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

Malignant tumors of the pharynx are a rare otolaryngological disease. According to statistical data from the mid-20th century, obtained at the Leningrad Institute of Oncology, out of 11 thousand cases of malignant neoplasms of various localizations, only 125 were tumors of the pharynx. Malignant tumors of the pharynx can develop from all layers that form this organ.

Cancer (malignant epitheliomas) develops from the superficial epithelial layer, and sarcomas of connective tissue and lymphoid origin develop from the mesenchymal layer that supports the epithelial and lymphoid layers. Along with these types of malignant tumors, melanosarcomas and teratomas can occur in the pharynx.

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Malignant tumors of the nasopharynx

Malignant tumors of the nasopharynx in the overwhelming majority of cases (80-95%) occur: in males, with sarcomas occurring at a younger age, epithelioma at an older age. According to some data, sarcomas occur more often in women. According to foreign statistics, people of the so-called yellow race get sick more often than representatives of other nations.

The clinical evolution of malignancy of nasopharyngeal tumors is divided into four periods: the debut period, the period of the developed state, the period of exterritorialization, and the terminal period.

The debut period may manifest itself with several clinical symptoms. Most often, which is especially characteristic of lymphoepitheliomas, adenopathy phenomena are observed, manifested in the internal jugular lymph nodes, which acquire a woody density and are fused with the vascular-nerve bundle. At the same time, signs of obstruction of the auditory tube appear, manifested by decreased hearing in one or both ears, autophony, noise in the ear, which is caused by the spread of the tumor into the nasopharyngeal opening of the auditory tube. The spread of the tumor in the direction of the choanae causes difficulty in nasal breathing, first unilateral, then bilateral. In this period, neuralgic pains begin, most often manifested at first by intermittent, then persistent otalgia. Most often, the signs of the debut period are under the sign of various banal diseases (colds, inflammation, allergies, etc.) and attract attention as signs of an oncological disease only when the patient begins to complain of a sensation of a foreign body in the nasopharynx. It is in this case that the tumor becomes accessible to visual recognition, as well as X-ray diagnostics. At the earliest stages, the tumor can only be recognized using MRI.

The period of the developed state is characterized by the fact that all the above-mentioned signs of the debut period acquire significant intensity and the tumor is quite easily detected both by posterior and anterior rhinoscopy, depending on the direction of its growth. Depending on the morphological structure, the tumor has either the appearance of a bleeding papillomatous formation with an ulcerated surface (cancer), or a dense diffuse formation on a wide base (sarcoma). The pain that arises in the ear, in the nasopharynx, in the deep parts of the base of the skull acquires the character of paroxysms, practically not amenable to the action of analgesics. On the neck, packages of dense lymph nodes are palpated, fused with the underlying tissues with movable skin above them.

In this period, X-ray diagnostics acquires special significance, since its results can be used to judge the spread of the tumor and determine the treatment tactics and prognosis. Thus, on lateral images it is possible to detect a tumor growing into the sphenoid sinus and sella turcica, in axial projections according to Hirsch, details of the skull base and changes caused by the spread of the tumor are visualized in relation to the basal openings of the skull (posterior lacerated, oval and round).

The period of tumor exterritorialization is characterized by tumor spread beyond the anatomical formation in which it arose. Its growth mainly occurs along the "line of least resistance", i.e. it grows into the surrounding cavities, then into the soft tissues and, finally, destroys bone tissue. When spreading in the cranial direction, the tumor, penetrating the sphenoid sinus and the cells of the ethmoid bone, can destroy the bottom of the sella turcica and the ethmoid plate and penetrate into the middle and anterior cranial fossa, in which its growth does not encounter any obstacles. Phenomena of increased intracranial pressure (headache, vomiting, bradycardia, etc.), signs of retrobulbar lesions (loss of visual acuity, blindness), focal symptoms caused by damage to the cranial nerves, as well as mental disorders quickly occur. With lateral invasion, when penetrating the canal of the auditory tube, the lacerated anterior opening, the tumor reaches the middle cranial fossa with the same consequences. With this direction of tumor growth, it can grow into the zygomatic and temporal fossae, causing deformation of the corresponding anatomical areas of the head. In addition to these changes, trismus, neuralgic pain in the area of the branches of the first branch of the trigeminal nerve and persistent otalgia occur. When the tumor spreads in the oral direction, it penetrates through the choanae, affecting the anterior paranasal sinuses and the orbit. Much less often, the tumor spreads in the caudal direction, i.e. in the direction of the oral part of the pharynx, it can affect the soft palate, and penetrating through the lateral wall of the pharynx in its upper sections, it can prolapse through the posterior lacerated opening in the posterior cranial fossa and affect the caudal group of cranial nerves - IX, X, XI and XII. In addition to these nerves, tumor invasion into the cranial cavity can also affect other cranial nerves, such as I, II, III, IV, V, VI, VII, which causes the so-called neurological form of malignant tumor of the nasopharynx. Information on the clinical picture of cranial nerve lesions can be found in the books Clinical Vestibulology (1996) and Neurootorhinolaryngology (2000).

The terminal period in duration depends on the localization and degree of malignancy of the tumor. It is not so long in poorly differentiated sarcomas and teratomas and their invasion of the cranial cavity, metastases to the lungs and liver. Epitheliomas spreading towards the oropharynx are characterized by the same rapid development of the terminal state. Tumors of the tubular direction evolve more slowly, which for many months may manifest themselves only as ear congestion and noise in it. Ulcerating and secondarily infected tumors are characterized by accelerated evolution. Young people with such a tumor may die within a few months. Metastases occur rarely, usually in the lungs, liver, spine. Patients in the terminal stage are sharply anemic, weakened, cachexic and usually die from intracranial complications, secondary infections or profuse erosive bleeding with damage to large cerebral, cervical, pulmonary or abdominal blood vessels.

Diagnosis of malignant tumors of the nasopharynx

Diagnostics are effective only at the debut stage and at the very beginning of the period of the developed state, when the applied combined treatment can either cure the patient or prolong his life by 4-5 years. However, in practice, patients most often come to the attention of an ENT oncologist during the period of the developed state, when metastases and tumor exteriorization phenomena are not excluded. In these cases, treatment becomes long, painful with frequent relapses and in a significant number of cases ends in vain.

Successful early diagnostics of nasopharyngeal tumors, unlike tumors of other respiratory tracts that are well visualized, should primarily be based on the oncological alertness of the physician to whom the patient comes, for example, with such complaints as congestion in one ear that does not respond to any treatment, hearing loss in this ear by air conduction with good tissue conduction, constant noise in this ear and nasal congestion on the same side, as well as constant headaches, pain in the depth of the nose, increased fatigue, etc. It is not always possible to see a nasopharyngeal tumor during a regular posterior rhinoscopy. The use of modern video endoscopic means significantly facilitates the task of early diagnostics, however, it is important not only to suspect the presence of a tumor in time. Such patients need to undergo appropriate laboratory tests, appropriate X-ray examination, but even better CT or MRI. After all the above measures, a preliminary biopsy is possible or it is carried out during surgery.

Malignant tumors of the nasopharynx should be differentiated from syphilitic gumma, the infiltrative forms of which are very similar to sarcomas, therefore, in all cases of suspicious neoplasms of the nasopharynx, serological tests and histological examination of the biopsy should be performed.

Pott's disease with suboccipital localization differs from malignant tumor of the nasopharynx in that the tumor arising in the area of the posterior wall of the nasopharynx (the result of caseous decay of the vertebral body) is determined by palpation as a fluctuating swelling of soft consistency, while any malignant tumor has a certain density and there is no symptom of fluctuation. X-ray examination of the spine at this level is indicated, which in Pott's disease reveals destructive changes in the corresponding bone structures.

Ulcerative-proliferative form of lupus resembles a decaying cancerous tumor in appearance. Such signs as uneven and raised edge of the ulcer, spread of the lesion to the oropharynx, paleness of the mucous membrane allow only to suspect the presence of lupus. The final diagnosis is established by histological examination.

Often, in children, nasopharyngeal tumors in the early stages are mistaken for adenoids, and the resulting tubular and auditory disturbances, usually observed with adenoid growths, do not contribute to establishing a true diagnosis.

Malignant tumors of the nasopharynx should also be differentiated from numerous types of tumors of the skull base, as well as from lymphoid proliferations that sometimes occur in the nasopharynx with leukemia. A comprehensive examination of the patient in such cases allows one to differentiate the true tumor from the aforementioned lymphoid formations.

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Treatment of malignant tumors of the nasopharynx

Treatment of malignant tumors of the nasopharynx is an extremely complex and thankless task, the exhaustive or partial solution of which can be achieved only at the very beginning of the disease. Attempts at surgical treatment, carried out in the last century, in most cases did not give a positive result: the impossibility of radical removal of the tumor due to its early germination into bone tissue, the ethmoid labyrinth and the sphenoid sinus, the proximity of vital anatomical structures, inevitable relapses, the actual "biting" of the tumor, leading to massive metastasis - all this forced leading rhinosurgeons to abandon surgical treatment and limit themselves to non-surgical methods of treatment (Curie and deep radiation therapy, cobalt therapy, chemotherapy), the effectiveness of which is quite acceptable with timely diagnosis and complex treatment.

Malignant tumors of the oropharynx

These tumors arise in the space limited from above by the projection of the hard palate onto the back wall of the pharynx, and from below by the level of the root of the tongue. In this space, malignant tumors can arise from any tissue and in any place, but their preferred localization is the palatine tonsils, soft palate, and less often the back wall of the pharynx.

Malignant tumors of the palatine tonsil

Malignant tumors of the palatine tonsil are, in the overwhelming majority of cases, tumors that affect only one tonsil and occur in people aged 40-60 years, but cases of these tumors occurring in children under 10 years have been described. Men are more often affected than women in a ratio of 4:1. Predisposing factors include smoking, alcoholism, atmospheric occupational hazards, and syphilitic infection.

Pathological anatomy. Malignant tumors of the tonsils are divided into epithelial, connective tissue and lymphoreticular. The varieties of these classes of tumors are reflected in the classification presented below (according to foreign publications).

Classification of malignant tumors of the palatine tonsils

• Epitheliomas:
  • epitheliomas of the integumentary epithelium of the spinocellular type;
  • trabecular epitheliomas of the spinocellular type with a metatypical structure;
  • epitheliomas of undifferentiated cellular structure;
  • Keratinizing epitheliomas.
• Lymphoepitheliomas.
• Sarcomas and lymphosarcoma:
  • fascicular sarcoma;
  • lymphoblastoma;
  • lymphocytic sarcoma with atypical and transitional cells;
  • giant cell follicular sarcoma (Brill-Simmers disease).
• Reticulosarcomas:
  • embryonic (teratomas) sarcomas;
  • differentiated sarcomas;
  • reticulolymphosarcoma;
  • reticuloendotheliosarcoma;
  • reticulofibrosarcoma;
  • reticuloenthelioma (according to G. Ardoin).

Tonsil epitheliomas are relatively common in all stages - from minor superficial ulceration without regional adenopathy to extensive and deep ulceration with massive cervical adenopathy. The onset of the disease is unnoticed, and tonsil cancer remains unnoticed for a long time. The first clinical manifestations occur when the tumor extends beyond the tonsil bed and metastasizes to the regional lymph nodes. It is the appearance of a dense tumor-like formation in the area of the angle of the lower jaw that attracts the patient's attention, and then he "remembers" that he is also bothered by mild pain in the throat, which intensifies when swallowing and radiates to the ear on the same side. And only after this does the patient consult a doctor, who may be faced with three different forms of the disease:

• ulcerative in the form of a round crater with uneven edges, the bottom of which is covered with granular formations of a bright red color;
• proliferative, resembling a blackberry, red in color, on a wide base deeply embedded in the parenchyma of the tonsil;
• cryptogenic, also resembling a blackberry, red in color, clogs the crypt.

The above forms may escape the doctor's attention during a cursory superficial examination and pass for chronic caseous cryptogenic tonsillitis. However, the unimpeded introduction of a button probe into the crypt, easily penetrating the parenchyma of the tonsil, and its blood staining should awaken the doctor's dormant oncological alertness, which should be crowned by decisive action on his part - sending the patient to an ENT oncologist.

At a more advanced stage, when the tonsil reaches a significant size, dissonant with the size of the opposite tonsil, otalgia becomes constant. The development of the tumor in the depth of the crypt leads to a significant increase in the volume of the tonsil, while the soft palate shifts to the opposite side, the remaining crypts gape, and the tonsil itself is tense, has a woody density and is painful to palpation. Regional lymph nodes are also enlarged, dense and fused with the underlying tissue. The general condition of the patient at this stage of the disease remains almost good, which should also alert the doctor, since with chronic caseous tonsillitis, patients usually complain of weakness, headaches, and increased fatigue.

The terminal period in untreated cases usually occurs after 6-8 months from the first manifestation of the disease. The patient is cachexic, pale, severely weakened, otalgia manifests itself as unbearable ear pain. The same pain occurs when swallowing, which makes the patient refuse food. Usually at this stage the tumor affects the root of the tongue, the entrance to the larynx, cervical lymph nodes. The latter reach significant sizes, interfere with head movements, compress the vascular-nerve bundle, which causes congestion in the brain. Compression of the last cranial nerves by enlarged lymph nodes leads to paralysis of the muscles innervated by them. The affected lymph nodes, disintegrating, entail fatal erosive bleeding from large cervical vessels.

Lymphosarcoma of the tonsil at the debut stage is manifested by an increase in the volume of this lymphadenoid organ. Until the tumor reaches a certain size, it does not cause any problems to the patient. Then breathing and swallowing disorders appear, and later - a violation of voice formation. Only after the appearance of packets of enlarged lymph nodes on the neck, the patient consults a doctor. Pharyngoscopy reveals asymmetry of the pharynx, caused by a significant increase in one of the tonsils, often in a ratio of 3:1. The surface of the affected tonsil is smooth, sometimes lobed, pink or red in color, soft-elastic consistency, unlike epithelioma, which gives the tonsil a woody density. A feature of sarcoma of the palatine tonsil is that, unlike tonsil cancer, swallowing movements remain painless for a long time, which often confuses the doctor, since gumma of the palatine tonsil also proceeds painlessly. Almost simultaneously with the enlargement of the tonsil, regional adenopathy develops. A chain of lymph nodes extends from the submandibular region, along the anterior edge of the sternocleidomastoid muscle to the clavicle. The lymph nodes are soft-elastic in consistency, painless.

The slow onset of lymphosarcoma lasts until significant damage to the lymph nodes occurs, then the course is very rapid. The palatine tonsil reaches a significant size and blocks the pharynx; breathing, swallowing and voice formation are sharply hampered. At the same time, dysfunction of the auditory tube occurs. Very quickly the tumor becomes covered with ulcers and secondarily inflamed. The body temperature rises, the general condition of the patient progressively worsens. Adenopathy generalizes: pretracheal, paravasal, mediastinal and mesenteric lymph nodes increase. Otalgia sharply increases. The mediastinal lymph nodes, by their pressure on the surrounding organs, cause a sharp deterioration in the patient's condition. In a state of increasing cachexia, general intoxication and with secondary complications, the patient dies during the first year of the disease.

Differential diagnostics of palatine tonsil lymphosarcoma is carried out with banal hypertrophy of one of these glands, which has an external resemblance to this malignant tumor. In these cases, the hemogram and myelogram clarify the diagnosis. Tuberculous lesions are similar to palatine tonsil lymphosarcoma, since tuberculous granuloma is accompanied by regional lymphopathy. MBT inoculated into the palatine tonsil causes its progressive hypertrophy, and only microscopic examination of the biopsy allows differentiating these two diseases from each other. In pharyngeal syphilis, both tonsils are enlarged in the secondary period, and in the tertiary period, the formation of tonsil gumma is not accompanied by regional adenopathy characteristic of lymphosarcoma. In differential diagnostics, one should also keep in mind tonsillolithiasis, which, unlike lymphosarcoma, occurs with pain syndrome. An aneurysm of the internal carotid artery can sometimes simulate a tumor of the retrotonsillar region; it has the appearance of an elongated swelling covered by normal mucous membrane and pulsating on palpation.

Reticulosarcoma of the palatine tonsil is similar to lymphosarcoma in its clinical course and significant radiosensitivity. Like this tumor, reticulosarcoma produces early metastases to nearby and distant organs and often recurs despite intensive radiation therapy. Of all the morphological varieties of reticulosarcoma, teratomas are the most malignant.

Fibroblastic sarcoma of the palatine tonsil is very rare and is characterized by painlessness in the initial period, an enlargement of one of the palatine tonsils, the surface of which is furrowed and red. The tonsil is characterized by significant density, regional adenopathy is absent. The affected tonsil within a few months reaches gigantic sizes and ulcerates. During this period, the tumor infiltrates all surrounding tissues - the palatine arches, soft palate, pharyngeal walls and penetrates into the parapharyngeal space, where it affects the vascular-nerve bundle. The spread of the disintegrating bleeding tumor in the dorsal-caudal direction causes a violation of swallowing, breathing and voice formation and soon leads to forced tracheotomy. Progression of the disease leads to metastasis of the tumor to the cervical lymph nodes, which reach significant sizes. Death usually occurs when internal organs are damaged by progressive cachexia, with the patient suffering agonizingly for several weeks.

The prognosis for malignant tumors of the tonsil varies from favorable (in limited initial forms without metastases) to pessimistic (in the presence of metastases and tumor extraterritorialization).

Treatment is surgical (extended tonsillectomy at the initial stage followed by radiation therapy), or in inoperable cases - radiation therapy in combination with chemotherapy and symptomatic treatment.

Malignant tumors of the posterior pharyngeal wall

These are mainly epithelial cancers, which ulcerate rapidly and metastasize early, often bilaterally, to the jugular-carotid lymph nodes. Connective tissue tumors are represented by reticulosarcomas and lymphosarcomas.

Subjectively, the patient feels a foreign body in the throat for a long time, then spontaneous pains radiating to one or both ears join in. Pharyngoscopy reveals a more or less widespread reddish-gray ulcer on the back wall of the throat, covered with granulation tissue, painful to the touch. The tumor can also develop on the lateral wall of the throat, causing unilateral adenopathy. Without treatment, the ulcer spreads in all directions. X-ray therapy leads to a temporary cure, but subsequently relapses occur in adjacent tissues and organs (root of the tongue, pyriform sinus, etc.), in rare cases, metastases occur in distant organs (lungs, liver, bones).

Lymphosarcoma and reticulosarcoma are rare and occur mainly in young people. These tumors ulcerate in the pharynx much earlier than in other parts of the upper respiratory tract and metastasize early to regional lymph nodes. They have significant radiosensitivity and can be completely destroyed at early stages using radiation therapy methods. Electrocoagulation is used for post-radiation relapses, and regional lymph nodes are removed after the primary lesion has been cured.

Malignant tumors of the laryngopharynx

These tumors can be closely related in origin to tumors of the oropharynx, larynx, and initial section of the esophagus. Endoscopic examination often fails to determine the initial point of tumor growth, since it can simultaneously originate from the transition sites of the lower pharynx to the vestibule of the larynx or the entrance to the esophagus. The lower pharynx is limited above by the projection of the hyoid bone and below by the entrance to the esophagus. According to St. Gorbea et al. (1964), for diagnostic, prognostic, and therapeutic purposes, this space can be divided into two sections separated by an imaginary plane intersecting the upper horns of the thyroid cartilage. The upper section is structurally represented by membranous tissue bordering internally on the aryepiglottic folds, anteriorly on the thyrohyoid membrane, and laterally on the pharyngeal-epiglottic fold. This part is spacious enough for visual examination, and the tumors that arise in it have significant radiosensitivity. The lower part is narrow, has the form of a groove going from top to bottom, bordering on the inside on both sides with the arytenoid cartilages, and in front - with the lower horns of the thyroid cartilage. This area is difficult to visualize, morphologically it is represented by fibrocartilaginous tissue and has a relatively high radioresistance. Cases of early diagnosis of a malignant tumor in this area are rare, since minor symptoms in the form of a sore throat, urge to cough are often attributed to a smoker's "syndrome" or some professional hazards. Only after the enlarging tumor begins to cause a violation of voice formation or with an increase in cervical lymph nodes does the patient consult a doctor, however, according to St. Girbea et al. (1964), by this time the tumor is inoperable in 75% of those who seek help. Most often, malignant tumors of the laryngopharynx occur in men after 40 years of age, however, according to foreign statistics, in northern European countries, women are more often affected (up to 60%) with the predominant localization of such tumors in the retroarytenoid and retrocricoid areas. Contributing factors are smoking, alcoholism, harmful professional aerosols, syphilis.

Pathological anatomy of malignant tumors of the laryngopharynx

Macroscopically, the tumor has the appearance of an infiltrate, the development of which can acquire ulcerative, proliferative or mixed forms. Most often, the tumor is epithelial in nature, much less often - connective tissue. The starting point of the tumor can be the free part of the epiglottis, the anterior angle and wall of the pyriform sinus, the retroarytenoid and retrocricoid areas, the posterior wall of the lower pharynx. However, in most cases it is not possible to determine the starting point of tumor growth, since the patient consults a doctor at such a stage of the process development, in which the tumor occupies a fairly large space.

In malignant tumors of the laryngopharynx, metastases to the cervical lymph nodes are almost inevitable. Most often, metastases affect the lymph nodes of the jugular vein and those located on the cricothyroid membrane. Sometimes solitary lymph nodes appear, located in the area of the large horn of the hyoid bone. In the advanced stage, the lymph nodes fuse with the surrounding tissues through periadenitis and form massive conglomerates of fused lymph nodes affected by metastases. In untreated cases, the lymph nodes disintegrate along with the adjacent tissues. The jugular nodes, when disintegrating and infected, damage large vessels and cause fatal erosive bleeding. Metastasis occurs in the liver, lungs and bones of the skull.

Symptoms of malignant tumors of the laryngopharynx

The clinical course is divided into several periods, which smoothly transition from one to another. The characteristics of these periods are of great importance for the diagnosis and prognosis of the disease.

The initial period is characterized by minor sensations of irritation in the lower pharynx, dry cough and increased salivation. Difficulty swallowing and transient spasms of the pharynx may be observed. These initial subjective symptoms should be actively identified during the anamnesis, since the patient himself may not attach much importance to them, focusing only on the cough as a phenomenon that almost all tobacco smokers and drunkards suffer from without exception. In this period, hypopharyngoscopy most often does not reveal any suspicious formations. In some cases, accumulations of saliva can be seen on the pharyngeal-epiglottic fold on one side, or on the same side, accumulation of saliva in the pyriform sinus. If the tumor originates from the entrance to the esophagus, then with direct laryngoscopy, its spasm can be observed, which quickly passes when this area is lubricated with a cocaine solution.

The period of the developed process is characterized by pronounced subjective symptoms: sharp pain when swallowing, spontaneous pain at night, violent salivation, increasing swallowing and voice formation disorders, often sudden aphonia, putrid odor from the mouth (decay and secondary infection of the tumor), general weakness, anemia, weight loss due to refusal to eat. Respiratory disorders arising from tumor infiltration of the laryngeal walls and their compression predetermine preventive tracheotomy.

Diagnosis of malignant tumors of the laryngopharynx

Laryngoscopy reveals secondary damage to half of the larynx by an infiltrate originating from the lower parts of the pharynx, the vocal fold on the affected side is immobile, there is swelling of the surrounding tissues, obstruction of the pyriform sinus, and accumulation of a large amount of saliva. When examining the anterior surface of the neck, its contours are smoothed on the affected side due to enlarged lymph nodes, which are palpated as enlarged packets along the entire lateral surface of the neck.

The terminal period does not differ from that of malignant tumors of the nasopharynx and tonsils; the only difference may be that such patients undergo early tracheotomy and usually die earlier.

The prognosis is mostly pessimistic. Patients die from erosive bleeding from large vessels of the neck, secondary infectious complications, cachexia.

Diagnosis is difficult only in the initial period, but even detection of a tumor at an early stage does not significantly optimize the prognosis, since tumors in this area metastasize early and often do not respond to radical treatment even with the most modern methods of radiation therapy.

The main methods for recognizing tumors of the laryngopharynx are endoscopy, biopsy and radiography.

Malignant tumors of the laryngopharynx should be differentiated from secondary lesions of the laryngopharynx by a laryngeal tumor, which has its own characteristics. Malignant tumors of the laryngopharynx are also differentiated from the infiltrative phase of syphilis of the pharynx (absence of pain), tuberculosis, benign tumors of the pharynx, and diverticula of this area. The decisive link in diagnostics is biopsy and histological examination.

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Treatment of malignant tumors of the laryngopharynx

Treatment of malignant tumors of the laryngopharynx in modern conditions is usually combined - surgical and radiation. Before surgical intervention, as a preoperative preparation, D.I. Zimont (1957) proposed performing bilateral ligation of the external carotid arteries, which ensured the cessation of the flow of substances feeding the tumor and "bloodless" removal of the tumor.

According to the author, this method helps in some cases to convert an inoperable tumor into an operable one, provided that radiation therapy is subsequently used.

Malignant tumor of the larynx was first described by the outstanding Italian anatomist D. Morgagni. Much time has passed since then, the study of laryngeal cancer has received worthy development, however, even in our time this disease is far from rare, affecting people in the prime of life. And it is not known where the greater danger lies - in the disease itself, early recognition of which in most cases with modern achievements in the field of treatment leads to recovery, or in human carelessness, and sometimes elementary medical illiteracy, due to which patients seek medical help in advanced forms, when the prognosis becomes either questionable or very serious.