Laryngeal tumors

Of the benign tumors of the laryngopharynx, the most common are papilloma, somewhat less common are hemangioma, and rare are neoplasms developing from muscle tissue (leiomyoma, rhabdomyoma), neuroma, fibroma, etc.

The laryngopharynx is much less frequently than the larynx the primary localization of the tumor process. For malignant tumors of the laryngopharynx the exophytic form of growth is most typical. Infiltratively growing tumors are prone to rapid ulceration, although an exophytic tumor often disintegrates and ulcerates.

The most common initial site of a laryngopharyngeal tumor is the medial wall (lateral surface of the aryepiglottic fold) of the pyriform sinus. Neoplasms of this localization penetrate into the larynx quite quickly. Somewhat less often, the tumor originates from the anterior wall (anterior angle of the pyriform sinus - the place where the medial wall transitions to the lateral wall) of the pyriform sinus. Along the anterior wall, the tumor spreads upward toward the epiglotopharyngeal fold and downward to the cervical esophagus. As with localization on the medial wall of this sinus, the tumor can penetrate into the larynx and the anterior surface of the neck. Even less often, neoplasms originate on the lateral wall of the sinus.

Less common are tumors of the posterior wall of the laryngopharynx and the retrocricoid region. Neoplasms that arise on the posterior wall of the laryngopharynx often grow exophytically, slowly spreading upward and downward, reaching the oropharynx at the top, the mouth and the cervical esophagus at the bottom. The process does not spread to the spine for a long time, the tumor spreads along the prevertebral fascia. This fact should be taken into account when deciding on the possibility of surgical treatment. From the retrocricoid region, the tumor quickly descends to the cervical esophagus, and through the esophagus - forward to the trachea.

Symptoms laryngeal tumors

The most common symptoms of benign tumors of the laryngopharynx in this location are signs of dysphagia - a sensation of a foreign body, difficulty swallowing. Pain is not typical for these tumors. Pain may bother the patient only with some types of neurinoma. Hemangiomas may cause bleeding from the pharynx. Reaching large sizes, the neoplasm can compress and cover the entrance to the esophagus, narrow the lumen of the larynx (if the tumor is located at the entrance to the larynx). Narrowing of the entrance to the larynx leads to difficulty breathing.

Symptoms of malignant tumors of the laryngopharynx

Most patients associate the onset of the disease with the sensation of a foreign body in the throat, less often the first sign is pain. At first, these are mild pain sensations that bother patients mainly in the morning when swallowing saliva. Gradually, the pain intensifies and occurs not only when swallowing saliva, but also when eating. Since neoplasms of the laryngopharynx quite quickly affect the larynx, symptoms of laryngeal damage are added to the symptoms of dysphagia: hoarseness, choking, coughing, difficulty breathing. With the disintegration of the tumor, an unpleasant odor from the mouth and an admixture of blood in the sputum appear.

Diagnostics laryngeal tumors

The diagnosis of benign tumors of the laryngopharynx is established on the basis of anamnesis data (sequence of symptoms, duration of the disease), results of hypopharyngoscopy (direct and indirect), fibroscopy, radiography and other radiation examination methods (CT, MRI). Biopsy with subsequent histological examination is of decisive importance in determining the type of tumor (its histological structure).

Diagnosis of laryngopharyngeal tumors is more difficult than that of oropharyngeal tumors. The patient's age and sex, the presence of bad habits, professional or industrial hazards, the duration of the disease, and the presence of precancerous conditions are important. All this information can be obtained by studying the anamnesis.

It is difficult to establish a correct diagnosis with a limited tumor process on the anterior and outer walls of the pyriform sinus, as well as in the retrocricoid region. The first symptoms are often regarded as an exacerbation of chronic pharyngitis or tonsillitis. Patients sometimes persistently complain of a sensation of a foreign body in the throat. This symptom is not always given due importance, since it often occurs in pharyngitis, diseases of internal organs, and some disorders of the nervous system. The tumor infiltrates the walls of the pyriform sinus, and even if it is not yet possible to determine it, in some patients indirect signs of damage can already be detected: asymmetry of the pyriform sinuses, accumulation of saliva on the affected side.

Disruption of food passage is observed only in advanced processes, when the tumor occupies both pyriform sinuses or has spread downwards to the “mouth” and cervical part of the esophagus.

Instrumental research

Auxiliary diagnostic methods are radiography, CT and MRI of the laryngopharynx and cervical esophagus, as well as contrast fluoroscopy. With the help of these research methods, it is possible to determine the spread of the process to the esophagus, trachea, and cervical spine. Hypopharingoscopy with the use of optics and a fiberscope is of great importance in the diagnosis of laryngopharynx tumors.

The final diagnosis is established based on the results of histological examination of the material obtained during biopsy. In some cases, direct hypopharyngoscopy or fibroscopy must be performed when performing a biopsy.

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Treatment laryngeal tumors

Treatment of benign tumors of the laryngopharynx is surgical. Small neoplasms on a thin base (pedicle) can be removed endopharyngeally by direct or indirect pharyngoscopy using a microscope. Large tumors located deep in the tissues (neurinomas, leiomyomas, rhabdomyomas, etc.) are removed through external access, which is achieved by using various pharyngotomy methods. Cryotherapy can be successfully used for diffuse hemangiomas.

Treatment of patients with malignant tumors of the laryngopharynx. despite certain successes of surgical and radiation treatment, does not give good results. Radiation therapy for tumors of the laryngopharynx is ineffective.

Often, when the tumors of the laryngopharynx spread to the larynx, large interventions in terms of the volume of tissue removed are performed: laryngectomy with circular resection of the pharynx. The operation can be expanded by resecting the root of the tongue, the cervical part of the esophagus, and the trachea. The intervention is completed by forming a pharyngostomy, orostomy, esophagostomy, and tracheostomy. Subsequently, it is necessary to perform plastic surgery of the esophageal tract. F. G. Sarkisova (1986) believes that it is possible to leave half of the larynx in non-spreading tumors of the pyriform sinus.