What Is Stage 4a Throat Cancer?

There are two types of laryngeal cancer: primary and secondary. Primary laryngeal cancer refers to a tumor at the primary site in the larynx. Squamous cell carcinoma is the most common. Secondary laryngocarcinoma refers to malignant tumors from other parts that have metastasized to the larynx, which is rare. Symptoms of laryngeal cancer include hoarseness, dyspnea, cough, dysphagia, and cervical lymph node metastasis. People at high risk should pay attention to quit smoking, drink alcohol appropriately, and do a good job of prevention. Early detection and early diagnosis and treatment are very important to reduce the harm of laryngeal cancer. On the one hand, it can improve the survival rate of patients after surgery. In addition, it is possible to preserve the vocal function of the throat as much as possible and reduce postoperative complications.

Basic Information

English name

laryngeal cancer

Visiting department

Otorhinolaryngology head and neck surgery

Common causes

The exact cause is unknown

Common symptoms

Swallowing discomfort, hoarseness, difficulty breathing, cough, difficulty swallowing, etc.

Causes of laryngeal cancer

The exact cause of laryngeal cancer is currently unknown. It may be caused by a variety of factors, including the following.

Smoking

Smoking is closely related to respiratory tumors. Most patients with laryngeal cancer have a long history of heavy smoking. The incidence of laryngeal cancer is directly proportional to the number of daily smokers and the total length of smoking. In addition, passive smoking should not be ignored and may cause cancer. Tobacco tar can be produced when smoking, and phenylpropanine has carcinogenic effects, which can cause mucosal edema, congestion, epithelial hyperplasia, and squamous metaplasia, stopping ciliary movement, and causing cancer.

2. Drinking

According to the survey, the risk of throat cancer among drinkers is 1.5-4.4 times higher than that of non-drinkers, especially the above-glottic throat cancer is closely related to drinking. Smoking and drinking have a synergistic effect on carcinogenesis.

3. Air pollution

Long-term inhalation of industrially produced dust, sulfur dioxide, chromium, arsenic, etc. may cause respiratory tract tumors. The incidence of laryngeal cancer in cities with severe air pollution is high, and urban residents are higher than rural residents.

4. Occupational factors

Long-term exposure to toxic chemicals such as mustard gas, asbestos, nickel, etc.

5. Virus infection

Human papilloma virus (HPV) can cause laryngeal papilloma, which is currently considered a precancerous lesion of laryngeal cancer.

6. Sex hormones

The larynx is a secondary sex tube and is thought to be a target tube for sex hormones. Laryngeal cancer patients are significantly more men than women. Clinical studies have found that testosterone levels in patients with laryngeal cancer are higher than in normal people, and estrogen levels are reduced.

7. Trace element deficiency

Some trace elements are an important part of some enzymes in the body. Deficiency may cause changes in the structure and function of the enzyme, affect cell division and growth, and cause gene mutation.

8. Radiation

Long-term exposure to radionuclides such as radium, uranium, and thorium can cause malignant tumors.

Clinical manifestations of laryngeal cancer

Symptoms of laryngeal cancer include hoarseness, dyspnea, cough, dysphagia, and cervical lymph node metastasis. The order of symptoms may be different in different primary sites.

Supraglottic laryngeal carcinoma

Mostly originate at the root of epiglottis. There are no symptoms in the early stage, and even when the tumor develops to a certain degree, there are only slight or non-specific sensations, such as itching, foreign body sensation, swallowing discomfort, etc., which often cause alertness when the lymph node metastases occur. This type of tumor is poorly differentiated and develops rapidly. When there is deep infiltration, there may be sore throat and it radiates to the ear. Such as tumor invasion of scoop cartilage, paraglottic or recurrent laryngeal nerve can cause hoarseness. Patients at advanced stages will experience difficulty breathing and swallowing, coughing, blood in sputum, and hemoptysis. Therefore, patients with middle-aged or older patients who have persistent discomfort in the throat should pay attention to timely detection and early detection and treatment of tumors.

Glottic laryngeal carcinoma

Because the primary site is the vocal cord, the early symptoms are changes in sound, such as fatigue, weakness, and easy to be considered as "pharyngitis". Therefore, those who are 40 years of age and hoarse for more than 2 weeks should be carefully checked for laryngoscope. With the progress of the tumor, there can be exacerbation of hoarseness or even loss of sound, and the increase in tumor volume can cause breathing difficulties. In the later stage, as the tumor develops into the upper or lower glottis, it may be accompanied by radiation ear pain, dyspnea, difficulty swallowing, sputum, and bad breath. Eventually it can result from major bleeding, aspiration pneumonia, or cachexia. This type is generally less susceptible to metastasis, but tumors that break through the glottic area quickly develop lymphatic metastases.

3. Subglottic laryngeal cancer

This type is rare, with the primary site below the vocal cord plane and above the lower edge of the ring cartilage. Due to its hidden location, early symptoms are not obvious and it is easy to misdiagnose. When the tumor develops to a considerable extent, irritating cough and hemoptysis may occur. Obstruction of the subglottic region may cause dyspnea. Hissing occurs when the tumor invades the vocal cords. For those with unexplained aspiration dyspnea and hemoptysis, the subglottic area and trachea should be carefully checked.

4. Transglottic laryngeal cancer

Refers to a laryngeal cancer that originates in the larynx and spans the supraglottic area and the glottic area. It is not easy to find early, and the tumor develops slowly. It takes more than six months from the first symptoms to clear diagnosis.

Laryngeal cancer test

Neck examination

Including inspection and palpation of the shape of the larynx and cervical lymph nodes. To observe whether the larynx is enlarged, palpation of cervical lymph nodes should be based on the distribution of cervical lymph nodes, from top to bottom, from front to back, and gradually check the location and size of the enlarged lymph nodes.

2. Laryngoscopy

(1) Indirect laryngoscopy The easiest and most convenient way can be done in the clinic. You need to look at the various parts of your throat during the inspection. Due to patient cooperation problems, sometimes the structure of the larynx cannot be checked clearly, and other tests such as fiber laryngoscopes need to be further selected.

(2) Direct laryngoscopy For those who have difficulty in obtaining a biopsy under an indirect laryngoscope, this test can be used, but the patient is suffering.

(3) Fiber laryngoscope examination The fiber laryngoscope body is slender, soft, bendable, bright, has a certain magnification function, and has the function of taking biopsy, which is helpful for seeing the full picture of the laryngeal cavity and adjacent structures, and facilitates early detection The tumor was biopsied.

(4) stroboscopic laryngoscope examination By dynamically observing the vocal cord vibration, tumors can be detected early.

3. Imaging examination

X-ray, CT and magnetic resonance examination can determine the invasion and metastasis of laryngeal cancer in surrounding organs. By superficial ultrasound imaging examination, metastatic lymph nodes and their relationship with surrounding tissues can be observed.

4. Biopsy

Histopathological examination is the main basis for the diagnosis of laryngeal cancer. Specimen collection can be done under a laryngoscope. Note that the central part of the tumor should be clamped, not on the ulcer surface, because there is necrotic tissue. Some require multiple biopsies to confirm. Biopsy should not be too large or too deep to avoid bleeding.

Laryngeal cancer diagnosis

A detailed medical history and physical examination of the head and neck, indirect laryngoscope, laryngeal tomography, laryngeal CT, MRI, etc. can determine the location, size and scope of laryngeal cancer tumor lesions.

Pathological biopsy under indirect laryngoscope or fiber laryngoscope is the most important method to determine laryngeal cancer. If necessary, biopsy can be taken under direct laryngoscope. The size of pathological specimens varies depending on the location. Larger biopsy specimens can be taken for laryngeal cancer in the supraglottic region, and the glottic specimens should not be too large to avoid permanent vocal cord damage ^[2] .

Differential diagnosis of laryngeal cancer

Laryngeal tuberculosis

Early laryngeal cancer must be distinguished from it. Most of the vocal cord cancers originate in the first 2/3 of the vocal cords. Most of the laryngeal tuberculosis is located in the back of the larynx. It is characterized by pale larynx mucosa, edema, and multiple superficial ulcers. The main symptoms of laryngeal tuberculosis are hoarseness and sore throat. Chest radiographs and sputum tuberculosis tests are good for differential diagnosis, but the final diagnosis requires biopsy.

Laryngeal papilloma

Presented as hoarseness and difficulty breathing. Its appearance is rough and pale red, which is difficult to identify with the naked eye; especially the adult laryngeal papilloma is a precancerous lesion and must be identified by biopsy.

3. Laryngeal amyloidoma

Non-genuine tumors may be due to chronic inflammation, blood and lymphatic circulation disorders, and metabolic disorders caused by amyloidosis of the laryngeal tissue, manifested as hoarseness. Examination shows a dark red mass in the larynx, vocal cord, or glottis, which is smooth and difficult to clamp on biopsy. take. Pathological examination is needed for identification.

4. Laryngeal syphilis

The lesions are mostly located in the front of the larynx, often with syphilis, followed by deep ulcers, and scar tissue formation after healing leading to malformations in the larynx. The patient was hoarse but strong and had a sore throat. Generally has a history of sexually transmitted diseases, syphilis-related tests are feasible, and biopsy can confirm.

5. Recurrent laryngeal nerve palsy or cycloiliac arthritis

May also be mistaken for laryngeal cancer.

6. Other malignant tumors of the larynx

Such as lymphoma, sarcoma, and other cell types.

7. Other diseases

Such as vocal cord polyps, laryngeal keratosis, leukoplakia of the larynx, sclerosis of the respiratory tract, ectopic thyroid, laryngeal swollen larynx, chondroma of the larynx, Wengerner's granuloma of the larynx, etc., should be combined with the corresponding medical history, examination and especially biopsy to identify.

Laryngeal Cancer Treatment

The current treatment of laryngeal cancer includes surgical treatment, radiation treatment, chemotherapy and biological treatment, etc. Sometimes combined treatments can improve the 5-year survival rate of laryngeal cancer, maximize the preservation of the vocal function of the patient's throat, and improve the patient's Quality of Life.

Surgical treatment

In histology and embryology, the left and right sides of the larynx develop independently, and the glottis, glottis, and subglottis are from different primordia; the left and right lymphatic drainage are not connected to each other, and the glottic, glottic, and subglottic lymphatic drainage are not related. They are independent and provide a basis for surgical treatment of the larynx, especially partial resection. Depending on the location of the cancer, different procedures can be used.

(1) Support laryngoscope resection for laryngeal carcinoma in situ or lighter invasive lesions. At present, the development of laryngeal laser surgery and plasma surgery is gradually promoted, which has the advantages of minimally invasive, less bleeding, low tumor spread, and good vocal retention. Mainly suitable for earlier cases.

(2) Partial laryngectomy includes laryngeal dehiscence and vocal cordectomy; partial frontal laryngectomy; vertical hemi-laryngectomy; and some corresponding surgical modifications, which are selected based on the extent of glottic cancer invasion.

(3) Glotrectomy is applicable to supraglottic cancer.

(4) Total laryngectomy is suitable for advanced laryngeal cancer.

2. Radiation therapy

⁶⁰ cobalt and linear accelerators are currently the main means of radiation therapy. For early-stage laryngeal cancer, the radiotherapy cure rate and 5-year survival rate are comparable to surgical treatment. The disadvantage is that the treatment cycle is long, and symptoms such as taste, loss of smell, and dry mouth may appear.

3. Combined surgery and radiation therapy

Refers to surgery plus radiotherapy before or after surgery, which can improve the 5-year survival rate of surgery by 10% to 20%.

4. Chemotherapy

It is divided into induction chemotherapy, adjuvant chemotherapy, palliative chemotherapy and so on. Induction chemotherapy is administered before surgery or radiotherapy. At this time, the tumor blood supply is abundant, which is conducive to the role of drugs. Adjuvant chemotherapy refers to the addition of chemotherapy after surgery or radiation to kill tumor cells that may remain. Palliative chemotherapy refers to patients with relapse or systemic metastases who cannot be operated on and are treated with palliative care.

5. Biotherapy

Although there are some reports at present, most biological treatments are in the experimental stage, and the efficacy is not certain. Including recombinant cytokines, adoptively transferred immune cells, monoclonal antibodies, tumor molecular vaccines, etc.

Prognosis of laryngeal cancer

The 5-year survival rate of early laryngeal cancer after appropriate treatment is higher than 90%. Recurrence and metastasis are the main factors affecting prognosis.

The larger the number of metastatic lymph nodes, the larger the volume, and the lower the 5-year survival rate. The lower the degree of tumor differentiation, the higher the incidence of metastasis.

Laryngeal cancer prevention

1. No smoking and proper drinking control.

2. Strengthen environmental awareness and control environmental pollution.

3. Early detection and early treatment. For those who hoarse for more than 2 weeks and have a foreign body sensation, a throat examination should be performed in time. ^[1-2]