Laryngeal cancer: diagnosis
Last reviewed: 23.04.2024
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Timely recognition of laryngeal cancer is of great importance for the effective treatment of this disease, since in the early stages of it, a cure is possible in a large percentage of cases. Unlike tumors located on the threshold of the larynx and underlayment space, which develop over a long period in the absence of any symptoms, the cancer of the glottis manifests itself early as a sign of dysphonia, which, with the appropriate oncological alertness, can serve as an early diagnosis in the stage of the disease in which minimal surgical and additional means possible complete cure. It should be borne in mind that every man at the age of 35-40 years, who had hoarseness of voice, the cause of which is not clear, lasting more than 2-3 weeks, should be examined by a doctor. To the same alarming signs include "causeless" cough, sensation of a foreign body in the throat, a slight violation of swallowing, ear pain in a normal otoscopic picture, an increase in the cervical lymph nodes.
Diagnosis is based on laryngoscopy (indirect, direct using modern endoscopic drugs) and radiography; to additional methods should be attributed and stroboscopy of the larynx, displaying a violation of the motor function of the affected voice fold. Visual methods for recognizing laryngeal tumors are effective only in the case of lesions of the larynx and the region of the glottis. In order to investigate the lining space, along with direct fibrolaringoscopy, x-ray methods are widely used. As for the possibility of visual diagnostics of laryngeal tumors, the illustrations shown above show that, as for the x-ray study, it is facilitated by the fact that the larynx, being a hollow organ with well-known identification features, is available to this method practically without any methods of artificial contrasting, as evidenced by the above below the radiograph.
[Physical examination
By the nature of the first symptoms of the disease and their changes, it is possible to judge the initial location of the tumor, which is important for predicting tumor progression and radiosensitivity of the neoplasm. If patients complain about the feeling of a foreign body in the throat and a feeling of inconvenience when swallowing, the tumor lesion of the vestibular department should be excluded. The adherence to these symptoms of pain during swallowing, irradiating in the ear on the side of the lesion, is pathognomonic for tumors of this localization. When patients complain of hoarseness, cancer of the pharynx of the larynx can be suspected. As the process progresses, there are pains, difficulty breathing, associated with stenosis of the larynx. Gradual increase of stenosis against a background of slowly progressing hoarseness testifies to the defeat of the podogolosovogo department.
When viewed, pay attention to the skin condition, shape and contours of the neck, the volume of active movements of the larynx, its configuration. With palpation, the volume, configuration, displacement of the larynx, crepitation, and the condition of the lymph nodes of the neck are specified. At the same time, one should listen to the breathing and voice of the patient so as not to miss the signs of stenosis of the larynx and dysphonia.
Palpation of regional metastasironone zones on the neck should be performed for each patient. A necessary condition for it is considered the study of all possible zones of metastasis (upper, middle and lower nodes of the deep jugular chain, prelaryngeal, pre-tracheal, supraclavicular).
Laboratory diagnosis of laryngeal cancer
Conduct a general clinical examination.
Instrumental research
With indirect laryngoscopy, the localization and boundaries of the tumor, the shape of growth, the color of the mucous membrane, its integrity, the size of the lumen of the glottis, the mobility of the vocal folds, the presence of chondroperichondritis.
Fibrolaringoscopy allows you to inspect the larynx, which in some cases is not available for indirect laryngoscopy: the laryngeal ventricles, the fixed part of the epiglottis, the podogolos department, the front commissure. Fibrolaringoscopy is considered a method of choice for trism. At an endoscopy it is possible to make aim biopsy.
Radiography in the lateral projection in addition to the data obtained with direct laryngoscopy, allows you to obtain information about the tumor lesion of the pre-glandular space, the fixed part of the epiglottis, the cartilaginous skeleton of the larynx and the surrounding soft-tissue larynx. It is necessary to radiological examination of the chest, CT allows you to clarify the spread of the tumor process in the guttural ventricles and podogolosovoy department. CT scan is very important in detecting tumor germination in the pre-glandular and near-confluence space.
The diagnosis of a malignant tumor of any stage before the beginning of treatment should be confirmed by a histological examination, which is considered the final stage of the diagnosis.
In cases where repeated biopsy does not reveal a tumor, and the clinical picture is characteristic of cancer, it is necessary to resort to intraoperative diagnostics and to produce a thyroid or laryngophyssure with urgent histological examination. Using this method, it is possible to obtain the necessary material for morphological investigation and confirmation of the diagnosis.
The appearance of regional metastases complicates the course of the disease, the prognosis worsens. The main methods of diagnosing regional metastases: palpation, ultrasound and cytology.
Currently, one of the methods of early recognition of metastatic cancer of the larynx on the neck is ultrasound. The use of modern devices with sensors with a frequency of 7.5 MHz and more allows to detect non-palpable metastases of laryngeal cancer on the neck. If a metastatic disease is suspected, a lymph node puncture is performed (with non-palpable nodes under ultrasound guidance). Suspected of the presence of metastases are the lymph nodes with a structure disorder, its unevenness with the predominance of hypoechoic areas, increasing with dynamic observation.
A fine needle aspiration puncture of regional lymph nodes on the neck is performed in order to obtain a morphological confirmation of the appearance of regional metastases. With non-palpable metastases, it is carried out under the supervision of ultrasound. The sensitivity of the method followed by cytological examination approaches 100% (in patients after repeated puncture).