Malignant tumors of the oropharynx: causes, symptoms, diagnosis, treatment

Of malignant tumors of the oropharynx, cancer is observed more often, rarely sarcoma, and lymphoepithelioma and lymphomas are rarely seen. Malignant tumors develop mainly in individuals over 40 years of age. This position is true only the days of malignant neoplasms of epithelial origin. As for connective tissue tumors, they are more common in young people, and often in children. Initial localization of malignant tumors in 5% of patients - palatine tonsils, 16% - posterior pharyngeal wall, 10.5% soft palate.

Most malignant neoplasms of the middle part of the pharynx are marked by rapid infiltrultinium growth and a tendency to ulceration; apparently, therefore, 40% of patients on admission to the clinic diagnosed III and IV stages of the disease and chini, 20% - I-II stage. Malignant tumors of this localization often metastasize. Metastases in regional lymph nodes are found in 40-45% of patients already on admission, and in remote organs - in 5%.

Symptoms of malignant tumors of the oropharynx

Malignant tumors of the middle pharynx grow rapidly. They are for a while, usually a few weeks, much less often - months, can go unnoticed. The first symptoms of malignant tumors depend on their primary localization. In the future, as the tumor grows, the number of symptoms increases rapidly.

One of the earliest signs of a tumor is the sensation of a foreign body in the pharynx. Soon pains in the throat attach to him, which, like the sensation of a foreign body, are strictly localized. Epithelial tumors are prone to ulceration and disintegration, which causes the patient to have an unpleasant smell from the mouth and an admixture of blood in saliva and sputum. When the tumor process spreads to the soft palate, its mobility is violated, nasalis develops: liquid food can get into the nose. Since swallowing disorders and eating disorders occur early enough, patients start to lose weight early. In addition to local symptoms, due to intoxication and concomitant tumor inflammation, general symptoms develop, such as malaise, weakness, headache. When the lateral wall of the pharynx is affected, the tumor quickly penetrates into the tissues in the direction of the neurovascular bundle of the neck, which causes the danger of profuse bleeding.

Among malignant tumors of the oropharynx, neoplasms of epithelial origin predominate. Epithelial tumors, in contrast to connective tissue, tend to ulcerate. This to some extent determines the clinical picture of the disease. The appearance of the tumor depends on its histological structure, type, prevalence and, to a lesser extent, on primary localization. Epithelial exophytally growing tumors have a wide base, their surface is tuberous, in places with foci of decomposition: the color is pink with a grayish tinge. Around the tumor is an inflammatory infiltrate. The tumor bleeds easily when you touch it.

Infiltrative growth of epithelial tumors is prone to ulceration. Tumor ulcers are often localized on the palatine tonsil. The affected amygdala is increased in comparison with the healthy one. Around the deep ulcer with uneven edges, the bottom of which is covered with a dirty gray coating, an inflammatory infiltrate.

Diagnosis of malignant tumors of the oropharynx

Laboratory research

Cytological examination of smears-prints or reprints can be done. Despite the existence of sufficiently informative research methods, the final diagnosis of the tumor with the definition of its type is established on the basis of the results of studying its histological structure.

It should be emphasized that cytological studies of smears-prints and reprints are not very informative, since they take into account only the result, in which signs of malignant growth are found; In addition, this method of investigation does not allow a detailed study of the histological structure of the neoplasm.

Instrumental research

Biopsy - excision of a piece of tissue for histological examination is one of the important diagnostic methods in oncology. From the way a biopsy is taken, the result of histological examination largely depends. It is common knowledge that a piece of tissue should be taken at the border of the tumor process, but it is not always possible to determine this boundary, especially in tumors of the ENT organs. Neoplasms of the palatine, pharyngeal and lingual tonsils, especially connective tissues, arise at the depth of the tonsil tissue. The tonsil is enlarged. The enlargement of the amygdala should alert, t requires targeted research, including biopsy. Most common oncologists do not know the methods of indirect and direct pharyngo- and laryngoscopy, use the services of endoscopists who take a biopsy from the upper (nasopharynx), middle (mouth-pharynx), and the lower (pharyngeal) pharyngeal sections using a fibroscope. Thus, a biopsy can be taken from the edge of an exogenous or exophytally growing tumor.

If the neoplasm is in the depth of the amygdala, the tumor cells and a piece of tissue taken for the study do not fall. This result of the biopsy calms the doctor and the patient, precious time is lost, over time, the biopsy is repeated one or two more times until the tumor approaches the surface of the amygdala. In this case, there are other signs of the tumor process, which quickly progresses. In the case of asymmetry of the palatine tonsils about suspicion of the tumor process, if there are no contraindications, it is necessary as a biopsy to produce a one-sided tonsillectomy or tonsilotomy. Sometimes such tonsillectomy can be a radical surgical intervention in relation to the tumor.

Differential diagnostics

An ulcerated tumor of the amygdala must be differentiated from the ulcerative-glandular angina of Simanon-Venus, syphilis and Wegener's disease. To this end, it is necessary to examine the swabs taken from the edges of the ulcer, and perform the Wasserman reaction.

Treatment of patients with neoplasms of the oropharynx

The main method of treating patients with benign tumors of the middle part of the pharynx is surgical. The extent of surgical intervention depends on the prevalence, histological structure and localization of the tumor. Limited neoplasms, such as the papilloma of the palatine arch, can be removed in the clinic with a loop, scissors or forceps.

The initial site of the tumor after its removal is treated with an electrocautery or a laser beam. Similarly, you can remove the fibroma on the foot of a small, superficially located cyst of the tonsil or palatine arch.

A small mixed tumor of the soft palate can be removed through poot under local anesthesia. More often when removing tumors of the oropharynx, anesthesia is used, using as an access sublingual pharyngotomy, which is often supplemented with a lateral one. Wide External access will allow to completely remove the tumor and provide good hemostasis.

External access is also required when removing vascular tumors of the pharynx. Prior to removal of hemangiomas, the external carotid artery is previously bandaged or embolization of the leading vessels is performed. Interference with these tumors is always accompanied by the danger of severe intraoperative bleeding, which may require a ligation of not only the external but also the internal or common carotid artery. Given the possibility of intraoperative bleeding and the severity of the effects of dressing the internal or common carotid artery, in patients with parapharyngeal chemodectomies and hemangiomas for 2 = 3 weeks before surgery, we "train" intracerebral anastomoses. It consists in pinching the common carotid artery on the side of the tumor localization 2-3 times a day for 1-2 minutes. Gradually, the duration of the experience is increased to 25-30 minutes. At the beginning of the "training" and subsequently with an increase in the duration of the clamping of the common carotid artery, the patient experiences a feeling of dizziness. This sensation serves as a criterion for determining the length of the clamping of the artery, as well as the duration of the "training" course. If the clotting of the artery for 30 minutes does not cause a sensation of dizziness, then after repeating the clamping for another 3-4 days, you can proceed to the operation.

Cryogenic exposure as an independent method of treatment of patients with benign tumors is shown mainly in superficial (located under the mucous membrane) diffuse hemangiomas. It can be used in the treatment of deep hemangiomas in combination with surgical interventions.

The main methods of treatment for malignant tumors of the oropharynx, as well as for neoplasms of other localizations, are surgical and radial. The effectiveness of surgical treatment is higher than the exposure to combined treatment, the first stage of which is irradiation.

Through the mouth, only limited neoplasms can be removed that do not go beyond one of the fragments of the given area (soft palate, palatal tongue, palatine amygdala). In all other cases, external accesses are indicated - foreground or sublingual pharyngotomy in combination with the lateral; Sometimes, in order to obtain wider access to the root of the tongue, in addition to pharyngotomy, a lower jaw resection is performed.

Operations for malignant tumors are performed under anesthesia with a preliminary ligation of the external carotid artery and tracheotomy. Tracheotomy is performed under local anesthesia, and subsequent stages of intervention are performed under intratracheal anesthesia (intubation via tracheostomy).

When the palatine tonsil is affected by a tumor that does not go beyond its limits, it is limited to the removal of the amygdala, palatine arch, laratonsillar fiber and part of the root of the tongue adjacent to the lower pole of the amygdala. The stock of uninfected tissues around the tumor center should not be less than 1 cm. This rule is also followed when removing the common tumors with the help of external access.

Radiation treatment of patients with pharyngeal neoplasms should be carried out under strict indications. This curative effect can be used only for malignant tumors. As an independent method of treatment, irradiation can be recommended only in those cases when surgical intervention is contraindicated or the patient refuses surgery. Combined treatment, the first stage of which is surgery, we recommend to patients with stage III tumor. In other cases, you can only use the operation.

In tumors that occupy the middle and lower parts of the pharynx, extending to the larynx, they produce a circular resection of the pharynx with removal of the larynx. After such extensive intervention, they form an orostoma, tracheostomy and esophagostomy. After 2-3 months, the plastic of the lateral and anterior walls of the pharynx is performed, thereby restoring the way of food.

Comparing the results of treatment with the use of different methods, we were convinced of the high efficiency of the surgical method; five-year survival of patients after surgical treatment was 65 ± 10,9%, after combined (operation + irradiation) - 64,7 + 11,9%, after radiation therapy - 23 ± 4,2% (Nasyrov VA, 1982) .

[1], [2], [3], [4], [5]