Laryngopharyngeal cancer is a malignant tumor of the lower part of the pharynx. In the initial stages, it is asymptomatic. Subsequently, there are pains, a feeling of a foreign body, tickling, excessive salivation, hoarseness of voice, cough and difficulty breathing. The order of appearance of signs of the disease depends on the localization of neoplasia. Laryngopharyngeal cancer is prone to aggressive course and early regional metastasis. The diagnosis is made taking into account the data of neck ultrasound, CT and MRI of the larynx and fibropharyngolaryngoscopy with biopsy. Treatment – laryngopharyngeal resection, extended laryngectomy, lymphadenectomy, chemotherapy, radiotherapy.
Meaning
Laryngopharyngeal cancer is a malignant neoplasia of the lower part of the pharynx, located between the free edge of the epiglottis and the lower edge of the cricoid cartilage. Laryngopharyngeal cancer is a common pathology, accounting for 40-60% of the total number of malignant neoplasms of ENT organs, 8-10% of the total number of oncological lesions of the head and neck and 1.3% of the total number of cancers. It usually affects patients aged 40-60 years. Men suffer 5 times more often than women.
Laryngopharyngeal cancer is considered a severe, unfavorable oncological process, due to the complexity of the anatomical structure of this area, the rapid local growth of neoplasia, the early appearance of lymphogenic metastases, the low effectiveness of conservative therapy and the crippling nature of surgical interventions. The average five-year survival rate for laryngopharyngeal cancer is approximately 30%. Treatment is carried out by specialists in the field of oncology and otolaryngology.
Pathological anatomy
Laryngopharynx is the lower part of the pharynx, located between a line drawn perpendicular from the free edge of the epiglottis to the back wall of the pharynx, and a horizontal line passing at the level of the lower edge of the cricoid cartilage. The main part of the larynx is located behind the larynx, while the anterior wall of the larynx is the back wall of the larynx. The entrance to the larynx is located below and in front of the larynx. On the sides of the entrance there are cone–shaped depressions – pear-shaped sinuses.
From 60 to 75% of laryngopharyngeal cancers are localized in the area of the pear-shaped sinuses. 20-25% of neoplasias are found on the posterior wall of the larynx. Less often, there is a lesion of the post-hiperstnoid zone. In approximately 50% of cases, during histological examination, squamous cell keratinizing cancer of the larynx is detected. About 30% are squamous non-corneal neoplasms and about 7% are undifferentiated forms of cancer. In other cases, there is no data on the histological structure of the tumor. Usually there is an exophytic growth of laryngopharyngeal cancer towards the larynx.
The submucosal layer of this anatomical zone contains a large number of longitudinally located lymphatic vessels that unite into larger collectors. Laryngopharyngeal cancer cells enter these vessels and spread through the lymphatic system, which explains the high frequency of lymphogenic metastasis. In addition, collectors depart from the larynx, collecting lymph from non-organ lymphatic vessels located in the area of the outer walls of the organ.
Causes
The causes of laryngopharyngeal cancer have not been precisely clarified, but it has been established that repeated adverse chemical and thermal effects are essential in the development of this disease. Among other risk factors for cancer of the larynx, researchers indicate smoking, frequent intake of strong alcoholic beverages, as well as the habit of eating too hot and too spicy food. Hereditary predisposition and immune disorders play a certain role.
Classification
Taking into account the prevalence of the local oncological process, in accordance with the TNM classification, the following stages of laryngopharyngeal cancer are distinguished:
- T1 – neoplasia with a diameter of less than 2 cm is located within one anatomical zone of the larynx.
- T2 – laryngopharyngeal cancer of 2-4 cm in size spreads to several anatomical zones or affects nearby structures, there is no fixation of half of the larynx.
- T3 – a node with a diameter of more than 4 cm is detected in combination with a lesion of several anatomical zones or nearby structures, or neoplasia of 2-4 cm in size in combination with fixation of half of the larynx.
- T4 – laryngopharyngeal cancer affects cartilage, muscles and fatty tissue, carotid artery, thyroid gland, esophagus and other nearby anatomical formations.
The letter N denotes secondary foci in lymph nodes, the letter M – in distant organs.
Symptoms
The disease may be asymptomatic for some time. A characteristic sign of laryngopharyngeal cancer is a triad found in more than 50% of patients and includes dysphagia, sore throat and radiating pain in the ears. Experts consider it appropriate to distinguish two groups of local symptoms of laryngopharyngeal cancer: laryngeal and pharyngeal. Pharyngeal symptoms include dysphagia, tickling, a feeling of a foreign body, pain and discomfort when swallowing, as well as increased salivation.
The list of laryngeal symptoms includes a change in voice, cough (possibly with blood) and shortness of breath due to narrowing of the larynx. The order of occurrence of clinical signs of laryngopharyngeal cancer is determined by the location and direction of neoplasia growth. Often, the first manifestation of a tumor is an increase in cervical lymph nodes. With the progression of laryngopharyngeal cancer, local symptoms become more pronounced, supplemented by general signs of cancer. Weakness and weight loss are noted, signs of cancer intoxication are revealed.
Diagnostics
The diagnosis is established on the basis of complaints, medical history, palpation of the neck and additional research data. Due to the nonspecific nature of the manifestations, the initial stages of laryngeal cancer are often mistaken for manifestations of chronic tonsillitis or chronic pharyngitis, which indicates the need to show increased oncological alertness when examining patients at risk (over the age of 40, smokers, alcohol abusers and spicy food).
When making a diagnosis, the results of CT and MRI of the larynx and ultrasound of the neck are taken into account. Fibropharyngolaryngoscopy data play a crucial role in the detection of laryngopharyngeal cancer. During the study, the specialist performs a visual assessment of the size, localization and structure of the neoplasm, and then performs a biopsy of the suspicious area. The final diagnosis is made by oncologists on the basis of histological examination.
Treatment
Treatment of laryngopharyngeal cancer is a complex task, due to the rapid spread of the tumor, the complexity of anatomical and topographic relationships of organs in this zone, as well as the high prevalence of concomitant diseases. According to research data, 75% of patients with laryngopharyngeal cancer have disorders of the cardiovascular system, 68% of the respiratory system. More than half of the patients are diagnosed with inflammatory diseases of the lungs and upper respiratory tract. All of the above creates limitations when choosing methods of treating laryngeal cancer and increases the likelihood of complications during operations and in the postoperative period.
Therapeutic tactics are determined by the prevalence of the oncological process. With small neoplasms of the first stage, remote radiation therapy is performed or resection of the larynx is performed. With laryngopharyngeal cancer of the first and second stages without involving the tip of the piriform sinus, laryngectomy above the level of the glottis is necessary. In the late stages of laryngopharyngeal cancer, an extended laryngectomy, lymphadenectomy, excision of the neck tissue and (if the esophagus is affected) resection of the cervical esophagus is required.
In the pre- and postoperative period, patients with laryngeal cancer are prescribed radiotherapy and polychemotherapy. The use of conservative therapeutic techniques does not lead to complete regression of the tumor, but it can significantly reduce its diameter and provide optimal conditions for radical surgical intervention. Subsequently, patients with laryngopharyngeal cancer often require reconstructive surgery to restore the function of swallowing. To close the defects, local skin flaps and skin-muscle flaps on the leg are used. To replace the removed part of the esophagus, sections of the stomach and large intestine are used.
Forecast
Laryngopharyngeal cancer is considered a prognostically unfavorable oncological disease. The five-year survival rate after radical operations for tumors of the first and second stages is about 50%. With common oncological processes, approximately 30% of patients manage to live up to five years from the moment of diagnosis. Many patients with laryngopharyngeal cancer have a significant decrease in the quality of life due to the presence of a tracheostomy, impaired voice formation, disorders of esophageal functions, the need to use cannulas, constant probe feeding, etc.