Laryngeal cancer: symptoms

The nature of the clinical manifestations depends on the invasive properties of the tumor and its stage (prevalence). Tumors in the area of the vestibule cause the sensation of a foreign body and when reaching certain dimensions (defeat of the epiglottis, cherpalodnagortan folds and pear-shaped sinuses) cause swallowing disorders and an increasing pain syndrome. Tumors of the lining space cause mainly a violation of breathing; when the upward extension to the area of the vocal folds and the arytenoid cartilage arises hoarseness of voice and increases the violation of respiratory function.

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Laryngeal cancer and voice disorders

Tumors in the area of the glottis early cause the phenomenon of voice dysfunction - fonet, the hoarseness of the voice, which for a long time remain the only symptoms of laryngeal cancer. A distinctive feature of the resulting hoarseness of the voice is its constant without remission character, but over time the voice becomes dim, up to complete aphonia. At the same time, the phenomena of difficulty in breathing are also growing due to the spread of the process to the muscles and joints that provide the movement of the vocal folds.

Respiratory disorders in laryngeal cancer usually occur later in the development of the tumor and develop gradually, which for a long time determines the effective adaptation of the organism to increasing hypoxic hypoxia. However, with an increasing narrowing of the respiratory lumen of the larynx, dyspnea appears first with physical effort, and then at rest. At this stage, there is a danger of acute asphyxia on the soil of various contributing factors (cold, swelling of the mucous membrane, secondary infection, the consequences of radiation therapy). In cancers of the vocal fold, respiratory failure occurs many months or even 1 year after the onset of the disease. Previously, these disorders occur in cancer of the lining space and much later - only with developed forms, with cancer of the threshold of the larynx. Noisy breathing on inspiration is typical for tumors of lining space.

Cough in laryngeal cancer

Cough is a constant symptom of laryngeal cancer and has a reflex character, sometimes accompanied by spasm of the larynx. Sputum is sparse, sometimes with veins of blood.

[2], [3], [4]

Pain in laryngeal cancer

Pain syndrome is typical for tumors that affect the upper larynx, it appears in widespread processes with disintegrating and ulcerating tumors. The pain radiates into the ear and becomes especially painful when swallowed, which causes the patient to refuse to eat. With advanced forms of cancer with a lesion of the inhibitory function of the larynx, there is a casting of the poor in the larynx and trachea, which provokes attacks of a painful indomitable cough.

The general condition of the patient suffers only with the widespread cancer of the larynx: anemia, sharp weight loss, high fatigue, pronounced general weakness. The face is pale with a yellowish tinge with an expression of despair; in contrast to tuberculous intoxication, which is characterized by euphoria, in cancer of the larynx patients fall into a state of severe depression.

Endoscopic picture

Endoscopic picture in cancer of the larynx is characterized by a significant diversity in both form and location. The epithelioma of the vocal fold in the debut stage is an exclusively one-sided formation, limited only by the fold itself, manifested with extensive growth in the form of a small proliferative tubercle in the anterior third of the vocal fold or in the region of the anterior commissure. Very rarely, the primary cancer is localized at the back of the vocal fold, at the point where contact granulomas (the apophysis of the vocal appendage of the arytenoid cartilage) are usually formed, or in the area of the posterior commissure. In other cases, the tumor may have the form of a reddish-colored spreading along the vocal fold, with a tuberous surface that extends beyond the midline. In rare cases, the tumor has a polypoid appearance, a whitish-gray color and is most often located closer to the anterior commissure.

Tumors with infiltrating growth have the form of monochordite and are manifested by a thickening of the vocal fold that acquires a reddish color, soft and easily disintegrating and bleeding when probed with a button probe, with a finely bumpy surface. Often this form is ulcerated and covered with a whitish-dirty coating.

The mobility of the vocal fold in proliferative forms of cancer persists for a long time with a satisfactory, albeit slightly altered, voice function, while in the infiltrative form the voice fold is quickly immobilized and the voice loses its individuality, becomes hoarse, "split" and subsequently completely loses its tonality. With such forms of cancer of the vocal fold, the opposite fold often takes on a form characteristic of banal laryngitis, which makes diagnosis difficult and can guide it along the wrong path. In such cases, attention should be paid to the asymmetry of the volume of the vocal folds and, if it is even insignificant, to refer the patient to the ENT oncologist.

In a later period, the tumor affects the entire vocal fold, the vocal process, extends into the ventricle of the larynx and below, into the nodding space. Simultaneously sharply narrows the respiratory cleft, deeply ulcerates and bleeds.

A cancerous tumor with a primary manifestation in the ventricle of the larynx later extends beyond it into the laryngeal lumen, either as a prolapse of the mucous membrane covering the vocal fold, or as a reddish polyp infiltrating the vocal fold and the walls of the ventricle.

The tumor of the lining space, spreading from below to the lower surface of the vocal fold, covers it and immobilizes it, then it quickly becomes ulcerated and extends to the scapular fold and pear-shaped sine. The secondary edema arising with this form of laryngeal cancer hides the size of the tumor and the place of its primary appearance. In most cases, when the tumor is localized, sufficiently developed forms of cancer of both proliferative and infiltrative growth are observed in this region, causing significant destruction and penetrating into the pre-nodular space. In this stage, the general condition of the patient (anemia, cachexia, a general decline in strength) is severely affected, and there are also metastases to the regional lymph nodes. The top jugular lymph nodes are affected first, which first increase, they retain mobility and are painless. Later, merging, the lymph nodes form dense conglomerates, soldered to the membrane of the sternocleidomastoid muscle and the larynx. Sprouting endings of sensitive nerves, in particular of the superior laryngeal nerve, these conglomerates become very painful on palpation, while spontaneous pains, radiating to the corresponding ear, also occur. Lymph nodes of the neck are affected in the same way, their disintegration with the formation of fistulas occurs.

The development of laryngeal cancer in untreated cases leads to death within 1-3 years, however, there is a longer duration of this disease. Usually, death comes from suffocation, profuse arrosive bleeding from the large vessels of the neck, bronchopulmonary complications, metastases to other organs and cachexia.

Most often, a cancerous tumor is localized in the vestibular larynx. With cancer of this section of the larynx, endophytic growth of the tumor, manifested by its more malignant development, is observed more often than with the defeat of the voice department. Thus, in cancer of the vestibular part of the larynx, the indistinct form of tumor growth is revealed in 36.6 ± 2.5% of patients mixed in 39.8 ± 2.5%, which proceeds less aggressively, and the exophytic form of growth - in 23.6%. In the presence of vocal cords, these forms of tumor growth are found in 13.5 ± 3.5%, 8.4 ± 2.8% and 78.1 ± 2.9% of patients, respectively.

A typical squamous cell carcinoma is considered to be a morphological form of a malignant tumor of the larynx.

Sarcoma is a rare disease of the larynx, which, according to the literature, is 0.9-3.2% of all malignant tumors of this organ. Most often, these tumors are observed in men aged 30 to 50 years. Sarcoma of the larynx have a smooth surface, rarely ulcerate, they are characterized by slow growth and a rare metastasis. Sarcomas are a less homogeneous group than cancer. Round-cell sarcoma, carcinosarcoma, lymphosarcoma, fibrosarcoma, chondrosarcoma, myosarcoma are described in the literature.

Regional metastases in cancerous tumors of the larynx reveal in 10.3 ± 11.5% of patients. In the localization of the tumor In the vestibular department - in 44, ± 14.0% of patients, in the voice department - in 6.3%, in the podgolosovom - in 9.4%.

Development of a cancer of the vestibular department is revealed in 60-65% of patients. The cancer of this localization proceeds particularly aggressively, the cancerous tumor spreads rapidly to surrounding tissues and organs: prednadgortanic space is affected in 37-42% of patients, pear-shaped sine - in 29-33%, vallecula - in 18-23%.

The incidence of a cancerous tumor in the vocal portion of the larynx is 30-35%. Hoarseness, which occurs with a tumor of the vocal cords even of small dimensions, causes the patient to see a doctor soon after the appearance of this symptom. In a later period, hoarseness is joined by difficulty breathing caused by stenosis of the laryngeal lumen by the exophytic part of the tumor and the appearance of the immobility of one of its halves. The tumor affects mainly the front or middle sections of the vocal folds. The clinical course of cancer of this department is most favorable.

Cancer of the lining of the larynx is diagnosed in 3-5% of patients. Tumors of this localization grow, as a rule, endophytic, narrowing the laryngeal lumen, causing difficulty in breathing during inspiration. Propagating in the direction of the vocal fold and infiltrating it, these tumors lead to the development of hoarseness. Another direction of tumor growth is the upper ring of the trachea. In 23.4%, the tumor can be detected in several sections of the larynx, which is manifested by the corresponding symptomatology.

The frequency of regional metastasis of laryngeal cancer largely depends on the location of the tumor. So, with the defeat of the vestibular department, it is the highest (35-45%). Especially often, metastases are found in the fusion of the common facial and inner lobular veins. Later, metastases affect the lymph nodes of the middle and lower chain of the deep yurm vena, the lateral triangle of the neck.

Cancer of the vocal cords metastasizes rarely (0.4-5.0%). Metastases are usually located in the lymph nodes of the deep-necked chain.

The frequency of regional metastasis in cancer of the podgotosal department of the larynx is 15-20%. Metastases affect the pre-lordal and pre-tracheal lymph nodes, as well as the nodes of the deep-necked chain and the mediastinal mediastinum. Remote metastases are relatively rare (1.3-8.4%), they are usually located in the lungs, the spine and other organs.

[5], [6], [7]