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

Malignant tumors of the pharynx are a rare otolaryngological disease. According to statistical data of the mid-20th century, obtained at the Leningrad Oncology Institute, out of 11,000 cases of malignant tumors of different locations, only 125 were pharyngeal tumors. Malignant tumors of the pharynx can develop from all layers forming this organ.

From the superficial epithelial layer develops cancer (malignant epithelioma), from the mesenchymal layer supporting the epithelial and lymphoid layers, sarcomas of connective tissue and lymphoid origin develop. Along with ethane kinds of malignant tumors, melanosarcomas and teratomas can arise in the pharynx.

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

Malignant neoplasm of nasopharynx

Malignant tumors of the nasopharynx in the overwhelming majority of cases (80-95%) arise: in males, with sarcomas - at a younger age, epitheliomas - in older age. According to some sources. Sarcomas occur more often in women. According to foreign statistics, the people of the so-called yellow race are sicker than the representatives of other peoples.

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

The period of a debut can be manifested by several clinical symptoms. Most often, which is especially characteristic of lymphoepithelioma. There are phenomena of adenopathy, manifested in the internal jugular lymph nodes, which acquire a woody density and are welded to the neurovascular bundle. Simultaneously there are signs of obturation of the auditory tube, manifested by a decrease in hearing on one or both ears, autophony, noise in the ear, which is due to the spread of the tumor into the nasopharyngeal opening of the auditory tube. Propagation of the tumor in the direction of the khohan causes difficulty in nasal breathing, first unilateral, then bilateral. In this period, neuralgic pains begin, most often manifested first by intermittent, then by persistent otalgia. Most often, the signs of the debut period are under the sign of various banal diseases (catarrhal, inflammatory, allergic, etc.) and attract attention as signs of cancer only when the patient begins to make complaints about the 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 be recognized only with the help of MRI.

The period of the developed state is characterized by the fact that all the signs of the debut period listed above acquire a significant intensity and the tumor is fairly easily detected both in the posterior and anterior rhinoscopy, depending on the direction of its growth. The tumor, depending on the morphological structure, has either the form of a bleeding papillomatous formation with a ulcerated surface (cancer) or a dense diffuse formation on a wide base (sarcoma). Emerging pain in the ear, in the nasopharynx, in the deeper parts of the base of the skull acquires the character of paroxysms, which practically do not lend themselves to the action of analgesic agents. At the neck palpable bags of dense lymph nodes, soldered to the underlying tissues with moving skin above them.

In this period, X-ray diagnostics becomes particularly important, because by its results it is possible to judge the prevalence of the tumor and determine the treatment tactics and prognosis. Thus, in the lateral photographs, a tumor that grows into the sphenoid sinus and the Turkish saddle can be detected, the details of the base of the skull and the changes due to the spread of the tumor are visualized in the axial projections of Hirsch, with respect to the basal apertures of the skull (the posterior lacerated, oval and round).

The period of tumor extrarritization is characterized by the spread of the tumor beyond the anatomical formation in which it originated. Its growth mainly occurs along the "line of least resistance", i.e., it sprouts into the surrounding cavities, then into soft tissues and, finally, destroys the bone tissue. When spreading in the cranial direction, the tumor, penetrating the sphenoid sinus and the cells of the latticed bone, can destroy the bottom of the Turkish saddle and the trellis plate and penetrate into the middle and anterior cranial fossa, in which growth does not encounter any obstacles. Rapidly appearing phenomena of increased intracranial pressure (headache, vomiting, bradycardia, etc.), signs of retrobulbar lesions (loss of vision, blindness), focal symptoms due to cranial nerve damage, and mental disorders. When the invasion in the lateral direction when penetrating into 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 of the branching region of the first branch of the trigeminal nerve and persistent otalgia arise. When the tumor spreads in the oral direction, it, penetrating through the choana, affects the anterior paranasal sinuses and orbit. Significantly less often, the tumor spreads in the caudal direction, that is, 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, can prolapse through the posterior laceration in the posterior cranial fossa and affect the caudal group of cranial nerves - IX, X, XI and XII. In addition to these nerves, invasion of the tumor into the cranial cavity can affect other cranial nerves, for example I, II, III, IV, V, VI, VII, which causes the so-called neurological form of the malignant tumor of the nasopharynx. Information on the clinical picture of lesions of the cranial nerves can be obtained in the books "Clinical Vestibulosis" (1996) and "Neurotoxrinolaringology" (2000).

The terminal period in terms of duration depends on the localization and degree of malignancy of the tumor. It is not so prolonged with malodifferentiated sarcomas and teratomas and their invasion into the cavity of the skull, metastases to the lungs and liver. Epitheliomas that propagate in the direction of the oropharynx differ in the same transient development of the terminal state. Tumors of the tubular direction, which for months can only manifest themselves with a puncture of the ear and noise in it, evolve more slowly. Ulcers and secondarily infected tumors are characterized by accelerated evolution. Persons at a young age, if they have 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, cachectic and die usually from intracranial complications, secondary infections or profuse arthrosis bleeding in the defeat of large cerebral, cervical, pulmonary or abdominal blood vessels.

Diagnosis of malignant tumors of the nasopharynx

Diagnosis is effective only at the stage of debut and at the very beginning of the period of the developed state, when the combined treatment applied can either heal the patient or extend his life for 4-5 years. However, in practice, patients most often fall into the field of vision of an ENT oncologist during the period of the developed state, when both metastasis and extrarritization of the tumor are not excluded. In these cases, treatment becomes long, painful with frequent relapses and in a significant number of cases ends in vain.

The success of early diagnosis of nasopharyngeal tumors, in contrast to tumors of other airways that are well visualized, must first of all be based on the oncologic alertness of the doctor, to which the patient refers, for example, with complaints such as unresponsive nasal congestion, hearing loss it is an ear for air conduction with good tissue, constant noise in this ear and nasal congestion on the same side, as well as persistent headaches, pain in the depth of the nose, increased fatigue and etc. It is not always possible to see the swelling of the nasopharynx at the usual back rhinoscopy. The use of modern video endoscopy significantly simplifies the task of early diagnosis, but it is important not even this, but in time to suspect the presence of a tumor. Such patients should conduct appropriate laboratory tests, appropriate X-ray examination, but even better CT or MRI. After all these measures, an initial biopsy or a preoperative biopsy is possible.

To differentiate malignant tumors of the nasopharynx follows from syphilitic gum, whose infiltrative forms are very similar to sarcomas, therefore in all cases of suspicious neoplasm of nasopharynx it is necessary to carry out serological tests and histological examination of the biopsy specimen.

Pott's disease with suboccipital localization differs from a malignant tumor of the nasopharynx in that the tumor arising in the region of the posterior nasopharyngeal wall (the result of the curdled disintegration of the vertebral body) is determined by palpation in the form of a fluctuating swelling of a soft consistency, while any malignant tumor has a certain density and there is no symptom fluctuations. Radiographic examination of the spine at this level is shown, which in the case of Pott's disease reveals destructive changes in the corresponding bone structures of the spine.

The ulcerative-proliferative form of lupus is similar in appearance to a disintegrating cancerous tumor. Such signs as uneven and raised edge of the ulcer, the spread of the lesion to the oropharynx, the pallor of the mucous membrane allow only suspicion of the presence of lupus. The final diagnosis is established by histological examination.

Often in children at the initial stages of a tumor, the nasopharynx is taken as an adenoid, and the tubar and auditory abnormalities that are usually observed in adenoid outgrowths do not contribute to the establishment of a true diagnosis.

To differentiate malignant tumors of the nasopharynx follows from numerous types of tumors of the base of the skull, as well as from lymphoid proliferation, sometimes occurring in the nasopharynx in the course of leukemia. A comprehensive examination of the patient in such cases makes it possible to differentiate the true tumor from the indicated lymphoid formations.

[5], [6], [7], [8], [9],

Treatment of malignant tumors of the nasopharynx

Treatment of malignant tumors of the nasopharynx is an extremely difficult and ungrateful task, an exhaustive or partial solution of which can be achieved only at the very beginning of the disease. Attempts at surgical treatment in the last century, in most cases, did not give a positive result: the impossibility of a radical tumor removal due to its early germination into bone tissue, a latticed labyrinth and a sphenoid sinus, the proximity of vital anatomical formations, inevitable relapses, the actual "lump" of the tumor, leading to a massive metastasis - all this made the leading rhinosurgeons abandon surgical treatment and confine themselves to non-operative methods of treatment (curie and deep radiotherapy, cobalt therapy, chemotherapy), the effectiveness of which with timely diagnosis and comprehensive treatment is quite acceptable.

Malignant tumors of the oropharynx

These tumors arise in a space bounded above by the projection of the hard palate on the back wall of the pharynx, from below - by the level of the root of the tongue. In this space, malignant tumors can arise from any tissue and anywhere, but the preferred location is palatine tonsils, soft palate and, rarely, the posterior wall of the pharynx.

Malignant neoplasm of tonsil

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

Pathological anatomy. Malignant tumors of the tonsils are divided into epithelial, connective tissue and lymphoreticular. Varieties of these classes of tumors are reflected in the classification below (but foreign publications).

Classification of malignant tumors of palatine tonsils

• Epithelioma:
  • epithelioma of the cover epithelium of the spinocellular type;
  • epithelioma of the trabecular spinocellular type of the metatype structure;
  • epitheliomas of undifferentiated cell structure;
  • epithelioma is horny.
• Lymphoepithelioma.
• 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;
  • retikloidotiosarcoma;
  • reticulofibrosarcoma;
  • reticulo-enamel (G.Ardoin).

Epitheliomas of the amygdala 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 passes unnoticed, and the cancer of the amygdala remains unnoticed for a long time. The first clinical manifestations occur when the tumor extends beyond the amygdala bed and metastasizes into the regional lymph nodes. It is the appearance of a dense tumor-like formation in the angle of the lower jaw that attracts the attention of the patient, and then he "remembers" also that he is troubled by slight pain in the pharynx, worse when swallowing and giving in the ear on the same side. And only after that the patient turns to the doctor, before which can appear three different forms of the disease:

• ulcerous in the form of a rounded crater with uneven edges, the bottom of which is covered with granule formations of bright red color;
• proliferative, resembling a blackberry berry, red, on a wide, deeply penetrating parenchyma of the amygdala base;
• cryptogenic, also reminiscent of the blackberry, red color, clogs the crypt.

These forms can escape from the attention of the physician in a cursory superficial examination and go for chronic caseous cryptogenic tonsillitis. However, the unimpeded introduction into the crypt of a buttoned probe that easily penetrates the parenchyma of the tonsils, and the coloration of it with blood, should awaken the onlooked doctor's sleepiness, which must be crowned with a decisive action-sending the patient to the ENT oncologist.

At a more advanced stage, when the amygdala reaches a considerable size, dissonant with the size of the opposite tonsil, the otalgia becomes permanent. The development of a tumor deep in the crypt leads to a significant increase in the volume of the amygdala, while the soft palate shifts in the opposite direction, the remaining crypts gap, and the amygdala itself is stressed, woody in density and painful on palpation. The regional lymph nodes are also enlarged, dense and welded to the underlying tissue. The general condition of the patient on this ethane of the disease remains practically good, which should also alert the doctor, since in chronic caseous tonsillitis patients usually complain of weakness, headaches, increased fatigue.

The terminal period in untreated cases usually occurs after 6-8 months from the first manifestation of the disease. Patient kaheksichen, pale, sharply weakened, otalgia manifests intolerable ear pain. The same pain occurs when swallowing, which causes the patient to refuse food. Usually at this stage the tumor affects the root of the tongue, the entrance to the larynx, the cervical lymph nodes. The latter reach considerable dimensions, impede the movements of the head, squeeze the vascular-neural bundle, which causes stagnant phenomena in the brain. The compression of the enlarged lymph nodes of the last cranial nerves leads to paralysis of the innervated muscles. Affected lymph nodes, decaying, entail deadly, arrosive bleeding from large cervical vessels.

Lymphosarcoma of the amygdala in the debut stage is manifested by an increase in the volume of this lymph node-adonate organ. Until the tumor has reached a certain size, it does not cause the patient any disorders. Then there are disorders of breathing and swallowing, and later - violation of voice formation. Only after the appearance of packets of enlarged lymph nodes on the neck does the patient consult a doctor. With pharyngoscopy, asymmetry of the pharynx is revealed, due to a significant increase in one of the tonsils, often in a ratio of 3: l. The surface of the affected tonsil is smooth, sometimes lobular, pink or red, soft-elastic consistency, unlike epithelioma, which gives the almond woody density. The peculiarity of the sarcoma of the palatine tonsil is that long, unlike the tonsil cancer, the swallowing movements remain painless, which often confuses the doctor, since the palate of the palatine tonsil also proceeds painless. Along with the growth of the tonsil, regional adenopathy develops. The chain of lymph nodes extends from the submandibular region, along the anterior margin of the sternocleid-mastoid muscle to the clavicle. Lymph nodes of soft-elastic consistency, painless.

The slow onset of lymphosarcoma lasts until there is a significant lesion of the lymph nodes, further the flow is very rapid. The palatine tonsil reaches considerable dimensions and blocks the pharynx; breathing, swallowing and voice formation are greatly hampered. At the same time, there are disturbances in the function of the auditory tube. Very quickly, the tumor becomes covered with ulcers and again becomes inflamed. The body temperature rises, the general condition of the patient progressively worsens. Adenopathy is generalized: pre-tracheal, paravasal, mediastinal and mesenteric lymph nodes increase. A sharp increase in otalgia. Mediastinal lymph nodes with 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 diagnosis of lymphosarcoma of the palatine tonsil is carried out with banal hypertrophy of one of these glands, which has an external similarity with this malignant tumor. In these cases, the hemogram and myelogram clear the diagnosis. Similar to the lymphosarcoma of the palatine tonsil tuberculous lesion, because the tuberculosis granuloma is accompanied by regional lymphopathy. MW, inoculated into the palatine tonsil, causes its progressive hypertrophy, and only a microscopic examination of the biopsy allows differentiating these two diseases from each other. With syphilis of the pharynx, both tonsils are enlarged in the secondary period, and in the Tertiary period the formation of the amygdala gum is not accompanied by regional adenopathy typical for lymphosarcoma. When differential diagnosis should be borne in mind and tonsillitholithiasis, which, unlike lymphosarcoma, proceeds with pain syndrome. An aneurysm of the internal carotid artery sometimes can simulate a tumor of the retinomandalic region; it has the form of an oblong lump, covered with a normal mucosa and pulsating during palpation.

Reticulosarcoma of the palatine tonsil both in clinical course and in significant radiosensitivity approaches lymphosarcoma. As well as this tumor, reticulosarcoma gives early metastases to the nearest and remote organs, often recurs, despite intensive radiation therapy. Of all the morphological varieties of reticulosarcomas, the greatest malignancy is characterized by teratomas.

Fibroblastic sarcoma of the palatine tonsil is very rare and is characterized by painlessness in the initial period, an increase in one of the palatine tonsils, the surface of which is furrowed and red. Tonsil differs considerable density, regional adenopathy is absent. The affected amygdala reaches a gigantic size for several months and is ulcerated. During this period, the tumor infiltrates all surrounding tissues - the palatine arch, the soft palate, the pharyngeal wall and penetrates the parapharyngeal space, where the vascular bundle strikes. The spreading of a decaying bleeding tumor in the dorsal-caudal direction causes a disturbance in swallowing, respiration and voice formation and soon leads to an induced tracheotomy. Progression of the disease leads to tumor metastasis in the cervical lymph nodes, which reach significant dimensions. Death usually comes with the defeat of internal organs from progressive cachexia in the painful sufferings of the patient for several weeks.

Prognosis for malignant tonsil tumors varies from favorable (with limited initial forms without metastases) to pessimistic (in the presence of metastases and extrarritization of the tumor).

Surgical treatment (advanced tonsillectomy at the initial stage with subsequent radiotherapy), or in inoperable cases - radiation therapy in combination with chemotherapy and symptomatic treatment.

Malignant tumors of the posterior pharyngeal wall

Basically, these are epithelial cancers, rapidly ulcerating and early giving metastases, often bilateral, to the jugular-lumbar lymph nodes. Connective tissue tissues are represented by reticulosarcomas and lymphosarcomas.

Subjectively, the patient feels the presence of a foreign body for a long time in the throat, then spontaneous pains, radiating into one or both ears, join. With pharyngoscopy, a more or less common ulcer of a reddish-gray color, covered with a granulation tissue, is painful in contact with the pharyngeal wall at the back wall of the pharynx. A tumor can also appear on the side wall of the pharynx, with one-sided adenopathy. In the absence of treatment, the ulcer spreads in all directions. X-ray therapy leads to a temporary cure, but later there are relapses in neighboring tissues and organs (the root of the tongue, pear-shaped sinus, etc.), in rare cases metastasises in distant organs (lungs, liver, bones).

Lymphosarcomas and reticulosarcomas are rare and occur mainly in young people. These tumors in the pharynx ulcerate much earlier than in other parts of the upper respiratory tract and early metastasize to the regional lymph nodes. They have significant radiosensitivity and in the early stages can be completely destroyed by the methods of radiation therapy. Electrocoagulation is used for nosiluchevyh relapses, the removal of regional lymph nodes produces after the treatment of the main focus.

Malignant tumors of the larynx

These tumors can be closely related to tumors of the oropharynx, larynx and the initial department of the esophagus. Often, with endoscopic examination, it is not possible to determine the initial point of tumor growth, since it can simultaneously originate from the places of the lower pharyngeal transition to the threshold of the larynx or into the entrance to the esophagus. The lower part of the pharynx is bounded above by the projection of the hyoid bone, from below - by the entrance to the esophagus. By St. Gorbea et al. (1964), in a diagnostic, prognostic and curative plan, this space can be divided into two sections, separated by an imaginary plane intersecting the upper horns of the thyroid cartilage. The upper part is structurally represented by membranous tissue bordering internally with cherpalodnagortan folds, in front with the membrane of the membrane and laterally with a pharyngeal epiglottis fold. This part is quite spacious for visual inspection, and the tumors that arise in it have significant radiosensitivity. The lower part is narrow, has the form of a gutter going from top to bottom, bordering on both sides with arytenoid cartilages, anteriorly with the lower horns of the thyroid cartilage. This area is difficult to visualize, morphologically represented by a fibrous-cartilaginous tissue and has a relatively high radioresistance. Cases of early diagnosis of a malignant tumor in this area are a rare phenomenon, because minor symptoms in the form of perspiration, the urge to cough, are often written off to the "syndrome" of the smoker or any occupational hazards. Only after the growing tumor starts to cause a violation of voice formation or when the cervical lymph nodes increase, the patient consults a doctor, however, according to St. Girbea et al. (1964), by this time in 75% of the treated tumor is inoperable. More often, malignant tumors of the laryngopharynx appear in men after 40 years, however, but in foreign countries, in northern European countries, women (up to 60%) are more likely to suffer from the predominant localization of such tumors in retroarytenoidal and retrocicoidal areas. Contributing factors are tobacco smoking, alcoholism, harmful occupational aerosols, syphilis.

Pathological anatomy of malignant tumors of the larynx

Macroscopically, the tumor has the form of an infiltrate, the development of which can acquire ulcerative, proliferative or mixed forms. Most often, the tumor is epithelial, much less often - connective tissue. The initial point of the tumor can be a free part of the epiglottis, the anterior corner and the wall of the pear-shaped sinus, behind the pterygoid and the posterolentine area, the posterior wall of the lower pharynx. However, in most cases, the initial point of tumor growth can not be determined, since the patient consults a doctor at a stage in the development of the process in which the tumor occupies a large enough space.

In malignant tumors of the laryngopharynx metastasis in the cervical lymph nodes - a phenomenon almost inevitable. Most often, lymph nodes of the jugular vein are affected by metastases and located on the peristonechoid membrane. Sometimes there are solitary lymph nodes, located in the region of the large horn of the hyoid bone. In the advanced stage, the lymph nodes through the periadenitis coalesce with surrounding tissues and form massive conglomerates of fused, metastatic lymph nodes. In untreated cases, the lymph nodes disintegrate together with the surrounding tissues. Jugular knots during decay and infection damage large vessels and cause deadly, arrosive bleeding. Metastasis occurs in the liver, lungs and skull bones.

Symptoms of malignant tumors of the larynx

The clinical course is divided into several periods, which smoothly pass one into another. Characteristic of these periods is of great importance for the diagnosis and prognosis of the disease.

The initial period is characterized by slight sensations of irritation in the lower part of the pharynx, dry cough and increased salivation. There may be difficulty in swallowing and transient spasms of the pharynx. These initial subjective symptoms must be actively identified in the collection of an anamnesis, because the patient himself can not attach special importance to them, focusing only on cough as a phenomenon that affects almost all tobacco smokers and drunkards without exception. In this period, with hypopharyngoscopy, most often no suspicious formations are detected. In some cases, one can see saliva accumulations on the pharyngeal-epiglottis fold on one side, or on the same side a collection of saliva in the pear-shaped sinus. If the tumor originates from the entrance to the esophagus, then with a direct laryngoscopy, one can observe its spasm, which quickly passes when the area is smeared with a solution of cocaine.

The period of the developed process is characterized by pronounced subjective symptoms: severe pain during swallowing, spontaneous pain at night, rapid salivation, increasing disruption of swallowing and voice formation, often sudden aphonia, putrid odor from the mouth (decomposition and secondary infection of the tumor), general weakness, anemia, emaciation due to refusal to eat. Disturbances of respiration arising from the infiltration of the larynx by the tumor and their compression, predetermine a preventive tracheotomy.

Diagnosis of malignant tumors of the larynx

With laryngoscopy, a secondary lesion of the half of the larynx is determined by an infiltrate emanating from the lower parts of the pharynx, the vocal fold on the side of the lesion is immovable, edema of the surrounding tissues, obstruction of the pear-shaped sinus, accumulation of a large amount of saliva. When examining the front surface of the neck, the smoothness of its contours on the side of the lesion is determined by enlarged lymph nodes that are palpated in the form of enlarged packages along the entire side surface of the neck.

The terminal period does not differ from that in malignant tumors of the nasopharynx and palatine tonsils; the difference can only be that such patients produce a tracheotomy early and usually die earlier.

The forecast is mostly pessimistic. Patients die from arrosive bleeding from the major vessels of the neck, secondary infectious complications, cachexia.

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

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

Differentiating malignant tumors of the larynx is due to secondary lesions of the throat part of the pharynx by a tumor of the larynx, which has its own characteristics. Malignant tumors of the larynx are also differentiated from the infiltrative phase of pharyngeal syphilis (absence of pain), tuberculosis, benign pharyngeal tumors, diverticula of this region. The crucial link in diagnosis is biopsy and histological examination.

[10], [11], [12]

Treatment of malignant tumors of the larynx

Treatment of malignant tumors of the larynx is in modern conditions, as a rule, combined - surgical and radial. Prior to surgery as a preoperative preparation, DI Zimon (1957) proposed to perform a bilateral dressing of the external carotid arteries, which provided an end to the supply of tumor-feeding substances and a "bloodless" removal of the tumor.

According to the author, this method contributes in some cases to the treatment of an inoperable tumor in the operable under the condition of the subsequent application of radiotherapy.

For the first time, a malignant tumor of the larynx was described by the outstanding Italian anatomist D. Morgagni. Since then, a lot of time has passed, the doctrine of cancer of the larynx has received a worthy development, however even in our time this disease is far from rare, affecting people in their prime. And it is not known what is the big danger - in the disease, the early recognition of which in most cases, with modern advances in the field of treatment leads to recovery, or in human carelessness, and the elementary medical illiteracy, due to which patients turn to the doctor with neglected forms, when the forecast becomes either questionable or very serious.