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Laryngeal cancer

Among laryngeal tumors (including benign), laryngeal cancer is frequent: from 1.5 to 6% of all tumors of the body, and among tumors of the upper respiratory tract - 69-70%. In addition, it should be noted that laryngeal cancer affects almost exclusively men and among men after 55 years of age, it occupies the first place among all diseases of the larynx. A role is played by alcohol and smoking. Unfortunately, patients go to the doctor, usually late with severe dysphonia or sore throat when swallowing, when the development of cancer is already quite active.

Currently, there is no single point of view on the etiology and pathogenesis of tumors; there is not even a precise definition of what is a “true tumor”? The properties of a true tumor are most known:

1) Proliferation of tumor cells without reverse development, with infinite continuation;

2) Tumor growth is not regulated, it is “atypical”, which differs sharply from normal;

3) A tumor destroys neighboring tissues, occupies their living space;

4) Metastasis - transfer of tumor cells to other tissues and organs, followed by their new growth;

5) Tumor cells have the ability to transmit their malignant properties to descendant cells.

All taken together and defines the property and essence of the concept of "true tumor."

According to A. I. Paches (1997), the number of head and neck tumors among all tumors (in Russia) is from 17 to 20%, i.e., one fifth, while an increase in the absolute number of patients, including those with pharyngeal tumors, is noted and larynx.

The classification of tumors of the pharynx and larynx is also not fully unified. We prefer the classification of N. A. Karpov (1966), which is based on tissue affiliation, degree of differentiation, sensitivity to ionizing radiation.

Type I - highly differentiated tumors, practically insensitive to radiation.

1st group - benign (fibroma, osteoma, angioma, chondroma, etc.)

2nd group - borderline tumors, because they have some elements of malignancy - infiltrative, but slow growth, benign course of metastases (for example, fibroma of the base of the skull, cylindroma, epithelium).

Type II - differentiated tumors. These are malignant tumors, characterized by infiltrative growth and metastases, but also the degree of differentiation allows us to establish tissue affiliation.

Group 1 - epithelial malignant tumors (adenocarcinoma, squamous keratinizing and non-keratinizing cancers, low-grade cancer). This group of tumors is all the more sensitive to radiation, the less differentiated.

2nd group - connective tissue malignant tumors, which have greater malignancy, rapid growth and metastasis. Sensitivity to radiation is very low. These include sarcomas (osteosarcoma, fibrosarcoma, chondrosarcoma, large cell sarcoma, etc., except for tonsil sarcoma and lymphosarcoma).

3rd group - neurogenic tumors, such as melanoblastoma, estesioneuroblastoma (tumor of the olfactory nerve), characterized by persistent relapses and the ability to disseminate. They are not sensitive to radiation.

Type III - low-grade (tonsillar) radiosensitive tumors. The highest degree of malignancy is rapid growth and metastasis, generalization of the tumor process, ahead of the growth of metastases in comparison with the main tumor. These include lymphoepithelium (Schminke tumor), reticulocytoma, cytoblastoma. All tumors come from the tissues of the tonsils.

The histological structure of the larynx is more often represented (97%) squamous with keratinization or without keratinization.
Adenocarcinoma is rare, sarcoma is extremely rare (0.4%).

The diagnosis of laryngeal cancer is based on complaints, a medical history, examination of the larynx using indirect laryngoscopy (Fig. 4.22, 4.23 and 4.24), external examination of the neck, palpation of the lymph nodes. If necessary, X-ray tomography of the larynx is done (Fig. 4.25 and 4.26), and at present, computed tomography. Often it is necessary to resort to direct laryngoscopy to produce a biopsy under general anesthesia.

In the case of a positive diagnosis, three types of treatment are performed: radiation, surgical and combined, the latter most often when the operation is applied, then irradiation with a dose of 30-40 Gray. Radiation treatment in its pure form, for example, a tumor of the tonsils, involves telegram therapy in a full therapeutic dose of 60 Gray.

According to the data of A.N. Paches (1997), pharyngeal malignant tumors are more often found in the upper section (45-55%), then in the oropharynx (30-35%), and less often in the larynx and pharynx (Fig.). The same topographic features of the frequency of growth of laryngeal tumors (the higher the more often) are the over-folding section 56%, the folding section 41% and the under-folding section about 3% of all laryngeal tumors.

The volume of surgical treatment of laryngeal cancer is determined by the stage of development of the disease. In the early stages, relatively gentle operations are performed: chorectomy or anterolateral resection of the larynx, and in cases of a large tumor volume, laryngectomy, that is, complete removal of the larynx.

In any case, the operation begins with a tracheostomy, then endotracheal anesthesia is performed through the stoma, and breathing after the operation is ensured through it, and constantly with laryngectomy.

With chorectomy, soft tissues are longitudinally dissected from the hyoid bone to the jugular notch of the sternum, and the thyroid cartilage is exposed, then it is dissected along, its plates are pulled apart to access the vocal folds. The patient's fold is excised, sections of the mucous membrane of the larynx, thyroid cartilage, and soft tissues are sequentially stitched.

The anterolateral resection of the larynx is similar in technique to the previous one, although its volume is wider, because part of the plate of the thyroid cartilage is removed along with the fold on the sore side.

A laryngectomy also begins with the application of a tracheostomy, with an oblique incision of the trachea in the anteroposterior direction for subsequent hemming of the lower part of the trachea to the skin. Further, inhalation anesthesia is administered through the stoma. The skin incision is T-shaped from the hyoid bone to the jugular notch, and transverse at a level just below the hyoid bone, the separation of soft tissues and muscles. The thyroid gland intersects at the level of the isthmus and is sutured with catgut, or is crossed by two vertical incisions with the isthmus remaining on the trachea preparation. Separation of a single preparation - the upper part of the trachea and larynx is preferable from bottom to top, with separation from the esophagus and pharynx, then the hyoid bone is pulled down with the instrument and the muscles and piriform sinus mucosa are intersected above it with scissors. The larynx is removed, the throat defect is sutured with two rows of sutures, then, in layers, the wound. A stoma is formed by stitching the edges of the trachea and skin. A rubber tube is inserted into the stomach to feed the patient, as self-swallowing is restored in the first week after surgery. Later, after 2-3 months, the stoma is finally formed and the patient can do without a tracheotomy tube. By far the most severe consequence of laryngectomy is the loss of voice function. Methods and techniques have been developed for the formation of a pseudo-voice in patients with extirpation of the larynx, specially trained methodologists teach patients to master a new voice.
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Laryngeal cancer

  1. Laryngeal cancer
    Among malignant tumors of the upper respiratory tract, laryngeal cancer is most common (in relation to other localizations of the whole organism - more than 4%). In men, laryngeal cancer occurs many times more often than in women (approximately 12.5: 1). More often this tumor happens at the age of 50-60 years, however it is also possible in childhood and senility. To et o logichesk and m faktorem
  2. Laryngeal cancer, classification, clinic, diagnosis
    Among malignant tumors of the upper respiratory tract, laryngeal cancer is most common. In men, laryngeal cancer occurs many times more often than in women. Classification According to the place of tumor growth distinguish a) its vestibular localization when located on the threshold of the larynx; b) cancer of the middle section with damage to the vocal folds; c) cancer of the sub-vocal part of the larynx. The nature
  3. Laryngeal Cancer Modern treatments
    The main methods of treating laryngeal cancer are surgical, radiation, and chemotherapeutic. Surgical and radiation methods can be used independently, chemotherapeutic - only as an auxiliary. The choice of method depends mainly on the stage of the disease, the histological structure of the tumor and, to a certain extent, on its location. In stage I, endolaryngeal removal is performed, and
  4. Larynx
    The larynx is a wide, short tube made up of cartilage and soft tissue. It is located in the front of the neck and can be felt from the front and sides through the skin, especially in thin people. From above, the larynx passes into the laryngeal part of the pharynx. From below, it passes into the respiratory throat (trachea). Large cervical vessels and nerves are adjacent to the larynx from the sides, the lower part of the pharynx is behind,
  5. Laryngeal sarcoma
    Laryngeal sarcoma is rare, more often in middle-aged men, but also in children. The tumor usually originates from the connective tissue of the submucosal layer or from the perichondrium and is significantly more malignant than cancer, in terms of the speed of infiltrating growth and the vastness of metastasis. There are histological variants of sarcoma: spindle-cell, polymorphic cell,
  6. LARYNX
    The larynx (larynx) performs the functions of breathing, sound formation and protecting the lower respiratory tract from the ingress of foreign particles. It is located in the front of the neck, at the level of IV-VII cervical vertebrae; on the surface of the neck forms a small (in women) and strongly projecting forward (in men) elevation - the protrusion of the larynx. From above, the larynx is suspended from the hyoid bone; below, it connects to the trachea.
  7. Laryngeal injury
    Clinical picture Damage to the larynx is divided into open (cut, stab, gunshot wounds) and closed, among which external and internal are distinguished. The latter are usually caused by a foreign body entering the larynx. By the nature of the damaging factor, mechanical, thermal and chemical injuries are distinguished. Injuries to the larynx are always accompanied by a violation of the general condition. May develop
  8. Larynx HORSE
    The larynx is a short tubular valve consisting of cartilage and muscles and lined from the inside of the mucous membrane. In the head, it is located ventrally between the segmental planes drawn through the body of the sphenoid bone and the atlas. When the head is in the “normal” position, the rostral half of the larynx lies between the branches of the lower jaw. Strictly speaking, the larynx is the beginning of the larynx,
  9. Larynx stenosis
    Stenosis of the larynx and trachea lead to severe respiratory distress until death from asphyxiation. Laryngology studies only stenosis of the larynx and upper (cervical) section of the trachea, while thoracic surgeons are involved in stenosis of the thoracic section. Of course, there are differences in both the pathogenesis and clinic of acute and chronic laryngeal stenosis. Acute stenosis occurs most often as a result of fiber swelling in the area
  10. Larynx Injury
    In peacetime, laryngeal injuries are relatively rare. There are closed and open injuries, while closed are divided into internal and external. Internal injuries result from foreign bodies, medical manipulations, for example, tracheal intubation. Such injuries are not particularly dangerous except for the possibility of the development of chondroperichondritis of the cartilage of the larynx, when the prognosis
  11. Laryngeal palsy
    Deborah R. Van Pelt, DVM, MS 1. What conditions lead to the development of laryngeal paralysis? Congenital laryngeal paralysis is described in Siberian huskies, Flanders and English Bulldogs and Bull Terriers. Other conditions include systemic neuromuscular or metabolic diseases (such as myasthenia gravis and hypothyroidism), injuries (bite wounds or a blunt neck injury) and, less commonly, inflammation or
  12. Features of the larynx
    Larynx in children - funnel-shaped, is a continuation of the pharynx. In children, it is located higher than in adults, has a narrowing in the cricoid cartilage, where the ligamentous space is located. The glottis is formed by the vocal cords. They are short and thin, this is due to the high sonorous voice of the child. The diameter of the larynx in a newborn in the region of the subglottic space
  13. Laryngeal diseases
    Anomalies of development. Most often, deviations in the structure of the epiglottis are noted. It may be underdeveloped or even completely absent. Sometimes the epiglottis is sharply deformed: split into several lobes, rolled into a tube. Defects of the epiglottis usually do not significantly affect the function of voice formation. In some cases, a congenital diaphragm is observed.
  14. Examination of the larynx and trachea.
    Carry out external and internal studies of the larynx and trachea. Outdoor research. It consists of examination, palpation and auscultation. With an external examination, you can notice the lowering of the head, stretching of the neck and shortness of breath, sometimes swelling is established in the larynx and trachea due to inflammation and swelling of the surrounding tissues. When examining the trachea determine the change in its shape,
  15. Laryngeal stenosis
    DIAGNOSTICS Stenoses of the larynx differ in the rate of development and degree of compensation. According to the rate of development of laryngeal stenosis, they are divided into: - fulminant (obstruction by a large foreign body, laryngospasm), developing within a few minutes; - acute, developing within a few hours (days); -chronic. The main causes of stenosis of the larynx: -inflammatory processes in the larynx
  16. Clinical anatomy of the larynx
    The larynx (larynx) enters the initial part of the respiratory tract, the upper section of which opens into the pharynx, the lower part passes into the trachea. The larynx is located under the hyoid bone, on the front of the neck. In thin men, the contours of the larynx are well outlined. In adult men, the upper edge of the larynx is located on the border of CIV and Cv, and the lower one corresponds to Cvi (Fig. 3.1). In newborns,
  17. Laryngeal edema
    Laryngeal edema (oedena laryngis) is essentially a symptom of certain diseases; it can be inflammatory and non-inflammatory (see Fig. 8.2). Inflammatory edema often occurs as a manifestation of various diseases of the pharynx, larynx and other organs, and can occur in some acute and chronic infectious diseases, such as measles, scarlet fever, flu, tuberculosis,
  18. Laryngeal injury
    Traumatic injuries of the larynx are divided into open and closed, and the latter, in turn, are internal and external. With open injuries, in addition to damage to the larynx itself, other organs of the neck are often affected. Depending on the damaging factor, mechanical, chemical and thermal injuries are distinguished. Open injuries (wounds) of the larynx are cut, stabbed and gunshot.
  19. Syphilis of the larynx
    Laryngeal syphilis is observed as a manifestation of a general disease of the body. It can occur at any stage of the general process and at any age. Hard chancre in the larynx is extremely rare. Infection directly with the larynx can occur as a result of an injury by food or any object. The secondary stage manifests itself in the form of erythema, stimulating catarrhal laryngitis, when in
  20. CLINICAL ANATOMY OF THE LARYNX
    The larynx is a hollow organ that consists of a cartilaginous skeleton, ligamentous apparatus and own muscles. The laryngeal cavity is lined with a mucous membrane from the inside. The larynx has the appearance of a short socket located above the trachea at the level of the bodies of IV, V and VI cervical vertebrae. However, when swallowing and voice formation, it significantly exceeds the specified boundaries, shifting up and down. Organ mobility
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