Laryngopharyngeal cancer is a malignant tumor localized in the lower part of the pharynx. At the initial stage of progression, the disease does not show any symptoms, therefore, for a long time it continues to remain invisible. In the future, the patient begins to show severe pain, a feeling of something foreign in the throat, perspiration, burning, increased salivation, hoarseness, cough, respiratory disorders. The severity of the first signs of the disease will directly depend on the location of the spread of neoplasia.
Description of the disease
Cancer of the piriform sinus of the larynx is distinguished by its aggressive development, it leads to the appearance of early metastases in the patient. The diagnosis is established, taking into account the results after the ultrasound of the neck, MRI and CT of the laryngopharynx, fibrofarhinolaryngoscopy together with a biopsy. Treatments include pyriform sinus resection, laryngectomy expansion, chemotherapy, radiotherapy, and lymphadenectomy.
Features of pyriform sinus cancer
Hypopharyngeal cancer - definition,which is used to describe malignant tumors in the upper gastrointestinal tract, including the larynx and pharynx. As in many other subsite designations, the distinguishing features in hypopharyngeal cancer are anatomical rather than pathophysiological in form. In general, this type of cancer refers to cancer of the neck and head.
The cyst of the pyriform sinus of the larynx is named so because of its location. This includes the lateral, posterior, middle walls of the pharynx, as well as the cricoid area.
Many forms of malignant tumors are formed in the pyriform sinus. The disease occurs frequently. In the United States and Canada, about 56-85 percent of hypopharyngeal carcinomas are diagnosed in the pyriform sinus. From 10 to 20 percent of such formations are formed on the back of the pharynx, and from 3 to 5 percent - in the transocrine region.
Anatomy of the pyriform sinus of the larynx
The hypopharynx is the area located between the oropharynx (the level of the hyoid bone) and the esophagus (at the bottom of the cricoid cartilage). The larynx itself can be called a structure separable from the pharynx, since it is slightly forward, protruding from it. The piriform sinus is filled with soft tissue contents, in which oncology spreads rapidly. Tumor formations of a malignant nature in hypopharyngeal cancer spread, as a rule, without going beyond the boundaries of the sinus.
The hypopharynx includes three separate segments of the pharynx. It is wide at the top, as it increasessize narrows significantly towards the lower part of the cricopharyngeal muscles. In front, such an organ is limited by the posterior surface of the cricoid cartilage. In two opposite sides of the pharynx, pear-shaped sinuses or fossae are formed (it is for this reason that the name of such a part of the body appeared). Thus, the anatomy of the pyriform sinus of the larynx is clear to many.
As in other cases, neck or head cancer is diagnosed in 95% of all malignant tumors, neoplasms are formed on the mucous membrane, so this condition is referred to as squamous cell carcinoma. The precancerous condition of the mucous membrane can quickly change to a hyperproliferating form, which over time will begin to actively progress, increase in size and move to adjacent tissues. After the spread of cancer cells to the lymph nodes, a dangerous disease disrupts the work of other organs in the body, which provokes the development of metastasis.
Detection rate
Cancer of the pharynx is diagnosed in 7 percent of all oncologies of the upper respiratory tract and digestive tract. The incidence of laryngeal cancer is 4-5 times higher than the incidence of laryngopharyngeal cancer. Now on the planet every year larynx cancer is diagnosed in 125 thousand people.
Men suffer from this form of the disease three times more often than women. But despite this, oncological processes in the pharyngeal-esophageal junction in women are a more frequent occurrence. Doctors believe that the disease develops due to an improperly formulated diet (witheating too much junk food or insufficient content of vitamins and useful microelements in the daily consumed products). In different nationalities, the incidence of this disease also differs markedly: African Americans suffer from cancer of the larynx and pharynx much more than other races.
What do doctors say about cancer?
The biological reactions of pharyngeal carcinoma are different from simple laryngeal cancer. Throat carcinomas most often do not lead to the development of severe symptoms, so patients continue to be unaware of their disease for a long time. It is for this reason that the final prognosis established by the doctor is usually unfavorable. The rate of development and spread of metastases in pyriform sinus cancer is very high.
Also, with this disease, there is a high degree of damage to the lymph nodes, it ranges from 50 to 70 percent of the total cases of damage. About 70 percent of patients who go to see a doctor because of the appearance of unpleasant symptoms receive a diagnosis of "third stage cancer" from a specialist. Metastases and affected lymph nodes are found in most patients. The number of distant metastases in the development of cancer of the left pyriform sinus (or right) remains as high as in other forms of neck and head cancer.
Prognosis for any form of cancer will directly depend on the stage of development of the tumor formation, its general size, severity of the disease, symptoms andthe state of he alth of the patient at the time of the development of the disease. Cancer of the T1-T2 degree gives the patient another five years of life (this occurs in 60 percent of cases), but in the presence of a T3 or T4 degree of development, the survival rate decreases sharply, only up to 17-32 percent survive. Life expectancy of five years for all stages of cancer is about 30 percent.
What factors affect the life expectancy of a patient?
There are certain factors that affect the progression of pyriform sinus cancer and reduce the life of the patient. These include:
- patient's gender and age category;
- race (important to remember that African Americans suffer the most from this defeat);
- Karnofsky performance assessment (patients with insufficient body weight, with poor nutrition and not getting the right amount of nutrients, minerals and vitamins, as a rule, have an unfavorable prognosis);
- tumor formations (stage of development of the disease, degree of prevalence and localization);
- histology (features of the boundaries of the tumor formation, the rapidity of the spread of cells to adjacent tissue areas after irradiation);
- site of localization of the tumor formation;
- total size of cancer in cross section.
Accelerated lesion progression
Negative factors leading to accelerated development of the disease:
- regular smoking;
- drinking excessive amounts of alcohol (daily or 3-4 times a week, the appearance of alcoholism);
- Plummer-Vinson syndrome;
- irritable process in the throat as a result of gastroesophageal or laryngotracheal reflux;
- the presence of a predisposition to the disease at the genetic level;
- poorly formulated diet, lack of foods fortified with vitamins and nutrients.
Symptoms of the presence of the disease in the patient
The first stage of development of pyriform sinus cancer in humans sometimes speaks about itself with the following unpleasant symptoms:
- severe headache;
- presence of bleeding;
- regular cough with blood;
- trouble swallowing food;
- partial suction;
- with a large tumor formation, the patient may begin to obstruct the airways;
- rapid weight loss due to malnutrition (the patient stops eating food in the right amount, as it brings him discomfort when swallowing);
- tumor formation can actively develop in the area of the larynx.
Hipopharyngeal tumors of a malignant nature are considered very dangerous, they can reach a huge size in a short period of time. The larger the size of the tumor, the more the main signs of the disease appear.
Additional features
Also, doctors identify additional symptoms of the disease:
- feeling of a foreign object in the throat;
- dysphagia;
- increased size of lymph nodes;
- bitterness in the mouth, the presence of an unpleasant odor;
- the presence of swelling on the neck and face in the morning immediately after waking up.
The duration of the asymptomatic course of the disease can vary from two to four months. In the later stages of the development of the disease, the patient's voice becomes hoarse, his body weight rapidly decreases, sputum and saliva come out together with blood. In about 70 percent of patients, the disease provokes a fatal outcome even at the third stage of development.
Diagnostics
Diagnostic measures for laryngopharyngeal cancer will begin with a thorough examination of the neck and head. To do this, palpation or fiber-optic examination is performed using a flexible endoscope. Typical visual symptoms of laryngopharyngeal cancer are the development of ulcers on the mucous membranes, a large amount of saliva of a viscous consistency can accumulate in the pyriform sinus, in addition, one can determine a strong swelling of one or two vocal cords at once, asymmetry of the tonsils, hyperkeratosis or erythematosis of the mucosa.
In addition, the doctor evaluates the condition of the nerves of the skull, jaw mobility, checks the condition of the lungs and finds a possible chronic infection in them. An examination of the extremities helps to identify peripheral vascular disease or symptoms of advanced lung disease and secondary lung cancer.
About 30 percentpatients have a developing additional disease at the time of diagnosis of pyriform sinus cancer.
Carrying out treatment activities
As with other head and neck cancers, pyriform sinus cancers are treated with the following techniques:
- surgery;
- chemotherapy course;
- radiotherapy.
In addition, a subspecies of surgical removal is used - transoral laser resection. Due to its specific location, there is a high risk of partial or complete loss of voice, in addition, the operation can complicate the process of eating, chewing, swallowing, and worsen respiratory activity.
