Many people have unpleasant symptoms associated with the throat – sore throat, soreness, hoarseness, difficulty swallowing. In most cases, these symptoms are a sign of colds caused by bacteria or viruses. But if such phenomena are observed for a long time and do not pass, then they can indicate a much more dangerous disease – throat cancer.
Description of the disease
Malignant tumors of the throat, fortunately, cannot be considered among the most common cancers. At the same time, such a disease can not be called very rare. Throat cancer occurs in about 4% of cancer patients.
First you need to define the concept of “throat” from a physiological point of view. The throat is the vernacular name of the front half of the neck, located in front of the spinal column. In this place are located both the ways in which oxygen enters the lungs and the ways in which food enters the stomach. Just in the region of the throat, the common path for food and air is divided into two – the esophagus and the larynx, which then passes into the trachea. In addition, blood vessels supplying the brain with blood are located near the throat, and important nerve plexuses run, affecting the functioning of the heart. In the area of the throat is one of the most important endocrine glands – the thyroid gland.
The pharynx is the upper part of the throat, located above the larynx. From a physiological point of view, the pharynx is divided into three sections. Below they are listed in the order of their location, from the highest to the lowest:
Localization of the disease
The disease begins with a small tumor located in the throat, and more specifically, in the layer of epithelial tissue lining the surface of the larynx or pharynx.
If we consider the tumor in the pharynx, then the nasopharynx is most often affected. Such localization of the tumor is especially dangerous, since the tumor can grow into the air cavity of the skull.
Gradually, the tumor grows in size and affects the surrounding tissues. In the final stage of the disease, lymph nodes may be affected, as well as tumor metastasis in other parts of the body. Ultimately, in most cases, the patient dies either from massive bleeding from the blood vessels affected by the tumor, or from aspiration of blood or food.
A tumor can affect different parts of the larynx – lower (below the vocal cords), middle (in the area of the vocal cords) and upper (above the vocal cords).
The overbinding is most often affected (two thirds of the cases). Also, this site is characterized by rapid tumor development and early metastasis.
The ligament division is affected in about a third of cases. As a rule, with such a localization, the tumor develops slowly, which allows it to be detected in time and start treatment.
Subglottic localization occurs infrequently, it is typical for only 3% of cases. Due to the location of this type of cancer is very dangerous, it is characterized by diffuse development.
Of all cases of throat cancer, tumor localization in the larynx occurs in about 55% of cases, in the pharynx in 45% of cases.
From a histological point of view, almost all cases of laryngeal cancer (98%) are squamous cell cancers.
From a morphological point of view, the following types of squamous cell throat cancer are distinguished:
Nonthreshold cancer develops relatively quickly and forms a large number of metastases, actively grows into the surrounding organs. This type of disease is most common. It is usually located in the upper part of the larynx or in the ventricle of the larynx. Often there is the spread of this type of tumor from one part of the larynx to another. Nonthreshold cancer leads to a decrease in the lumen of the larynx, which causes the patient to shortness of breath and loss of voice.
Orogovevaya type of cancer is characterized by the presence of cells that eventually become cornified. This type of disease does not develop so rapidly compared to others. Metastases with him also practically do not appear. Most often, tumors with keratinizing cells are observed in the vocal cords.
With a highly differentiated type of cancer, there is a significant involvement of healthy tissues in the pathological process. Treatment of this type of disease is the most time consuming and long.
Causes of the disease
Unlike many other oncological diseases, throat cancer has a well-established dependence on certain adverse factors. And in the first place among these factors you should put tobacco. In fact, it can be argued that throat cancer is a disease of heavy smokers. More than 85% of patients with throat cancer have such an addiction as smoking.
The second important factor is gender. Throat cancer is a predominantly male disease. Approximately 95% of patients are men over 50 years old. In women, the disease is relatively rare, but this does not mean that a woman, especially a smoker, does not have a chance to get sick with this disease. At a young age, the disease is also rare, therefore, old age is another negative factor.
Other factors contributing to the disease include:
- inhalation of toxic fumes;
- working with hazardous chemicals (chemical industry, production of paints, construction and repair);
- wrong diet, plenty of smoked and salty food, lack of fresh vegetables and fruits;
- alcohol abuse
- poor oral hygiene;
- hereditary factors;
- infectious mononucleosis;
- neck and head tumors of other localization;
- radiation exposure.
Also, the following pathological processes and formations in the larynx increase the likelihood of the disease:
- chronic untreated upper respiratory tract inflammations (laryngitis , pharyngitis, sinusitis, etc.),
- chronic diseases of the teeth and gums,
- laryngeal pachydermia.
Statistics show that laryngeal cancer is much more common among residents of large cities than people in rural areas. This suggests that the occurrence of the disease is also influenced by the ecological situation.
The disease manifests itself in a severe form not immediately, but develops over long months or even years. Unfortunately, people often do not notice the unpleasant symptoms in time, and seek help from a doctor only when the disease becomes incurable. Meanwhile, throat cancer in its early stages has well recognizable symptoms. The exception to this rule is only the zero stage (precancer), in which pathological changes in the tissues do not manifest themselves and can only be detected by an accidental diagnostic examination of the respiratory organs.
In the early stages of the patient’s illness, pain, cracks or sore throat, and dry cough usually occur. Very often, these symptoms are taken sick for cold symptoms. However, unlike ARI, these signs are observed constantly and do not disappear after a while, but gradually increase. It is important to note that pains with throat tumors do not disappear after taking painkillers, and coughing does not go away after taking antitussive drugs. Since throat cancer is most often affected by smokers, patients are usually referred to as a hacking cough as a side effect of smoking. At first, the cough may be episodic, but then goes on permanent. Subfebrile temperature, anemia, numbness of some parts of the face, intradermal hemorrhages, swelling of lymph nodes in the neck or under the jaw may occur.
As the disease progresses, other symptoms appear – hoarseness (due to lesion of the vocal cords), taste deterioration, foreign body sensation in the throat, difficulty in swallowing, bleeding from the throat. A large tumor can interfere with breathing, and the patient has shortness of breath. Severe headaches, pain in the neck or ears, worsening of sleep and hearing, traces of blood or pus in nasal discharge. Nasal or mouth discharge has an unpleasant odor. Also, patients usually lose their appetite and, as a result, weight. The general state of health worsens, irritability appears. The tumor becomes visible outside due to the appearance of swelling in the neck. In severe cases, the patient loses the ability to open or close his mouth.
These symptoms already indicate a neglected disease. Unfortunately, it is at this stage that most patients go to the doctor.
Depending on the location of the tumor, the symptoms may differ slightly. For tumors in the nasopharynx and oropharynx, angina-like pains, nose bleeds from the tonsils, a feeling of nasal congestion, toothaches and tooth loss, headaches not relieved by analgesics, and an increase in the submandibular lymph nodes are most common.
The following symptoms most often manifest themselves in suprajunctional localization:
- foreign body sensation
- pain when swallowing.
Voice changes at this location occur only in the later stages of the disease.
When a tumor is located in the region of the vocal cords, pain is most common during a conversation, a change in voice, or its complete loss. These symptoms can manifest themselves in the very early stages of the disease.
With subglottic localization, pain or discomfort during the passage of the food lump is most often observed, as well as constant shortness of breath or difficulty breathing. Voice changes join only in the later stages of the disease.
Stages of the disease
When characterizing oncological diseases, doctors use such a concept as the stages of the disease. Certain symptoms correspond to different stages. Also for different stages can be applied various methods of treatment. The prognosis for recovery decreases as the stage of the disease increases.
|Stage||Symptoms||Tumor development||Survival prediction (over 5 years)|
|Zero||None||Minor ulceration of the mucous membrane||About 100%|
|First||Throat congestion, difficulty in swallowing and talking, but the voice does not change||The growth of the tumor, the size of the tumor is limited to one section of the larynx, no metastasis is observed||80%|
|Second||Hoarseness, impairment of speech||A gradual exit beyond one larynx, no metastasis is observed||75%|
|Third||Pain, loss of voice, up to a full, severe cough||Going beyond the larynx, germination beyond the larynx, it is possible the appearance of separate metastases||50%|
|Fourth||Loss of voice, severe pain when talking, swallowing||Germination in the surrounding tissue, lymph node damage, metastasis||25%|
The rate of development of the disease depends on the age of the patient. In younger patients, a more transient manifestation of symptoms is usually observed.
Various methods can be used to diagnose the disease. It is far from always that a visual examination of a patient by an otolaryngologist can reveal a disease, especially at an early stage. Therefore, primarily used instrumental methods of research. The simplest of these is laryngoscopy. This method consists in inspecting the surface of the mucous membrane of the larynx with a special lamp and a mirror.
Of great importance in identifying the disease and differentiating it from other pathological processes, in particular, inflammatory, plays a biopsy. This method consists of taking a piece of tissue from the affected area for analysis. Also, diagnostic methods such as MRI and radiography are used to identify the scale of the pathological process. They allow you to identify the presence of metastases, as well as determine the size and shape of the tumor.
The treatment strategy depends on the stage of the disease. At the early stage, the most effective treatment is surgery to remove the tumor. It can be carried out both in the traditional way and with the help of a laser.
For the prevention of relapse or in preparation for the operation, the patient may be prescribed a course of chemotherapy.
It should be borne in mind that in some cases, the operation may remove the vocal cords and tongue (partially or completely), which makes it difficult or impossible to speak and eat.
In later stages, the removal operation may not be possible. Therefore, methods such as chemotherapy and radiation therapy are used. During radiation therapy, a tumor is irradiated with a stream of high-energy particles that kill cancer cells. The goal of radiation therapy can be either the complete eradication of a tumor, or its significant reduction or stopping of growth. Sometimes radiation therapy precedes surgery.
Contraindications to radiation therapy – the germination of a tumor in the tissue of the esophagus and blood vessels, the patient’s serious condition.
Chemotherapy uses cytostatic drugs that slow down the division of cancer cells. Cytostatics can be administered intramuscularly, intravenously, orally or directly into the area affected by the tumor.
However, all measures for treating the disease are likely to be ineffective if the patient does not get rid of the harmful habit of smoking.
After the operation, the patient will need a rehabilitation course, including, in particular, speech skills.
If, due to the large size of the tumor, the patient loses the ability to breathe, he will undergo a tracheostomy operation, in which a tube is inserted into the trachea.
If the disease is recognized in time (in the early stages), then it is likely that the disease will be able to win. Thus, the five-year survival rate in patients with throat cancer in the first stage is 85%.
In patients with the disease in the fourth stage, the five-year survival rate is less than 20%. Much also depends on whether the patient agrees to have surgery to remove the larynx and vocal cords (laryngectomy), which, as mentioned above, can make a person dumb.
Throat cancer is primarily a disease of those who abuse alcohol and nicotine. That is why the rejection of these harmful habits greatly reduces the likelihood of illness.
Other risks include poor oral hygiene, as well as constant inhalation of carcinogenic chemicals. In older men, the disease is especially common, so people who are in this risk group should monitor hygiene and avoid manipulations associated with toxic substances. Substances with increased carcinogenicity include asbestos, benzene, petroleum products, coal dust, phenolic resins.
When dealing with potential carcinogenic aerosols, respiratory protection devices such as gauze bandages and respirators should be used. If the contact with carcinogenic substances is an inevitable consequence of the performance of professional duties (for example, for workers in the chemical industry or the construction industry), then in such a case it becomes necessary to undergo an annual checkup.
In addition, it should be borne in mind that early diagnosis of the disease significantly increases the likelihood of cure. This implies the need for regular examination at the otolaryngologist, timely treatment of chronic diseases of the respiratory tract.