Throat cancer — a malignant tumor of a throat of mainly planocellular character. Depending on an arrangement and prevalence throat cancer can be shown by violation of a voice, respiratory frustration (short wind, a chronic and sharp stenosis of a throat), a dysphagy, a pain syndrome, cough, symptoms of a cancer kakheksiya. The main methods allowing to diagnose throat cancer are the laringoskopiya, a X-ray analysis and KT of a throat, an endoscopic biopsy of a mucous throat and a biopsy of regionarny lymph nodes. Cancer therapy of a throat consists in carrying out radical operation (a resection of a throat or a laringoektomiya), radiation therapy and restoration of voice function, the chemotherapy is sometimes applied.
Throat cancer is quite widespread oncological disease. In the general structure of malignant tumors 2,6% of cases fall to its share. Among malignant new growths of the head and neck on occurrence frequency throat cancer wins first place. Patients with throat cancer make about 70% of all patients with cancer diseases of the top airways. Throat cancer affects mainly males, 9-10 men are the share of 1 sick woman. Most often throat cancer occurs at men at the age of 65-75 years, at women — in 70-80 years.
Causes of throat cancer
Throat cancer, as well as other malignant tumors, results from malignant regeneration of initially normal cages. Among the factors capable to provoke this process, allocate tobacco smoking, abuse of alcohol, existence of chronic inflammatory diseases (chronic laryngitis, laryngotracheitis, pharyngitis, syphilis), professional to harm (work on production of asbestos, nickel, sulfuric acid). The combined impact on tissues of a throat of alcohol and tobacco smoke which is also capable to cause growth of benign tumors of an oral cavity, developing of cancer of language, a lip, cheek, etc. is considered the most dangerous.
Throat cancer can develop as a result of malignant transformation of some benign tumors of a throat (for example, it is long the existing papillomas) and a throat leukoplakia. In some cases throat cancer is a consequence of distribution of tumoral process at throat cancer.
Classification of throat cancer
In otolaryngology throat cancer is classified depending on its histologic type, localization, the nature of growth, a stage of prevalence of a tumor, and also by the international TNM system. If to speak about a histologic form, then in 95% throat cancer is planocellular cancer, 2% are made by ferruterous cancer, another 2% - a bazalioma, 1% is the share of others, seldom meeting, cancer types. Throat cancer can have ekzofitny, the endofitny (infiltrative) and mixed nature of growth.
On a topographical sign allocate throat cancer top (70%), an average (28%) and lower (2%) department. Throat cancer located in its top department can be localized on a nadgortannik, throat ventricles, cherpalonadgortanny folds. Usually it arises on the one hand, but quickly extends to other party. At a tumor arrangement in throat ventricles it quickly blocks a throat gleam, being the reason of disorders of breath and a fonation. Throat cancer affecting it average department is most widespread. As a rule, the tumor is only on one voice sheaf. In an initial stage it leads to violations of a phonation that promotes earlier diagnosis of throat cancer of this localization. Throat cancer affecting its lower departments (subdepository space) in most cases differs in intensive infiltrative growth and for a short time occupies the opposite side.
On prevalence of tumoral process in clinical practice throat cancer is subdivided into 4 stages. To the I stage there corresponds the limited throat cancer which is localized within mucous or a submucous layer of one anatomic area of a throat. The II stage is characterized by tumoral process which completely strikes one department of a throat, but does not go beyond its limits and does not spread. Throat cancer of IIIA of a stage is followed by distribution of process on the subject fabrics that leads to restriction of mobility of a throat. Stages in malignant process are involved in IIIB the next departments of a throat and/or regionarny lymph nodes. Throat cancer of the IV stage affects the most part of a throat, passes to the next bodies and/or gives the regionarny and remote metastasises.
Throat cancer symptoms
The clinic of cancer damage of a throat depends on localization of process and its prevalence. According to it throat cancer can have various symptomatology, sequence of emergence and degree of a proyavlennost of the main symptoms.
Violations of a voice arise in an initial stage of throat cancer if it is localized in the field of voice folds. If throat cancer is located in other departments, disorder of voice function is observed in later period and is connected with distribution of malignant process. Violations of a voice at throat cancer are usually shown by its hoarseness or an osiplost. Their distinctive feature is constant character without the periods of improvement of a voice which are observed at neyropatichesky and functional paresis of a throat. At patients with throat cancer gradual progressing of hoarseness is noted, the voice becomes more and more dim and can disappear absolutely.
Respiratory violations most early develop at throat cancer in the lower department. If throat cancer is limited to a voice sheaf, then violations from breath can arise only in several months or even in a year after the beginning of tumoral growth. At cancer of the top department of a throat respiratory violations also appear in later widespread stage. They are characterized by gradually accruing short wind arising at first at physical activity and then and at rest. Gradual narrowing of a gleam of a throat in process of growth allows an organism to adapt to the arising hypoxia. Thus, at throat cancer the clinical picture of a chronic stenosis of a throat develops. On its background at influence of adverse factors (a SARS, an allergy, secondary infection) there can be a sharp stenosis of a throat.
The pain syndrome is observed at throat cancer in the top department and at widespread tumoral processes. It can be connected with disintegration and an ulceration of a cancer tumor. Quite often at throat cancer is followed by irradiation of pain in an ear and its strengthening when swallowing. The expressed pain syndrome forces patients to refuse with throat cancer food.
Cough at throat cancer has a reflex origin. In certain cases it is followed by the attacks typical for a false croup. Cough happens to allocation of a small amount of a mucous phlegm. At disintegration of throat cancer or an ulceration in a phlegm blood streaks are observed. At the widespread nature of throat cancer locking function of a throat suffers and there is a hit of food in a throat and a trachea that causes an attack of unrestrained painful cough.
The general symptoms of throat cancer are caused by cancer intoxication and arise at considerable prevalence of tumoral process. Pallor, increased fatigue, the general weakness, headaches, sleep disorders, anemia, considerable weight loss concern to them.
Metastasis. Throat cancer from the top department spreads in the top jugular lymph nodes, throat cancer of the lower department — in peritrakhealny and lower jugular lymph nodes. Throat cancer of the top department (35-45%) is followed by the most often regionarny metastasises, at cancer of the lower department of a throat regionarny metastasises are noted in 15-20% of cases. Because of poorly developed network of lymphatic vessels of average department of a throat throat cancer located in it late and seldom gives metastasises in regionarny lymph nodes. The remote metastasis at throat cancer is observed rather seldom. In 4% of cases throat cancer spreads in lungs with development of cancer of lung, 1,2% are the share of metastasises in a liver, a gullet and bones. Throat cancer metastasises in a brain, a stomach and intestines are observed extremely seldom.
Diagnosis of throat cancer
Early diagnostics has the defining value in the forecast and success of cancer therapy of a throat. In this regard survey by the otolaryngologist of each man with hoarseness of a voice or cough of not clear genesis is necessary if they remain more than 2-3 weeks. The symptoms guarding concerning throat cancer are also feeling of a foreign matter in a throat, the ear pains which are not followed by otoskopichesky changes, increase in lymph nodes of a neck.
Previously the careful laringoskopiya allows to diagnose throat cancer. The revealed endoscopic changes at throat cancer can have the most various character. In case of an epitelioma of a voice sheaf the limited education which is affecting only one ligament and having a hillock appearance comes to light. In other cases throat cancer can be defined as the widespread education with a hilly surface having reddish coloring. Infiltrative throat cancer is characterized by a thickening of a voice sheaf and its bleeding when sounding. In some cases throat cancer has a polipoobrazny appearance. The education biopsy made during a laringoskopiya helps to establish the exact diagnosis. If the histologic research does not reveal cancer cells, and the clinical picture testifies in favor of throat cancer, then performing intraoperative diagnostics is possible.
Additional methods in diagnosis of throat cancer are the researches of voice function allowing to estimate mobility of vocal chords, a shape of a glottis and so forth. The stroboskopiya, an elektroglottografiya, a fonetografiya concern to them. Prevalence of throat cancer is estimated by means of a X-ray analysis and MSKT of a throat. Existence of metastasises in tissue of a neck is revealed by means of ultrasonography. Make a biopsy of a lymph node for definition of regionarny metastasis.
Cancer therapy of a throat
Medical actions at throat cancer are directed to full removal of a tumor and restoration of golosoobrazuyushchy and respiratory function of a throat. The choice of medical tactics concerning throat cancer depends on a location of a cancer tumor, its borders and prevalence, existence of germination in the next structures and metastasis, radio sensitivity of tumor cells.
Radiation therapy. Throat cancer on average department differs in high radio sensitivity. Therefore throat cancer of this localization treat, since radiation therapy. If as a result of a course of beam influence the tumor decreases twice, then the course of preoperative radiation can be repeated. However in that case there is a danger of emergence of complications after operation. Beam influence as the initial stage of treatment, apply also at throat cancer of the I-II stage located in its top and lower department. Radiation therapy of throat cancer is carried out in usual conditions and in combination with hyperbaric oxygenation which strengthens the damaging impact of radiation on cancer cells and reduces damage of healthy fabrics.
Chemotherapy. Cancer therapy of a throat of the III-IV stage, located in the top department begins with chemotherapy. At throat cancer which is localized on average and lower departments, the chemotherapy is ineffective.
Surgical cancer therapy of a throat is carried out no later than in 2 weeks after radiation therapy as 14 days later after the end of beam influence restoration of cells of tumor begins. Organ-preserving resections of a throat, a gemilaringektomiya are effective at the I-II stage of throat cancer. For the purpose of the prevention of a postoperative stenosis of a throat during operation the expanding endoprosthesis which removal is made 3-4 weeks later after operation is entered into it. Throat cancer of the III-IV stage is the indication to a laringektomiya. At cancer of the lower department of a throat of the III-IV stage radiation therapy can be complicated by a sharp stenosis. Therefore treatment is begun with a laringektomiya at once, deleting during operation of 5-6 top rings of a trachea, and radiation therapy is appointed after operation. If throat cancer is followed by regionarny metastasis, then operation is supplemented with excision of cervical cellulose and lymph nodes. If necessary make a resection of the anatomic formations of a neck involved in tumoral process ( - a clavicular and mastoidal muscle, an internal jugular vein).
Restoration of voice function after the carried-out laringektomiya is the important task helping the patient to keep the professional and social status with throat cancer. This task is reached by installation of a voice artificial limb and the subsequent occupations with the doctor-foniatorom.
Forecast and prevention of throat cancer
Without treatment throat cancer proceeds within 1-3 years, in certain cases and is longer. Patients with fate of a throat perish from asphyxia, a cancer kakheksiya, arrozivny bleeding at spread of a tumor on large vessels of a neck, bronchopulmonary complications (pneumonia of infectious character, aspiration pneumonia, pleurisy), the remote metastasises. Five-year survival after the carried-out treatment at patients with throat cancer of the I stage makes 92%, with cancer of the II stage — 80%, the III stages — 67%.