Laryngeal cancer - Symptoms

The nature of clinical manifestations depends on the invasive properties of the tumor and its stage (spread). Tumors in the vestibule area cause a sensation of a foreign body and, when reaching a certain size (damage to the epiglottis, aryepiglottic folds and pyriform sinuses), cause swallowing disorders and increasing pain syndrome. Tumors of the subglottic space mainly cause respiratory failure; when spreading upward to the vocal folds and arytenoid cartilages, hoarseness of the voice occurs and respiratory function is impaired.

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Laryngeal cancer and voice disorders

Tumors in the glottis area early cause symptoms of voice dysfunction - phonosetnia, hoarseness of the voice, which for a long time remain the only symptoms of laryngeal cancer. A distinctive feature of the emerging hoarseness of the voice is its constant character without remissions, but over time the voice becomes dull, up to complete aphonia. At the same time, the phenomena of difficulty breathing increase due to the spread of the process to the muscles and joints that ensure the movement of the vocal folds.

Respiratory disorders in laryngeal cancer usually occur at a later stage of tumor development and develop gradually, which causes effective adaptation of the body to increasing hypoxic hypoxia for a long time. However, with increasing narrowing of the respiratory lumen of the larynx, dyspnea appears, first with physical effort, and then at rest. At this stage, there is a risk of acute asphyxia due to various interfering factors (cold, swelling of the mucous membrane, secondary infection, consequences of radiation therapy). In case of vocal fold cancer, respiratory failure occurs many months or even 1 year after the onset of the disease. Earlier, these disorders occur with cancer of the subglottic space and much later - only in advanced forms, with cancer of the vestibule of the larynx. Noisy breathing on inhalation is characteristic of tumors of the subglottic space.

Cough in laryngeal cancer

Cough is a constant symptom of laryngeal cancer and is reflexive, sometimes accompanied by attacks of laryngeal spasm. Sputum is scanty, sometimes with streaks of blood.

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Laryngeal cancer pain

Pain syndrome is typical for tumors affecting the upper part of the larynx, it appears in widespread processes with decaying and ulcerating tumors. The pain radiates to the ear and becomes especially painful when swallowing, which makes the patient refuse to eat. In advanced forms of cancer with damage to the locking function of the larynx, food is thrown into the larynx and trachea, which provokes attacks of excruciating uncontrollable cough.

The general condition of the patient suffers only in the case of widespread laryngeal cancer: anemia, rapid weight loss, high fatigue, pronounced general weakness. The face is pale with a yellowish tint with an expression of hopelessness; in contrast to tuberculosis intoxication, which is characterized by euphoria, with laryngeal cancer, patients fall into a state of severe depression.

Endoscopic picture

The endoscopic picture of laryngeal cancer is characterized by significant diversity in both form and localization. Vocal fold epithelioma at the debut stage is an exclusively unilateral formation, limited only by the fold itself, manifested during extensive growth as a small proliferative tubercle in the anterior third of the vocal fold or in the area of the anterior commissure. Very rarely, primary cancer is localized in the posterior part of the vocal fold, in the place where contact granulomas usually form (the apophysis of the vocal process of the arytenoid cartilage) or in the area of the posterior commissure. In other cases, the tumor may have the appearance of a reddish formation with a bumpy surface spreading along the vocal fold, extending beyond the midline. In rare cases, the tumor has a polypoid appearance, a whitish-gray color and is located most often closer to the anterior commissure.

Tumors with infiltrative growth have the appearance of monochordite and are manifested by thickening of the vocal fold, which acquires a reddish color, is soft and easily destroyed and bleeds when probing with a button probe, with a finely bumpy surface. Often this form ulcerates and becomes covered with a whitish-dirty coating.

The mobility of the vocal fold in proliferative forms of cancer is preserved for a long time with satisfactory, although somewhat altered, vocal function, while in the infiltrative form the vocal fold quickly becomes immobilized and the voice loses its individuality, becomes hoarse, "split" and subsequently completely loses its tonality. In such forms of vocal fold cancer, the opposite fold often takes on a look characteristic of banal laryngitis, which complicates diagnosis and can send it down the wrong path. In such cases, attention should be paid to the asymmetry of the volumes of the vocal folds and, even if it is insignificant, the patient should be referred to an ENT oncologist.

In a later period, the tumor affects the entire vocal fold, the vocal process, spreads into the laryngeal ventricle and below, into the subglottic space. At the same time, it sharply narrows the respiratory slit, ulcerates deeply and bleeds.

A cancerous tumor with a primary manifestation in the ventricle of the larynx late extends beyond its limits into the lumen of the larynx either in the form of a prolapse of the mucous membrane covering the vocal fold, or in the form of a reddish polyp infiltrating the vocal fold and the walls of the ventricle.

The tumor of the subglottic space, spreading from below to the lower surface of the vocal fold, covers it and immobilizes it, then quickly ulcerates and spreads to the aryepiglottic fold and the pyriform sinus. The secondary edema that occurs with this form of laryngeal cancer hides the size of the tumor and the site of its primary occurrence. In most cases, when the tumor is localized in this area, fairly developed forms of cancer are observed, both proliferative and infiltrative growth, causing significant destruction and penetrating into the preepiglottic space. At this stage, the general condition of the patient suffers significantly (anemia, cachexia, general loss of strength), there are also metastases in the regional lymph nodes. The upper jugular lymph nodes are affected first, which initially enlarge, remain mobile and are painless. Later, merging, the lymph nodes form dense conglomerates, fused with the membrane of the sternocleidomastoid muscle and the larynx. Growing into the endings of sensory nerves, in particular the superior laryngeal nerve, these conglomerates become very painful upon palpation, and spontaneous pains radiating to the corresponding ear also arise. Other lymph nodes of the neck are affected in the same way, their disintegration occurs with the formation of fistulas.

The development of laryngeal cancer in untreated cases leads to death within 1-3 years, but a longer course of this disease is also noted. Death usually occurs from suffocation, profuse erosive bleeding from large vessels of the neck, bronchopulmonary complications, metastases to other organs and cachexia.

Most often, a cancerous tumor is localized in the vestibular part of the larynx. In cancer of this part of the larynx, endophytic tumor growth is observed more often than in cases of damage to the vocal part, which is manifested by its more malignant development. Thus, in case of cancer of the vestibular part of the larynx, the endophytic form of tumor growth is detected in 36.6±2.5% of patients, mixed in 39.8±2.5%, proceeding less aggressively, and exophytic growth in 23.6%. In cases of damage to the vocal folds, these forms of tumor growth are detected in 13.5±3.5%, 8.4±2.8% and 78.1±2.9% of patients, respectively.

The typical morphological form of malignant tumor of the larynx is considered to be squamous cell keratinizing carcinoma.

Sarcoma is a rare disease of the larynx, which, according to the literature, accounts for 0.9-3.2% of all malignant tumors of this organ. Most often, these tumors are observed in men aged 30 to 50 years. Laryngeal sarcomas have a smooth surface, rarely ulcerate, are characterized by slow growth and rare metastasis. Sarcomas are a less homogeneous group than cancer. The literature describes round cell sarcoma, carcinosarcoma, lymphosarcoma, fibrosarcoma, chondrosarcoma, and myosarcoma.

Regional metastases in cancerous tumors of the larynx are detected in 10.3±11.5% of patients. When the tumor is localized in the vestibular region - in 44.0±14.0% of patients, in the vocal region - in 6.3%, in the subvocal region - in 9.4%.

The development of a cancerous tumor of the vestibular region is detected in 60-65% of patients. Cancer of this localization proceeds especially aggressively, the cancerous tumor quickly spreads to surrounding tissues and organs: the preepiglottic space is affected in 37-42% of patients, the pyriform sinus - in 29-33%, valleculae - in 18-23%.

The incidence of cancer of the vocal cords is 30-35%. Hoarseness, which occurs with a tumor of the vocal cords, even of small size, forces the patient to see a doctor soon after the appearance of this symptom. In a later period, hoarseness is accompanied by difficulty breathing, caused by stenosis of the lumen of the larynx by the exophytic part of the tumor and the appearance of immobility of one of its halves. The tumor affects mainly the anterior or middle parts of the vocal folds. The clinical course of cancer of this part is the most favorable.

Cancer of the subglottic part of the larynx is diagnosed in 3-5% of patients. Tumors of this localization usually grow endophytically, narrowing the lumen of the larynx, causing difficulty breathing when inhaling. Spreading in the direction of the vocal fold and infiltrating it, these tumors lead to the development of hoarseness. Another direction of tumor growth is the upper rings of the trachea. In 23.4%, tumor spread to several parts of the larynx can be detected, which is manifested by corresponding symptoms.

The frequency of regional metastasis of laryngeal cancer largely depends on the tumor localization. Thus, with damage to the vestibular section, it is the highest (35-45%). Metastases are especially often found in the area of the confluence of the common facial and internal jugular veins. Later, metastases affect the lymph nodes of the middle and lower chain of the deep jugular vein, the lateral triangle of the neck.

Vocal fold cancer metastasizes rarely (0.4-5.0%). Metastases are usually localized in the lymph nodes of the deep jugular chain.

The frequency of regional metastasis in subglottic laryngeal cancer is 15-20%. Metastases affect the prelaryngeal and pretracheal lymph nodes, as well as the nodes of the deep jugular chain and the mediastinal superior mediastinum. Distant metastases are observed relatively rarely (1.3-8.4%), they are usually localized in the lungs, spine and other organs.

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