Laryngeal cancer - Diagnosis

Early detection of laryngeal cancer is of great importance for effective treatment of this disease, since in its early stages it is possible to cure in a large percentage of cases. Unlike tumors located in the vestibule of the larynx and subglottic space, which develop over a long period in the absence of any symptoms, glottic cancer manifests itself early with a sign of dysphonia, which, with appropriate oncological alertness, can serve as an early diagnosis at the stage of the disease when complete cure is possible with minimal surgical and additional means. It should be borne in mind that every man aged 35-40 years who has experienced hoarseness of the voice, the cause of which is unclear, lasting more than 2-3 weeks, should be examined by a doctor. Such alarming signs include "causeless" cough, a sensation of a foreign body in the throat, minor swallowing disorder, ear pain with a normal otoscopic picture, enlargement of the cervical lymph nodes.

The basis of diagnostics is laryngoscopy (indirect, direct with the use of modern endoscopic means) and radiography; additional methods should include laryngeal stroboscopy, which displays the impairment of the motor function of the affected vocal fold. Visual methods of recognizing laryngeal tumors are effective only in case of damage to the vestibule of the larynx and the glottis region. To study the subglottic space, along with direct fibrolaryngoscopy, radiological methods are widely used. The above illustrations demonstrate the possibilities of visual diagnostics of laryngeal tumors. As for radiological examination, it is facilitated by the fact that the larynx, being a hollow organ with well-known identification features, is accessible to this method practically without any methods of artificial contrasting, as evidenced by the radiographs below.

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Physical examination

The nature of the first symptoms of the disease and their changes can be used to judge the initial localization of the tumor, which is important for predicting tumor progression and radiosensitivity of the neoplasm. If patients complain of a feeling of a foreign body in the throat and discomfort when swallowing, tumor damage to the vestibular part of the throat should be excluded. The addition of pain when swallowing, radiating to the ear on the affected side, to these symptoms is pathognomonic for tumors of this localization. If patients complain of hoarseness, cancer of the vocal part of the larynx can be suspected. As the process progresses, pain and difficulty breathing associated with stenosis of the larynx appear. A gradual increase in stenosis against the background of slowly progressing hoarseness indicates damage to the subglottic part.

During the examination, pay attention to the condition of the skin, the shape and contours of the neck, the volume of active movements of the larynx, its configuration. During palpation, the volume, configuration, displacement of the larynx, crepitus, and the condition of the lymph nodes of the neck are specified. At the same time, you should listen to the patient's breathing and voice so as not to miss signs of laryngeal stenosis and dysphonia.

Palpation of regional zones of metastasis of the cervix should be performed on each patient. A necessary condition is considered to be the study of all possible zones of metastasis (upper, middle and lower nodes of the deep jugular chain, prelaryngeal, pretracheal, supraclavicular).

Laboratory diagnostics of laryngeal cancer

A general clinical examination is carried out.

Instrumental research

Indirect laryngoscopy determines the location and boundaries of the tumor, the growth pattern, the color of the mucous membrane, its integrity, the size of the lumen of the glottis, the degree of mobility of the vocal folds, and the presence of chondroperichondritis.

Fibrolaryngoscopy allows for examination of laryngeal sections that are inaccessible to indirect laryngoscopy in some cases: laryngeal ventricles, fixed epiglottis, subglottic section, anterior commissure. Fibrolaryngoscopy is considered the method of choice for trismus. Endoscopy can be used to perform targeted biopsy.

Lateral radiography, in addition to the data obtained by direct laryngoscopy, provides information on tumor involvement in the pre-epiglottic space, the fixed part of the epiglottis, the cartilaginous skeleton of the larynx, and the soft tissues surrounding the larynx. A chest X-ray is necessary; CT allows for more precise determination of the tumor spread to the laryngeal ventricles and subglottic region. CT is of great importance in detecting tumor growth into the pre-epiglottic and periglottic space.

The diagnosis of a malignant tumor at any stage before the start of treatment must be confirmed by histological examination, which is considered the final stage of diagnosis.

In cases where a repeated biopsy does not reveal a tumor, and the clinical picture is characteristic of cancer, it is necessary to resort to intraoperative diagnostics and perform a thyro- or laryngofissure with an urgent histological examination. Using this method, it is possible to obtain the necessary material for morphological examination and confirmation of the diagnosis.

The appearance of regional metastases complicates the course of the disease, worsens the prognosis. The main methods of diagnosing regional metastases are palpation, ultrasound and cytological examinations.

Currently, one of the methods for early detection of laryngeal cancer metastases on the neck is ultrasound. The use of modern devices with sensors with a frequency of 7.5 MHz and higher allows detecting non-palpable metastases of laryngeal cancer on the neck. If metastases are suspected, a lymph node puncture is performed (with non-palpable nodes under ultrasound control). Lymph nodes with a disruption of the structure, its unevenness with a predominance of hypoechoic areas, increasing during dynamic observation are considered suspicious for the presence of metastases.

Fine-needle aspiration puncture of regional lymph nodes in the neck is performed to obtain morphological confirmation of the appearance of regional metastases. In case of non-palpable metastases, it is performed under ultrasound control. The sensitivity of the method with subsequent cytological examination approaches 100% (in patients after repeated puncture).