What Is Stage Four Throat Cancer?

1. HoarsenessLaryngeal cancer most often occurs in the true vocal folds and affects pronunciation. There is also a husky phenomenon when the throat is invaded at the end of hypopharyngeal cancer.

Throat Cancer

Throat cancer is a general term for nasopharyngeal cancer, oropharyngeal cancer, and throat cancer. The laryngo-pharynx is also called the hypopharynx. Hypopharyngeal cancers are more common in the piriform fossa, followed by the posterior wall of the hypopharynx. Treatment methods include radiotherapy alone, surgery alone, surgery plus radiotherapy, chemotherapy and immunotherapy.

Western Medicine Name: Throat Cancer
Affiliated Department: surgical-
Disease site: Pharynx
The main symptoms: Pain, husky

Main cause: Smoking, etc.
Multiple groups: All people
Contagious: Non-contagious
Whether to enter health insurance: Yes

Clinical manifestations of throat cancer

1. HoarsenessLaryngeal cancer most often occurs in the true vocal folds and affects pronunciation. There is also a husky phenomenon when the throat is invaded at the end of hypopharyngeal cancer.

2. Throat abnormality-especially hypopharyngeal cancer often has unilateral throat abnormality.

3. PainSwallowing pain will not heal for a long time.

4. Blood sputum-blood in sputum when bleeding from surface ulcer of throat cancer.

5. Difficulty swallowing-The continued growth of hypopharyngeal tumors prevents food from passing through.

6. Difficulty breathing-blockage of the respiratory tract when the larynx tumor is too large.

7, cervical lymphadenopathy-occurs when lymphatic metastasis.

8, other-such as Mo Ming's weight loss, loss of appetite.

Causes of throat cancer

1. Nicotine in tobacco, a chemical carcinogen; alcohol can be used as a solvent for carcinogens to promote the entry of carcinogens into the tongue mucosa.

2. Unsuitable physical carcinogenic factors such as dental trays, dentures, dental caries, incomplete pits, etc .; poor oral hygiene habits, long-term mechanical injuries, often stuck fish bones, bones, etc.

3. Biological carcinogenic factors of human papilloma virus, heredity, individual susceptibility, nutritional metabolism disorders, race and radiation, etc.

Throat cancer site

1. Supraglottic type: Including cancers above the vocal cords, such as epiglottis, epiphyseal epigastric dysentery, ventricular zone, and larynx. This type of cancer is poorly differentiated and develops rapidly. Due to the abundance of lymphatic vessels in this area, it is often easy to metastasize to the lymph nodes at the bifurcation of the common carotid artery in the upper deep neck group. In the early symptoms, a foreign body sensation is felt in the throat and the throat is uncomfortable. When the surface of the cancer ulcers later, there is a throat, which can reflect to the ear and even affect swallowing. After the advanced cancer erodes the blood vessels, there is blood in the sputum, often with sputum coming out; when it invades the vocal cords, there is hoarseness and difficulty breathing.

2. Glottic type: cancers confined to the vocal cords, which are more frequent in the previous and middle 1/3, and are well differentiated, which are grades I and II. It develops slowly, and because there are fewer vocal cord lymphatic vessels, it is not easy to metastasize to cervical lymph nodes. The main symptom is hoarseness, which gradually gets worse. When the tumor is enlarged, the glottis is blocked, sore throat and dyspnea may occur, and blood sputum and laryngeal obstruction may be present in the later stage.

3, subglottic type: that is, located below the vocal cord, above the lower edge of the ring cartilage cancer. Because the area is relatively hidden, it is not easy to find in routine laryngoscopy. It may be asymptomatic in the early stage, and cough and blood sputum may occur later. In the later stages, breathing is often difficult because the subglottic area is blocked by cancer. There are also penetrating the nail, invading the thyroid gland, pre-anterior soft tissue, and infiltration along the anterior wall of the esophagus.

4. Glottic type: refers to the cancer that originates in the larynx, also known as transglottic cancer. The area is very hidden. It can be asymptomatic in the early stage and easily spread to the lateral glottic space. Its clinical features are: hoarseness is the first symptom, often the vocal cord is fixed first, but the tumor is not seen. Later, with the cancer expanding towards the paraglottic space, sore throat may be present when the laryngeal cartilage is infiltrated and damaged. If it invades one side of the thyroid cartilage flap and the crust of the thyroid cartilage, the larynx cartilage scaffold can be felt on that side, and it has an irritating dry cough.

The dangers of throat cancer

1. Stubborn hoarseness: Laryngeal cancer often affects the vocal cords, and even small volume can cause hoarseness in patients. Hoarseness is the earliest sign of throat cancer. Any adult who has hoarseness for unknown reasons and lasts for more than two weeks should undergo a careful throat examination and should not be taken lightly.

2. Throat sensation abnormality: foreign body sensation, urgency or swallowing discomfort, are early symptoms of supraglottic laryngeal cancer. However, the initial symptoms of this type of cancer are often not obvious, and it is not discovered until the second or third stage. Therefore, if the middle and old people have throat discomfort, a comprehensive and detailed examination should be done.

3. Coughing blood in sputum: Due to tumor irritation, irritating dry cough can be produced, and blood in sputum can cause mucus adhesion. When the tumor grows, it can also block the airway, making the tracheal secretions difficult to discharge, causing respiratory infections, wheezing, and even breathing difficulties, and the middle and late stages are manifested by persistent cough and altered pronunciation.

4, reflex pain: laryngeal cancer with ulcers, inflammation or laryngeal periosteitis, can cause reflex pain in the nerves, manifested as ipsilateral headache, ear pain. These symptoms occur mainly in patients with supraglottic tumors.

5. Precancerous lesions appear: Some laryngeal diseases such as larynx, leukoplakia, and papilloma of the larynx may also become cancerous. This is called "precancerous lesions" and must be followed up regularly to prevent 10,000 One.

Throat cancer metastasis

A diagnosis is usually made when it progresses to two districts. According to the degree of differentiation and primary site, spreading and metastatic laryngeal cancer can spread in three ways:

1. Direct spread: Advanced laryngeal cancer often infiltrates and spreads to the submucosa. Symptoms of the epiglottic carcinoma, which can invade the anterior space, trough and tongue base of the epiglottis. The epiphyseal cancer spreads to the piriform fossa and the laryngo-pharyngeal wall. Glottic cancers can invade the anterior commissure and spread to the contralateral vocal cords; they can also destroy the thyroid cartilage forward, enlarge the larynx, and infiltrate the anterior cervical soft tissue. Subglottic cancer spreads down to the trachea, and can also penetrate the cricothyroid membrane to the anterior cervical layer, developing to both sides, invading the thyroid gland; involving the anterior wall of the esophagus backwards.

2. Lymphatic metastasis: The metastasis site is more common in the lymph nodes at the bifurcation of the common carotid artery in the upper deep cervical group, and then the lymph nodes develop along the internal jugular veins up and down. Subglottic carcinoma often metastasizes to the qi and paralymph nodes.

3. Vascular metastasis: it can be transferred to the lungs, liver, kidneys, bones, pituitary gland, etc. by blood circulation.

Throat cancer disease treatment

Throat cancer treatment guidelines

The most important thing is early diagnosis and early treatment. The first and second stages of laryngeal cancer can be treated with radiotherapy or local laser resection. After surgery, they can still vocalize naturally. The third and fourth stages require more extensive surgery or total laryngectomy. The latter need to speak by artificial voice. The five-year survival rates from the first period to the fourth period were about 75%, 60%, 48%, and 40%, respectively.

Pharyngeal cancer is prone to delay early detection because the early symptoms are not obvious. In the late stage of larynx invasion, the larynx must be resected together. Because of this, the lymphatic vessels are abundant, and neck or distant metastasis is prone. The prognosis is worse than that of laryngeal cancer. Five-year survival The rate is about 15% to 30%.

Treatment of throat cancer

1. Radiation therapy is mainly applicable to stage lesions: small and superficial unilateral or bilateral vocal cord cancer, which has not yet invaded the anterior commissure, vocal cord protrusion, or subglottic region, and the vocal cord movement is good. Marginal cancer of epiglottis with lesion less than 1cm. The general condition is poor and it is not suitable for surgery. For a wide range of cancers involving laryngopharynx, preoperative radiotherapy can be performed first. The preoperative radiotherapy dose of 60 cobalt is 45-50 Gy (4,500-5000 rad) within 4 weeks, and surgical resection is performed within 2-4 weeks after the end of radiation. The dose of radiation alone is 60-70Gy (6000-7000rad).

2. Vertical hemi-laryngectomy is suitable for stage I vocal cord cancer. The midline of the thyroid cartilage was cut slightly on the healthy side, and the affected vocal cord and the corresponding part of the thyroid cartilage were excised. But pronunciation is not as good as radiation therapy.

3, horizontal hemi-laryngectomy is suitable for supraglottic cancer, involving epiglottis, ventricular zone, laryngeal ventricle, sigmoid epiglottis and other areas, and the vocal cord is still intact. The scope of surgical resection includes epiglottis, ventricular zone, laryngeal chamber, anterior space of epiglottis or part of tongue base, and the upper half of thyroid cartilage is transected, the laryngopharyngeal mucosa is repaired, the vocal cords are retained, and the root of the tongue is sutured with the glottic area. If there is cervical lymph node metastasis, cervical lymph node dissection is performed at the same time. Laryngeal function can be basically retained after surgery.

4. Total laryngectomy is suitable for stage III and IV lesions: The vocal cord cancer has a wide range and the vocal cord is fixed; the vocal cord cancer has invaded the larynx and ventricle; subglottic cancer; Cancer; laryngeal cancer has spread outside the larynx, thyroid cartilage has been damaged or has invaded the anterior space of the epiglottis, penetrated the thyroid membrane, and affected adjacent tissues such as the thyroid.

5. New laryngeal reconstruction is a new surgical method developed in China in recent years. It is suitable for stage and laryngeal cancer. It is not suitable for radiotherapy alone, and does not require total laryngectomy. The principle of surgery is to reconstruct the laryngeal function on the basis of radical cure. The main method is to retain the posterior 1/5 and the upper and lower corners of the thyroid cartilage plate on the affected side and the posterior 1/3 and the upper and lower corners of the contralateral thyroid cartilage plate as the posterior scaffold for reconstructing the larynx. The outer periosteum of the thyroid cartilage plate is peeled and retained, and it enters the larynx cavity under clear vision, and the larynx is subtotally removed along the full safety margin. Free the hyoid bone and transfer its pedicle 90 ° downwards to make it suture with the retainable circular cartilage or the upper end of the trachea as a front scaffold of the new larynx. Transplant the cell hyoid musculature to repair the mucosa in the laryngeal cavity, and use the water bladder for the expansion of the newly constructed laryngeal cavity. The pronunciation and swallowing function can be basically restored after 3-4 weeks.

6. Tracheolaryngology is suitable for those who have undergone subtotal laryngectomy while retaining epiglottis. Separate the neck trachea to the plane of the fifth tracheal annulus, suture the lower edge of the pharyngeal orifice to the posterior wall of the trachea, and stitch the epiglottis to the anterior wall of the first trachea. Replace the throat with the cervical trachea Hyoid bone, can speak after surgery.

7. After esophageal and tracheal chlorination, a fistula is created between the posterior wall of the tracheostomy and the anterior wall of the esophagus, and the muscle mucosal flap is sutured to form a duct. A silicone tube can be placed in this fistula after surgery to induce airflow. Pronunciation to the pharynx and esophagus.

8. Colon replacement for laryngopharynx and upper esophagus is suitable for tumors that have invaded the laryngo-pharynx, piriform fossa, and cervical esophagus. When the pectoralis major skin flap or neck flap cannot be used for repair, free colon segments can be used instead. Defective area of laryngo-pharynx and upper esophagus.

9. Laryngectomy plus cervical lymph node dissection is an effective method for treating laryngeal cancer with cervical lymph node metastasis. If the patient's overall condition can be supported, one-stage surgery should be pursued, that is, neck lymph node dissection at the same time as performing laryngectomy, including the removal of lymph nodes in the submandibular, subcondylar, anterior, superficial, and deep cervical groups of the neck. To do this, the area from the lower edge of the mandible to the collarbone, from the midline of the neck, and back to the trapezius, must include the sternocleidomastoid muscle, scapula hyoid muscle, biceps, internal jugular vein, Tissues such as the accessory nerves and submandibular glands are removed with the lymph nodes.

10. Pronunciation training after total laryngectomy. Patients after total laryngectomy can practice esophageal gas storage. The air passes through the entrance of the esophagus and is contracted by the pharynx muscle instead of vocal cord vibration. The coordinating role of the soft palate, with patient training, can gradually learn simple everyday expressions from numbers and words. For those who have no success in training the pronunciation of pharyngeal and esophageal sounds, an electronic larynx can be used, placed on the side of the neck, and sounded by an audio oscillator. After amplification, when the patient makes a simulated speech, the voice can be emitted. Can adjust the audio, but the sound intensity still cannot be controlled freely, often there is noise, and it is still inconvenient to use.

Throat Cancer Surgical Nursing

Preoperative care of throat cancer

1. Total laryngectomy should do well the ideological work of patients and their families, explain the necessity of surgical treatment, explain that pronunciation can be practiced or artificial larynx can be used after surgery, and patients' concerns about surgery can be eliminated. If the patient undergoes laryngoplasty, in order to promote wound healing, do not swallow within 1 week after surgery. Try not to speak.

2. Prepare paper and pen for patients with throat cancer before surgery, so that patients can express their needs after surgery.

3. Mouthwash with Dobel solution or metronidazole injection 3 days before surgery, 4 times a day. At the same time, oral and dental disorders need to be treated.

4. Instruct patients with throat cancer to take deep breaths and effectively cough, and smokers are advised to quit smoking.

5. Preoperative skin preparation area and scope should be accurate, taking care not to damage the skin.

Throat cancer care

1. Patients with throat cancer should be nursed by a special person after general anesthesia. Closely observe the changes in the patient's complexion, temperature, pulse, breathing, and blood pressure. After general anesthesia was awake and blood pressure was stable, he was given a semi-recumbent position. People performing laryngoplasty should lie on their backs with their heads forward to reduce the anastomotic tension.

2. Keep the airway unobstructed and suck out tracheal secretions at any time. Prohibit morphine, codeine, atropine and other drugs that inhibit breathing and glandular secretion. Strictly grasp the aseptic technique to prevent tracheotomy and anastomotic infection.

3. Atomize and inhale 3 times / day. When the sputum is thick, coprotease can be dripped into the casing to prevent sputum from agglomerating.

4. Keep your mouth clean and oral care 2 times a day. Pay attention to the wound for exudation to prevent pharyngeal leakage.

5. After cervical lymph node dissection, receive negative pressure drainage to keep the drainage tube unobstructed. Pay attention to observe the color, quantity and properties of the drainage fluid.

6. Teach patients how to handle cannula. Patients with total laryngectomy must wear a cannula for 1 year to prevent a narrow mouth.

7. The room temperature should be kept at about 20 ° C and the relative humidity should be 60%. To keep the airways moist.

8. Patients with tracheotomy cannot hold their breath, keep the stool open, and prevent constipation. Avoid heavy physical labor and prevent colds.

9. For those with high body temperature, closely observe the changes in body temperature, and give physical cooling and medication according to the doctor's instructions.

10. Two weeks after the operation, patients can be assisted in pronunciation exercises, allowing patients to swallow a certain amount of air in the esophagus, and then slowly escape the sound. Based on the principle of easy first, then difficult, start with single-word sounds.

11. After semi-laryngectomy, the semi-occluded tube is gradually to the fully blocked tube before extubation. Observation for 1-2 days, no breathing difficulty, can be extubated when lying flat.

12. The inner cannula should be cleaned 1-2 times daily after operation to prevent the formation of phlegm and obstruction of the airway. The cannula wound dressing is changed once a day. The casing should be tied with a knot to prevent the casing from falling off. If the patient's face is bruised and irritable, it may indicate the possibility of extubation and report to the doctor in time. If extubation occurs, immediately insert a tracheostomy tube with a forceps prepared near the bed to keep the airway open, and then cooperate with the doctor to perform tracheal cannula replacement.

13. It is strictly forbidden to eat or drink by mouth after surgery. Nasal feeding should be provided with a nutrient-rich liquid diet, 200 ml each time, 4-5 times a day, and 200-300 mL of warm boiling water should be injected after infusion to maintain sufficient water and pay attention to vitamin supplementation. , Fill with vegetable juice and fruit juice. After the half-throat tube was removed, the general diet was gradually resumed. Pay attention to the patient's difficulty in choking and swallowing.

Prognosis of throat cancer disease

Of all cancers, the prognosis for laryngeal cancer is quite good, and it is considered a "curable cancer." And the sooner it is found, the sooner it is treated, and the better the prognosis. Overall, its 5-year survival rate is over 70%, and its 10-year survival rate is about 50%.

Throat cancer diet conditioning

The prominent symptom of throat cancer patients is difficulty swallowing, which is also a serious problem in diet for patients with throat cancer. Swallowing difficulties in most patients with throat cancer occur gradually and progressively. At the beginning, the patient only had a stubborn sensation when eating dry food, which gradually worsened, and even developed difficulties in eating soft food and semi-liquid food. Eventually, it became completely difficult to drink water and eat, making the patient's nutritional status worse and worse. Causes cachexia. It can be seen that difficulty in feeding is a very serious problem for patients with throat cancer.

For patients with diagnosed early and middle-term throat cancer, they should seize the opportunity to comprehensively add nutrition to the patient, give the patient soft or semi-liquid foods containing high protein and high vitamins, and use the gastrointestinal absorption function as much as possible to supplement the nutrition so that the patient Have a better physical condition.

In order to make the chemotherapy go smoothly, while the drug is being treated, it should be supplemented with rich nutritional foods to improve the tolerance of the human body to the toxic and side effects of anticancer drugs. During chemotherapy, the patient's diet should be based on high calories and high protein, such as chicken, duck, fish, shrimp, lean meat, eggs, etc., so as to play an adjuvant therapeutic role. The diet should be diversified, pay attention to the diet mix, in order to complement each other with nutrients, improve the body's immunity. If you have five upset symptoms of fever and yin deficiency, you should take white fungus porridge or soak 0.15 grams of American ginseng as tea. Where economic conditions permit, stewed turtle soup can be stewed. Pay attention to the color, aroma, and taste of cooking. It is best to steam, cook, and stew. Do not eat or eat less smoked, fried, grilled food, eat less pickled food, do not smoke or drink alcohol. Alcohol can activate many carcinogens. Reduces immune function. The staple food of chemotherapy patients can choose buns, dumplings, ravioli, noodles, etc. according to dietary habits and tastes. Patients with poor appetite may eat less frequently.

Unlike other tumors, throat cancer is not anorexia, but difficulty in swallowing and inability to eat, resulting in consumption of the body. Therefore, you should eat as much diet as possible into the esophagus, such as semi-liquid and full-flow. Pay attention to semi-liquid and full-flow. Quality, don't limit calories, be rich in nutrients, soft and easy to digest and absorb. If necessary, you can make homogeneous meals, elemental meals and mixed milk and other diets. A homogenized diet is a normal person's diet that has been stabbed and deboned, and then stirred with a high-speed tissue masher to form a paste. The nutritional content is similar to that of a normal diet, but it has been crushed in vitro, which is easy to digest and absorb. Avoid long single diets and prevent constipation. Eat more foods with anti-cancer effects. Studies have found that Cordycepin contained in Cordyceps can effectively swallow tumor cells, which is 4 times more effective than selenium. It also enhances the ability of red blood cells to adhere to tumor cells. It can be used during tumor chemotherapy and after surgery To prevent tumor recurrence and metastasis. Formula; choose Fulinmen Cordyceps, which has a high content of natural cordycepin, and take it after crushing, 1.5 grams each time, 2 times a day, most patients can get good curative effect.

The main precautions to avoid in the diet of throat cancer patients:

1. Do not swallow forcibly when the patient feels stubborn, otherwise it will stimulate local cancer tissue bleeding, spread, metastasis and pain. In severe cases, liquid or semi-liquid food should be taken.

2. Avoid eating cold liquid foods, and keep cold noodles, milk, egg soup, etc. that are relatively old. Because esophageal stenosis is very obvious for cold food stimulation, it is easy to cause esophageal spasm, nausea, vomiting, pain and numbness. So eat warm food as well.

3 Do not eat spicy, spicy, stinky, fishy irritating foods, because these foods can also cause esophageal spasm and make patients uncomfortable. For patients with laryngeal cancer who cannot eat at all, intravenous high nutrition method should be adopted to input nutrients to maintain the needs of the patient's body.

Medication for throat cancer

There are benign and malignant tumors. Malignant tumors are also called cancers. The following dietetic drugs and medicated diets have certain anti-cancer effects, and you can choose to take them according to the specific conditions of the patient. ^[1]

1) Boiled straw mushroom Hericium edodes 60g, fresh Hericium edodes 60g, sliced; fry the food hot, add a little salt, add both, stir-fry and add water to cook. This prescription is mainly used for digestive tract tumors.

2) 60 grams of Hericium erinaceus soup, 60 grams of Hedyotis diffusa, 60 grams of vine pear root, and decoction. For gastric cancer, esophageal cancer, cardia cancer and liver cancer.

3) 30 grams of water chestnut, 30 grams of water chestnut, 30 grams of water chestnut, add water decoction, take 2 times a day, take it for a long time. Can be used for gastric cancer, cervical cancer, etc.

4) Coix kernel porridge, raw coix kernels 20 grams, glutinous rice or japonica rice 30 grams, half a spoon of sugar. Pour the lotus root and rice together into a small steel fine pot, add about 1000 ml of cold water, cook on medium heat for about half an hour, and remove from heat. Once a day for breakfast or snacks. Consuming this porridge often is ideal for preventing gastric ulcer cancer; for those who have had gastrointestinal cancer and undergoing surgical resection, eating it can also reduce the chance of recurrence.

5) Baked Bamboo Leaf Tea 15 grams of dried Baked Bamboo Leaf, brew a large cup of boiling water, cover, and drink after 5 minutes. Polygonum odoratum leaves contain polysaccharides, so it has a wide range of anti-cancer and detoxification effects.

6) Purple grass mung bean soup 15 grams of purple grass, 30 grams of green beans, 1 spoon of sugar. First fry the purple grass, fry the mung beans with red grass juice, boil for about 3 minutes after the low heat, leave the fire when the mung beans are not blooming, filter out the soup, leave the mung beans, and leave a little juice. Then pour the second juice of purple grass into the mung bean pot and burn the mung bean. If the water is insufficient, add more water. When about 500 ml of juice is left, leave the fire.

7) Turtle Jieyu Decoction 1 turtle, 9 grams of Bupleurum, 9 grams of peach kernel, 15 grams of Atractylodes, 30 grams of Hedyotis diffusa, clean the turtle, decoction with other medicines, decoction, and eat the turtle Drink soup. One dose every 2-3 days. This prescription can be used as an adjunct diet for nasopharyngeal cancer.

8) Yuquan Tian Qifang yellow croaker, 3 grams of end of Sanqi, and rice wine in the right amount. Huanghua croaker is fried with fragrant and crispy, crushed to the end, 5 grams each time. 1 dose per day, even 15-20 doses for 1 course of treatment. This prescription can be used in patients with esophageal cancer with blood stasis.