previously developed chronic hyperplastic laryngitis, which is a trigger for many benign neoplasms and malignant processes.

CGL , according to the WHO classification (2003) and according to our data (I.D. Shlyaga, P.A. Timoshenko, 1996, 2015), is classified as an obligate form of precancerous disease. Chronic laryngitis makes up about 65–70% of the pathology of the larynx, and among all pathologies of the ear, nose and throat - 10–15% (S. N. Kovalenko et al., 2009; I. D. Shlyaga et al., 2013).

The peak incidence is observed in able-bodied individuals, whose average age is 45±5 years. The ratio of men and women suffering from this disease is 3:1 (Bertini S., 2002). The structure of the incidence of chronic laryngitis among older people is also dominated by men (V.D. Osipov, 2006). The incidence of CGL in the population varies between 30–65%, and the probability of malignancy of this disease varies from 3% to 35%, reaching in some cases 60% in periods from 6 months to 7 years (F.I. Chumakov et al., 2002; V. D. Osipov, 2006; I. D. Shlyaga, 2009).

Malignant neoplasms belong to the group of the most socially significant diseases; in terms of mortality they are in second place after cardiovascular pathology. Malignant tumors of the larynx account, according to various authors, from 4% to 7% in the structure of oncological diseases and do not have a tendency to decrease.

Laryngeal cancer (LC) is the most common malignant neoplasm of the upper respiratory tract—it accounts for 40–60% (V.I. Chissov, 2005).

Laryngeal cancer.

According to the Belarusian Cancer Register 2022, the incidence of malignant neoplasms of the larynx in the republic is 1.4% (among the working population 2.2%). Due to the low detection of the disease in the early stages, the one-year mortality rate in the country was 22.2%, and the mortality rate from malignant diseases of the larynx in the Minsk region was 3.7 (3.3 for working age) per 100 thousand population (in Belarus - 3 and 2.1 respectively). When malignant neoplasms of the larynx are diagnosed in stages 1–2, the survival rate is 73–86%, and in stages 3–4 - only 15–33%.

Men, according to international statistics, are much more likely to develop malignant tumors of the larynx than women. In European countries, the incidence among men is 8.4 times higher than among women. This gender difference in Belarus is 48.4, in Russia - 17.4, Poland - 7.6, Lithuania - 16.8, Latvia - 18.5, Ukraine - 25.7. The highest incidence is recorded in the age groups 50–69 years in both the male and female populations.

Laryngeal cancer. The problem of timely diagnosis of malignant neoplasms of the larynx and the seriousness of the issue of quality of treatment for patients with this pathology is evidenced by the very high value of the mortality-to-morbidity ratio in many countries. In Latvia, the ratio of mortality to morbidity, according to GLOBOCAN 2022, is 47.1%, Poland - 54.5%, Russia - 55.2%, Belarus - 57.5%, Ukraine - 58.8%, Lithuania - 74, 2%. In Western European countries, this figure is significantly lower: in Germany - 41.1%, Finland - 34.4%, Sweden - 32.3%, England - 29.0%, France - 27.3%.

Laryngeal cancer. In addition, the relevance is determined by the high proportion of people of working age among the sick and the proportion of cases detected in the 3rd–4th stage. An analysis of the incidence of malignant neoplasms of the larynx in Belarus showed that in 2000–2019 there was an increase in incidence among the entire population (from 5.5 to 7.3 per 100 thousand) with a slight increase in the incidence of people of working age (from 4.0 to 4.3 per 100 thousand).

In all regions of the republic, an increase in morbidity rates by 1.2–1.3 times was noted, and among the working-age population by 1.1–1.4 times (p<0.05). On average in the republic, the incidence of malignant neoplasms of the larynx among urban residents increased from 4.8 per 100 thousand population in 2000–2004 to 5.9 in 2015–2019 (growth rate +22.9%), among the rural population - from 7 .9 to 10.5 per 100 thousand (growth rate +32.9%).

In the Gomel Regional Clinical Hospital, from 2007 to 2022, a retrospective analysis of patients who were undergoing inpatient treatment and examination was carried out. It was found that among patients with newly diagnosed laryngeal cancer, only 34% had stage 1–2, 53% had stage 3, and 13% had stage 4.

Causes

Numerous epidemiological studies conducted in different countries of the world have shown that the main etiological factors for the development of RG are smoking, alcohol, exposure to carcinogens on the mucous membrane of the upper respiratory tract (working with chemicals and in conditions of gas pollution, dust), a state of chronic stress, as well as chronic processes of various origins, so-called obligate processes, such as CGL, single papillomas in adults, laryngeal papillomatosis, dyskeratosis, etc.

Infections (bacterial, fungal, viral) can also be common causes of the development of precancerous diseases and laryngeal cancer; external and internal injuries of the neck and larynx, including unsuccessful intubations. Increased vocal load is of great importance. For urban residents, an unfavorable environmental situation plays a significant role - constant dust, gas pollution, pollution of streets and premises.

Of all the fungal infections of the upper respiratory tract, laryngeal mycoses are the least studied. Most authors consider laryngomycosis to be an extremely rare disease, however, according to our data, mycotic lesions of the larynx are a common disease, detected in 25–27% of all chronic inflammatory diseases of the larynx (I. D. Shlyaga, D. D. Redko, 2014).

The main causative agents of fungal infections of the larynx are yeast-like fungi of the genus Candida (90–95%), which includes 20 species. In patients with laryngomycosis, C. albicans, C. tropicalis, and C. krusei are more common. Less commonly, in 5–7% of cases, laryngeal mycoses caused by fungi Aspergillus, Penicillium, Mucor, Alternaria, etc. are observed. In some cases, damage to the larynx is caused by two or more pathogens. Various chronic forms of laryngomycosis (catarrhal-membranous, hyperplastic, infiltrative, atrophic, as well as often recurrent fungal-bacterial forms) can be prerequisites for the occurrence of tumor diseases of the larynx.

Recently, some researchers have given priority to the viral component in the issue of laryngeal carcinogenesis. This is due to frequent infection of the laryngeal mucosa by the human papillomavirus (HPV) in both benign and malignant processes. Thus, the frequency of detection of HPV in benign and precancerous neoplasms of the head and neck region varies from 18.5% to 35.9% (McKaig R. et al., 1998). The share of HPV-associated papillomatosis of the larynx, according to some authors, accounts for 40–100%, with subsequent malignancy in 8–20% of cases within 10 years (A.I. Paches, 2000, 2004; Szydlows WJ et al. , 1999).

Features of clinical manifestations

Precancerous diseases are characterized by:

• hoarseness, hoarseness (of varying degrees of severity), up to aphonia, which leads to difficulty in verbal communication;
• rapid voice fatigue;
• frequent relapses;
• duration of the course;
• insignificant effect from conservative treatment.

Laryngeal papillomas. Patients may experience discomfort, a feeling of a lump in the throat, spontaneous pain in the larynx (in advanced stages), shortness of breath (if the process is localized in the vocal folds, subglottic space), cough (less often). Some patients report a sensation of a foreign body, soreness, burning, tingling in the larynx, and occasional itching.

In some cases, precancerous diseases are asymptomatic, which depends primarily on the location of the process.

Dyskeratoses of the larynx. The clinical diagnosis of precancerous diseases and RG, even with the classic picture of their manifestations, must be confirmed by the results of a morphological study. In practical work, when establishing a diagnosis, it is necessary to differentiate CGL from a malignant process of the larynx and a number of precancerous diseases and pathological conditions. These circumstances dictate the need to use additional research methods during dynamic monitoring of this category of patients.

Diagnostics

Early diagnosis of a malignant process is one of the most complex and as yet unsolved problems throughout the world; it presents certain difficulties due to the lack of specific symptoms, the long-term satisfactory condition of patients, the presence of concomitant inflammatory and dysplastic processes that mask the underlying disease, and the variety of clinical manifestations as precancerous ones. , and tumor diseases of the larynx, the difficulty of examining the larynx, insufficient qualifications of doctors, and the lack of oncological alertness among many clinicians.

The presence of many methods for diagnosing diseases of the larynx (direct and indirect laryngoscopy, electronic stroboscopy, fibrolaryngoscopy, radiation diagnostic methods, cyto-, histological and immunohistochemical studies, etc.) often puts laryngologists in a difficult position regarding the choice of the optimal method, especially since many of them are recommended as the most effective. Most otorhinolaryngologists are of the opinion that histological examination of the material obtained from a biopsy is the main method of confirming the clinical diagnosis.

However, in some cases, with an obvious clinical picture of a malignant process of the larynx, the results of a histological examination of the material obtained from an intralaryngeal biopsy, including a repeat one, may be negative, since the tumor is often localized in places difficult to access for biopsy and it is necessary to give an opinion on very small pieces of tissue, or it is not possible to take material from the lesion. It is especially difficult to obtain material during endophytic growth of a malignant tumor.

The use of other modern diagnostic methods (CT, MRI) provides significant additional information about the localization and extent of the process. However, based on these methods, it is impossible to judge the nature of the disease, especially in cases where there is a suspicion of malignancy of long-existing dysplastic processes.

This is possible, in particular, in cases of the formation of a large area of ​​perifocal edema and tissue inflammation around the tumor, which makes it possible to differentiate the onset of the malignant process and the proliferation of inflammatory epithelium.

Treatment approaches

Treatment of patients with precancerous diseases of the larynx, including CGL, should be individualized, taking into account oncological alertness, localization and extent of the process.

The principles of treatment of precancerous diseases of the larynx are as follows: the main condition is the exclusion of harmful etiological (cessation of smoking, alcohol) and occupational factors; compliance with voice mode; rehabilitation of foci of chronic infection (chronic rhinitis, sinusitis, tonsillitis, pharyngitis, tracheobronchitis).

It is very important to eliminate the curvature of the nasal septum in order to restore full physiological breathing through the nose. Patients in this category undergo both conservative treatment (general and local) and surgical treatment, depending on the localization and extent of the process, data from microbiological and morphological studies.

Conclusion

Thus, this problem is relevant in social and economic terms due to the high level of disability of patients with GC (about 65%), and most importantly - in demographic terms (one-year mortality in Belarus is 22%, and the survival rate of patients with diseases is 3 -4th stage - 15–33%).

The increase in the incidence of laryngeal tumors observed over the past 20 years dictates the need to develop measures to improve medical care for patients with this pathology. The above statistics indicate the need to take urgent measures to organize the timely detection of laryngeal tumors.

In order to draw attention to the problems of early diagnosis of this cancer, the European Head and Neck Society (EHNS) initiated the annual European Head and Neck Cancer Early Diagnosis Week in the third week of September. This initiative has been carried out in Belarus since 2014. Its main goal is to increase awareness of the population and medical workers about head and neck cancer, measures for its prevention, diagnosis and treatment. Patients have the opportunity to learn about tumor prevention measures, symptoms of diseases, and also understand the importance of early consultation with a doctor. All practicing doctors should have high oncological and mycological alertness.

To make a correct diagnosis, it is necessary to conduct a comprehensive examination of patients with the involvement of related specialists: GPs, therapists, infectious disease specialists, mycologists, endocrinologists, microbiologists, morphologists, oncologists, etc.

It is also mandatory to use instrumental and laboratory research methods, with a morphological examination of suspicious areas. If the clinical picture corresponds to RG, but it is not confirmed morphologically, further examination and repeated biopsies (more radical, from different areas under endotracheal anesthesia) are necessary.

A timely diagnosis not only contributes to the effectiveness of treatment and the preservation of various functions of the larynx (vocal, respiratory and protective), but most importantly, it makes it possible to prevent the development of various irreversible consequences and complications, often leading to patient disability and death.