Laryngeal cancer: causes and risk factors

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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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.

What does a CT scan of the larynx and throat show?

CT signs of laryngeal tumor:

The presence of a volumetric formation of soft tissue density (+30...+60 Hounsfield units) above the vocal folds, on the folds or under them

• With cancer of the supraglottic region, tumor invasion into the pyriform sinuses and spread into the preepiglottic fatty tissue is possible
• In case of vocal fold cancer, it is important to evaluate the involvement of the anterior commissure and cricoarytenoid joints in the process.
• For cancer of the subglottic region, it is necessary to assess the extent of tumor spread downwards (into the trachea)

What does throat cancer look like, photo of a CT scan. The volumetric process causing destruction of cartilage (right) and narrowing of the lumen of the larynx is clearly visible. It is necessary to carefully analyze the CT results so as not to make a mistake with the stage of the disease.

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.

Survival prognosis

How long do people live with laryngeal cancer? When a patient is diagnosed with throat cancer, the prognosis directly depends on the location of the tumor and the extent of the cancer process.

Table No. 1. Survival prognosis depending on the location of the laryngeal tumor

Is throat cancer deadly? If the disease is recognized in a timely manner, there is a high probability that the disease can be defeated. The five-year survival rate for patients with stage 1 throat cancer is 85%. When stage 4 gora cancer is detected, the prognosis is less optimistic. If stage 4 throat cancer is detected, how long do they live? The five-year survival prognosis for patients with stage four laryngeal cancer is 20%. Much depends on whether the patient agrees to surgery to remove the larynx and vocal cords, which could render the person mute.

Long-term survival of patients with throat cancer has remained virtually unchanged over the past 20 years, but the quality of life of cured patients has improved significantly. If radiation therapy does not lead to the expected result, doctors at the Yusupov Hospital use preservation surgery methods that allow the patient to partially preserve speech.

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.

Causes of pharyngeal cancer

The following are the main causes of throat cancer:

How much do you have to smoke to get throat cancer? Studies conducted by scientists have found a connection between the number of cigarettes smoked per day, smoking experience and the likelihood of throat cancer. The higher the first 2 indicators, the higher the risk of cancer. Other forms of tobacco use also increase risk. There is a potential risk of laryngeal cancer in both smokers and those who chew tobacco. In individuals who have both of these habits, the risk of developing throat cancer increases by 3-4 times. Excessive consumption of strong alcoholic beverages is the first reason that increases the risk of developing the disease.

Laryngeal cancer associated with human papillomavirus has characteristic biological features. In its treatment, less aggressive organ-preserving chemotherapy regimens are used. How long does it take for throat cancer to develop? The process of transformation of normal cells into atypical ones is individual for each person. Throat cancer does not develop immediately. It is preceded by long-term precancerous diseases:

• Dyskeratoses of the larynx (leukoplakia, leukokeratosis);
• Pachydermia;
• Fibroma;
• Papillomas;
• Cysts;
• Chronic inflammatory processes in the larynx, which are accompanied by frequent alcohol consumption and smoking;
• Scars of the larynx as a result of illnesses or injuries.

The cause of the development of laryngeal cancer may be exposure to harmful factors at work, a weakened immune system, ionizing radiation, or gastroesophageal reflux disease.

Provoking factors are paints, wood dust, asbestos, sulfuric acid, nickel. How quickly does throat cancer develop? It may take months or years from the appearance of the first changes in the cells of the mucous membrane of the pharynx or larynx to the clinical stage of the disease.

Recently, in Russia there has been an increase in the number of newly diagnosed throat cancers. This is due to the influence of external and internal factors. Around the world, the statistics are no less comforting. Every year 15,000 new cases of pathology are diagnosed. The ratio of sick men to women is 1000:8.

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.

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.

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.

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.

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 .

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

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.

Anatomical structure

The oropharynx is a continuation of the nasopharynx, the middle section of the larynx. It starts from the hard palate and ends at the entrance to the larynx. The organ is connected to the oral cavity by the pharynx, and is separated by the palatine arches, soft palate and dorsum of the tongue. In this section the digestive and respiratory tracts intersect. The oropharynx contains:

• the back third of the tongue (its root);
• tonsils;
• posterior and lateral walls of the pharynx. The posterior wall is located at the level of the third cervical vertebra. The side walls connect to the eustachian tubes of the ears.

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.

Signs depending on the type of disease

In addition to the differences that depend on the location of the disease, throat cancer can differ significantly in its appearance in different patients. This depends on the type of illness. Doctors distinguish the following types:

• keratinized squamous cell carcinoma;
• nonkeratinizing squamous;
• high-grade squamous cell disease of the larynx.

The first type is characterized by a long course and development in cells that can become keratinized. During the formation of such a tumor, metastases are almost completely absent. Location: vocal cords. If the disease affects the very lower parts of the throat, the scenario for the development of the disease worsens, since in this part the cancer forms with metastases very quickly. Due to the slow progression, there are practically no symptoms, so it is very difficult to diagnose the disease in time.

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.

MRI of the throat and larynx: what does it show?

Magnetic resonance imaging is similar to CT in that both methods produce layer-by-layer images of the organ - sections. When properly performed, MRI is even better than CT at identifying a tumor of the larynx, distinguishing it from inflammatory or cicatricial changes, determining its structure and extent, the exact size and degree of invasion of surrounding tissues. The disadvantages of the method, however, include the duration of the study and the inability of some patients to stay in a confined space for a long time.

Get an MRI of the larynx in St. Petersburg

Comparison of CT and MRI of soft tissues of the neck in cancer of the right vocal fold. The same patient. CT on the left, MRI on the right.