Benign neoplasms of the larynx. Benign and malignant tumors

Tumors in the throat area are a group of formations of various origins that occur on the mucous membranes of the pharynx and larynx. Oncology deals only with true tumors, and not with various swellings that occur in the throat area due to hemorrhage, swelling or inflammation. Benign tumors of the throat occur due to uncontrolled growth and division of pathological cells.

Epidemiology

Tumors of the larynx and pharynx can be malignant or benign. In the structure of tumor diseases of the larynx and pharynx, benign formations dominate (they occur 10 times more often than malignant ones). According to medical statistics, the highest incidence is registered among men of young and middle age (from 20 to 45 years).

Benign tumors of the throat do not carry such a serious danger to the life and health of the patient as malignant ones. However, even benign tumors must be treated in a timely manner. Firstly, there is always a risk of degeneration of benign formations into malignant ones (for example, papilloma of the throat degenerates into cancer in 7-20% of cases, which is a fairly high rate).

The process of turning a benign tumor into cancer can be rapid, or it can last for years (from 1 to 20 years from the moment the tumor appears). Secondly, some tumors have only a relatively benign course and are capable of slow germination and infiltration of neighboring tissues. A throat tumor can occur from various tissues, the clinical course of the disease and its prognosis depend on this.

Risk factors:

• Such a bad habit as smoking has a detrimental effect on the body as a whole and on the work of internal organs individually. Smoking increases the risk of cancer, especially lung cancer. The smoke coming from a cigarette irritates the mucous membrane of the mouth and throat, which leads to the formation of a pathological formation - a benign or malignant tumor. In addition, do not forget that cigarette smoke contains a large amount of toxic and carcinogenic substances that are harmful to human health.
• Regular drinking
• Inhalation of fine dust (coal, asbestos)
• Poor oral hygiene
• hereditary predisposition
• Age over 60

Benign tumors of the throat are much more common than malignant ones. The most common benign tumors of the throat are angioma, papilloma and angiofibroma.

Benign formations of the pharynx are characterized by the following features:

• Slow expansive growth. Tumor growth can be exophytic - when the bulk of the tumor grows outward and endophytic - with the growth of the formation inside the tissue.
• No effect of the tumor on regional lymph nodes
• Smooth, even surface of tumors (with the exception of papillomas)
• The mucous membrane that covers the tumor is not changed or has a more pronounced vascular pattern
• The presence of clear boundaries in the tumor
• Benign tumors usually do not metastasize.
• The structure of the tumor resembles maternal tissue (connective or epithelial).

Diagnostics

• Examination of the patient by an otolaryngologist. Questioning the patient, collecting an anamnesis.
• Examination of the patient's upper respiratory tract using endoscopic instruments (fibroendoscopy).
• Laryngoscopy
• Biopsy during endoscopic examination. The purpose of a biopsy is to identify abnormal cells in a scraping from the mucous membrane. A biopsy is a cytological study.
• Ultrasound (ultrasound examination). With the help of ultrasound, it is possible to exclude an increase in regional lymph nodes and check the condition of healthy tissues that border on the formation. For the same purposes, a more accurate diagnostic method is used - MRI (magnetic resonance imaging).

Classification of tumors of the pharynx and larynx
Clinical picture

Among the tumors in the throat area, the most common are papillomas(fibroepithelial tumors) and angiomas(tumors of vascular origin).

Papilloma is a formation originating from fibroepithelial tissue. Papilloma may be single, but more often it is a multiple outgrowth, which is located in the upper respiratory tract. In appearance, the formation resembles a mulberry or cauliflower.

Papilloma disrupts the conduction of the throat and interferes with breathing, eating, and the voice-forming function is impaired. The causative agent of the disease is papillomavirus types 6 and 11, as well as their combination. Papilloma has one characteristic feature - it grows unevenly, so periods of rapid growth can be replaced by periods of relative calm. Papillomas are divided into hard and soft - it depends on the ratio of connective tissue and epithelium in the body of the tumor. Most often, papilloma grows on a wide base, sometimes it has a small leg.

Surgical treatment of papillomas is performed in a hospital. Removal of papillomas is performed under local anesthesia or anesthesia. In the postoperative period, drug therapy is mandatory. If we talk about non-surgical methods of treating papillomas of the larynx and pharynx, then the photodynamic method is currently gaining more and more popularity.

The pachydermia of the larynx is an epidermal layer on the vocal folds. The larynx is located above the trachea, and behind the larynx is the esophagus. The larynx is formed from several cartilages - the epiglottis, the cricoid and the thyroid. In the middle (fold) section of the larynx are the vocal folds. Above the middle section is the vestibular (supraglottic) section, and the lower subglottic section is connected to the trachea.

In the practice of an otolaryngologist, benign tumors in the throat area are much more common than malignant ones. Tumor diseases of the larynx and pharynx are more susceptible to men than women. Vascular tumors are a very common disease in the structure of benign tumors in the throat area and are second only to papillomas.

Vascular tumors of the larynx and pharynx

Vascular tumors can be formed in any tissues and internal organs of a person. Angioma of the larynx is a benign tumor that is treated with surgical and medical methods, as well as with the help of radiation therapy. The prevalence of angiomas among all benign diseases of the larynx and pharynx is 13%. There are 2 types of angiomas: hemangiomas and lymphangiomas.

Hemangiomas consist of dilated blood vessels that are located on the vestibular or vocal folds. Hemangioma does not always have clear boundaries, it can be either encapsulated or diffuse. This tumor is dangerous by the occurrence of massive bleeding, which can be repeated and endanger the life of the patient. If the formation grows in a diffuse way (penetrates into other tissues), there may be a violation of the functions and damage to the organs and tissues surrounding the hemangioma.

Hemangioma has a red or reddish-bluish color, grows slowly, usually not reaching large sizes, often represented by a single formation. The clinical symptoms of hemangioma depend on the location and size of the formation. If the hemangioma is located in the upper part of the larynx, then the patient may be disturbed by a dry obsessive cough and a sensation of a "coma in the throat" or a foreign body. As the hemangioma grows, symptoms increase - pain, hoarseness, and blood in the sputum occur. In the event that the tumor affects the vocal folds, the main manifestation of the disease is a change in the patient's voice (from slight weakness to complete aphonia). If the hemangioma is located in the lower part of the larynx and is large, then it can lead to shortness of breath and other respiratory disorders.

Treatment of hemangiomas is surgical (it is always worth remembering the risk of intraoperative bleeding). During the recovery period, careful medical supervision of the patient is necessary.

Angioma of the larynx is a benign tumor in the throat, which has a vascular origin. Angiomas are divided into two types, depending on the vessels from which they grow. Hemangiomas develop from blood vessels, and lymphangiomas develop from lymphatic vessels. Vascular tumors grow slowly, but may have a diffuse development, damaging surrounding organs and tissues.

Hemangioma is a single formation of bright scarlet or red-bluish color. Most often, hemangiomas have a rounded shape. Hemangioma can grow on a narrow stalk or a wide base.

Lymphangiomas arise from dilated lymphatic vessels. These benign tumors are:

• have a pale yellowish color (less intense than that of hemangiomas)
• can be located on the epiglottis, in the subglottic space, in the ventricles of the larynx.

Lymphangiomas are less dangerous than hemangiomas, since if they are damaged, the risk of massive bleeding is much lower. Despite this, lymphangioma causes significant discomfort to the patient and must be removed in a timely manner. Lymphangiomas are divided into simple, cavernous and cystic.

Most often, the cavernous form of lymphangioma is diagnosed. The structure of cavernous lymphangioma are cavities filled with lymph and lined from the inside with endothelium. The partitions between the cavities are formed from connective tissue, which contains muscle fibers, small lymphatic vessels and an elastic frame. Cavernous lymphangioma has a spongy structure. When a cavernous lymphangioma is punctured, lymph is obtained.

Cystic lymphangioma consists of a single or multiple cysts, which can be separated or connected to each other. The size of a lymphangioma of the larynx can vary from a pinhead to a large pea, they almost never reach a larger size.

Symptoms

At an early stage, the disease is asymptomatic, so angiomas, as a rule, become an accidental finding during diagnostic examinations prescribed for another reason. Hemangioma of the larynx can be in an inactive state for years, and then abruptly begin to grow. In women, the impetus for active tumor growth can be pregnancy. If the hemangioma is damaged, massive bleeding is possible. Hemangiomas and lymphangiomas cause a sensation of a foreign body in the throat, difficulty swallowing, and hoarseness.

Treatment

Surgical diathermy or application of a galvanocaustic loop.

Most often, angiofibroma occurs in boys aged 10 to 18 years, for this reason it is called juvenile (youthful). When a teenager reaches maturity (20-22 years), angiofibroma may begin to resolve, undergoing reverse development. The body of a fibroma is made up of connective tissue fibers and many blood vessels.

Angiofibroma in the throat area can be located both in the upper (nasal) part of the pharynx - the nasopharynx, and in the lower - laryngeal cavity.

Angiofibromas of the upper pharynx

Juvenile angiofibroma is a tumor in the region of the upper pharynx, which has signs of both benign and malignant formation.

How does the development of the tumor progress?

As the angiofibroma grows, there is:

• facial asymmetry
• deformation of the soft and bone tissues surrounding the tumor
• cerebrovascular accident
• compression of nerve endings
• displacement of the eyeball

Angiofibroma in the upper part of the pharynx

Symptoms of the disease

In the early stages of the development of the tumor process, the patient feels a slight nasal congestion, sore throat and writes off his condition for colds. As the pathological process develops, breathing through one of the nasal passages becomes completely impossible, and through the second - difficult. Later join:

• Olfactory disturbance
• Voice changes - nasal, hoarseness
• The so-called "adenoid face" - swelling of the face, breathing through a parted mouth
• Recurrent nosebleeds

Angiofibroma in the nasopharynx can be combined with purulent otitis media or purulent sinusitis, which can complicate the diagnostic process. Externally, the tumor is a dense rounded formation of a bright scarlet color. The surface of an angiofibroma may be smooth or bumpy.

Diagnostics

• Anterior and posterior rhinoscopy
• X-ray examination
• Angiographic study
• Magnetic resonance imaging (MRI)
• Computed tomography (CT)

Differential diagnosis should be carried out with the following conditions:

• Adenoids
• polyps
• Papilloma
• Sarcoma
• Cancer of the nasopharynx

Angiofibroma of the larynx

Angiofibroma of the larynx is a red or bluish-red tumor. The formation has an uneven surface and is located on a thin leg. Symptoms of angiofibroma of the larynx are common to all tumors of this localization: hoarseness of the voice up to its complete disappearance - aphonia. The severity of clinical symptoms depends on the location and size of the formation.

Treatment operational.

Laryngeal cyst

A laryngeal cyst is most often localized on the epiglottis, or in the region of the laryngeal ventricles. Usually the cyst has a rounded shape and a smooth surface. Sometimes the cyst reaches a large size and occupies the entire surface of the epiglottis. Cysts, which are located on the vestibular folds, are a smooth or hemispherical swelling. The cyst of the vocal fold resembles a sac, which, as it were, lies on the upper surface of the fold.

A cyst of the larynx is a formation that, if left untreated, can lead to the death of the patient. There are certain difficulties in diagnosing this disease. Diagnostic errors and, as a result, incorrect treatment tactics are a frequent occurrence. A cyst can be both a congenital disease and a retentional one - arising from blockage of the glands of the larynx.

Walls retention cysts are composed of connective tissue and are quite thin, with watery, sticky contents inside the vesicle. A cyst that has a dense membrane and mushy contents is called dermoid.

Cysts resulting from the degeneration of benign tumors, such as fibromas, are called secondary. The secondary cyst should be differentiated from the retention one (there is an epithelium in the retention cyst, but not in the secondary one).

In the early stages of development, the cyst does not cause tangible inconvenience to the patient. As the tumor grows, the symptoms of the disease become more diverse:

• Sensation of a foreign body in the throat
• Hoarseness of voice
• Difficulty breathing

The cyst has a regular round shape and a smooth surface. Gradually, the walls of the tumor become thinner, and the cyst takes the form of a translucent bubble filled with fluid.

Cyst treatment

• surgery
• endolaryngeal cyst puncture
• cyst puncture

benigntumors. Among the three sections of the pharynx, benign tumors are least often found in its laryngeal part. Of the benign tumors of the laryngopharynx, the most common papillomas, somewhat less hemangiomas, rarely - neoplasms developing from muscle tissue ( leiomyomas, rhabdomyomas), neuromas, fibromas and others. The main symptoms of tumors of this localization are the phenomena of dysphagia: sensation of a foreign body, difficulty in swallowing. Pain is not typical for these tumors. With hemangiomas, bleeding from the pharynx is possible. Reaching large sizes, neoplasms can squeeze and cover the entrance to the esophagus, larynx.

A biopsy followed by a histological examination is of decisive importance in the diagnosis.

Surgical treatment.

Malignant tumors. The laryngopharynx, less often than the larynx, is the primary localization of the tumor process. Among malignant tumors of the laryngopharynx predominates squamous cell carcinoma.

Most often tumors of the laryngopharynx are localized in the region of the pear-shaped pocket. Neoplasms of this localization quickly penetrate into the larynx. Tumors of the posterior wall of the laryngopharynx are less common. Most patients note the sensation of a foreign body in the throat, less often the first sign is pain. Since neoplasms of the laryngopharynx quickly affect the larynx, symptoms of laryngeal damage join the symptoms of dysphagia: hoarseness, choking, coughing, difficulty breathing. With the collapse of the tumor, bad breath appears, an admixture of blood in the sputum.

The most effective in the treatment of patients with malignant tumors of the laryngopharynx is the use of a combined and complex method of treatment.

Neoplasms of the larynx

Among the organs of the respiratory tract, the larynx is one of the most frequent localizations of neoplasms, which are very diverse.

Precancerous diseases of the larynx are divided into two groups:

1. obligate states - with a high frequency of malignancy;

2. optional - with a low probability of malignancy.

The first group includes papilloma and papillomatosis, chondroma, leukoplakia, leukokeratosis, chronic hyperplastic laryngitis, contact ulcer of the vocal process of the arytenoid cartilage, laryngeal ventricular cysts.

Facultative precancerous conditions include solid papilloma, fibroma, hemangioma, lymphangioma, and laryngeal pachydermia.

benign tumors.Papilloma- one of the most common tumors of the larynx. It makes up from 35 to 45% of all benign tumors of this localization (Chireshkin D.G., 1971; Savenko I.V., 1994; Tsvetkov E.A., 2001). It has now been established that the etiological factor in the development of papillomatosis is the human papillomavirus (HPV) - a DNA-containing virus from the genus papillomavirus. However, Tsvetkov E.A. (2001) points out that the mere presence of the virus is not enough for the development of the disease, since it can exist in a latent form for a long time. HPV can be reactivated by the patient's immunosuppressive state, infection, intercurrent disease, trauma, and other causes.

There are two fundamentally different forms of damage to the larynx in papillomatosis: a) juvenile papillomatosis (recurrent papillomatosis of the larynx or respiratory recurrent papillomatosis), which manifests itself in children under 10-14 years old and b) adult papillomatosis, which develops after 18 years (Preobrazhensky Yu.B. et al. ., 1980; Tsvetkov E.A., 1996; Weiss et al., 1983). In such a division, the leading role is played not so much by the time of occurrence and development of papillomatosis, but by differences in etiopathogenesis, the nature of the clinical course of the disease, the pathomorphological and immunohistochemical structure of papillomas.

A common tumor process (papillomatosis) occurs more often in childhood. For adults, single papillomas are more characteristic, although even in them the tumor can occupy several departments or the entire larynx. The favorite localization of papillomas is the middle third of the vocal folds of the commissure. From the middle section, papilloma can spread to the entire larynx, and sometimes goes beyond it.

One of the significant differences between papillomas in adults and children is the tendency of the tumor in adults to malignancy. Tumor malignancy occurs in 15-20% of patients. Such a high percentage of malignancy makes it possible to attribute papilloma to obligate precancer.

The most frequent and relatively early sign of papillomas of this localization is hoarseness, which gradually increases, up to aphonia. Over time, difficulty in breathing joins the change in voice. Respiratory disorders are more common in children. Papilloma, like a number of other benign tumors, grows unevenly: periods of increased growth are replaced by periods of relative calm.

Diagnosis and treatment. Diagnosis of papillomas of the larynx in children is associated with certain difficulties, since it is almost impossible to perform indirect laryngoscopy in a child under 5-6 years old, and direct laryngoscopy is indicated for them. Fibroscopy can be considered the method of choice when examining the larynx in children. Currently, one of the main and highly informative methods for examining the larynx is microlaryngoscopy.

At present, the world practice of treating patients is dominated by a combined method, including surgical removal of papillomas and an immunomodulating effect on the body. Removal of papillomas is performed sparingly within healthy tissue with microlaryngoscopy under the control of an operating microscope. Immunotherapy is an important component of complex treatment of laryngeal papillomatosis. Various forms and types of interferon with pronounced antiviral activity are used (Savenko I.V., 1994; Chmyreva N.N., 2002).

Vascular tumors occupy the second place in frequency, second only to papillomas. Of the vascular tumors localized in the larynx, the most common hemangiomas, much less frequently lymphangiomas. Vascular tumors equally often occur in males and females aged 20 to 40 years. However, these neoplasms are also found in childhood and in people over 40 years of age.

Hemangiomas are localized in the upper larynx, can be diffuse and encapsulated. They grow slowly, have destructive growth.

Clinical manifestations of hemangiomas depend on the location and extent of the tumor. When it is localized in the upper part of the larynx, there is a sensation of a foreign body, sometimes coughing. Over time, after a few years, other signs appear: hoarseness, pain, and then an admixture of blood in the sputum. Severe spontaneous bleeding is possible. If the hemangioma comes from the vocal fold, then the first symptom is a gradual change in voice to aphonia. Then cough, admixture of blood in sputum, hemoptysis, bleeding join, difficulty in breathing may develop. Respiratory failure as one of the first signs is characteristic of tumors emanating from the lower larynx.

Treatment with hemangiomas of the larynx is associated with certain difficulties, which are due to the risk of intraoperative bleeding. Encapsulated hemangiomas can be removed endolaryngeally with direct laryngoscopy under anesthesia. Treatment of patients with diffuse hemangiomas of the larynx is recommended by repeated cryotherapy.

Dyskeratosis of the larynx. Dyskeratosis is a dysplasia of stratified squamous epithelium, the histological manifestation of which is hypertrophy, hyperplasia, hyperkeratosis, parakeratosis and acanthosis. The etiological factors of dyskeratosis are considered to be chronic processes of the mucous membrane due to bacterial, chemical and thermal stimuli, as well as hormonal disorders and a lack of vitamin A. The provoking factors for the occurrence of dyskeratosis are the abuse of alcohol, tobacco, and professional overload of the vocal apparatus. Depending on the degree of keratinization and proliferation of the epithelium, the following types of dyskeratoses are distinguished: leukoplakia, leukokeratosis, pachydermia.

Leukoplakia of the larynx endoscopically expressed in the appearance of oblong whitish spots on the hyperemic mucous membrane of the larynx, mainly on the vocal folds. Leukokeratosis- keratinization of the mucous membrane laryngoscopy has the appearance of whitish-gray, somewhat elevated areas above the surface of the mucous membrane, with a fleecy uneven surface. Localization mainly on the vocal folds, anterior and posterior commissures.

Pachydermia also refers to dyskeratosis of the larynx, develops against the background of the inflammatory process. It is characterized by hyperplasia of the mucous membrane of the larynx, which is manifested by thickening and significant thickening of the epithelial layer of the vocal folds. Epidermal layers are located on the vocal folds in their posterior third or in the interarytenoid space. Unlike leukokeratosis or leukoplakia, pachydermia rarely turns into cancer, so it belongs to facultative precancer.

The clinical manifestation of dyskeratosis is a sensation of perspiration, a foreign body, coughing, pain when swallowing, persistent hoarseness, and sometimes aphonia.

Treatment of dyskeratosis is surgical. The method of choice is microlaryngoscopy with microsurgical intervention.

In addition to the considered benign tumors of the larynx and precancerous conditions, it is necessary to dwell on some tumor diseases that are not facultative or obligate precancer, but they must be taken into account in differential diagnosis. Tumor-like formations include singing nodules (“screamer nodules”) and polyps of the vocal folds, as well as nonspecific (postoperative, intubation and contact) granulomas.

Granulomas are quite rare and occur as a result of trauma or a chronic nonspecific inflammatory process. The morphological structure of a granuloma is granulation tissue covered with a thin epithelial layer. They are mushroom-shaped or polypop-shaped, their sizes vary widely.

singing nodules are often found, more often in women, are localized on the border of the anterior and middle third of the vocal folds, on their free edge and are symmetrically located opposite each other. Their sizes, as a rule, are no more than a millet grain.

vocal cord polyps often localized in the anterior or middle third of the vocal fold, bright pink or bright red, with a broad base. Polyps are twice as common in men as in women. Unlike knots, the process is one-way.

Treatment of tumor-like formations is carried out by endolaryngeal intervention (removal of nodes) or by conventional laryngoscopy, or under a microscope (which is more desirable). The method of choice is cryodestruction.

Malignant tumors. Malignant neoplasms of the larynx account for 50-60% of all malignant tumors of the ENT organs. About 70% of them occur in men of working age (40-60 years). Among the malignant neoplasms of the larynx, epithelial neoplasms - cancers (98%) predominate. Among the factors contributing to the occurrence of laryngeal cancer, first of all, smoking, voice load and alcohol abuse should be noted.

Depending on the localization of the malignant process, there are cancers of the vestibular (upper), vocal (middle) and lower (subglottic) sections. Most domestic and foreign studies indicate that the most unfavorable course and the most frequent localization (60-70%) is cancer of the vestibular region. The vocal region is less commonly affected (25-30%), and in very rare cases, the sub-vocal region (0.5-3%).

Cancer of the vestibular larynx gives a high level of metastasis and quickly grows into nearby organs (piri-shaped pockets, root of the tongue, etc.). The favorite localization of cancer of the vestibular region is the epiglottis, less often the ventricles of the larynx and false folds, even more rarely the arytenoid cartilages, the aryepiglottic folds and the interarytenoid space. Cancer of the middle and lower sections are characterized by slower growth and metastasis. With tumors of the vocal region, growth is possible upward into the laryngeal ventricle and downward into the subvocal region. Tumors of the subvocal region grow in the direction of the trachea, as well as up to the vocal folds.

Distant metastases primarily appear in the lungs and mediastinum.

a – stage I, b – stage II, c – stage III (Likhachev A.G., 1953).

clinical picture. With cancer of the vestibular region, there is a sensation of a foreign body, discomfort, choking. Gradually there is pain when swallowing, which often radiates to the ear. With the spread of the tumor, the symptoms are supplemented by hemoptysis, bad breath, increasing hoarseness, and even stenosis of the larynx.

When the vocal folds are affected by the process (Fig. 3), the main and early symptom is persistent progressive hoarseness of the voice, gradually turning into aphonia. This symptom is later joined by coughing, pain and difficulty breathing (stenosis).

Diagnostics. In the diagnosis, direct and indirect laryngoscopy, microlaryngoscopy, cytological examination of sputum, punctate of tumor infiltrate, radionuclide scanning of the larynx are used. In addition, radiography and computed tomography are widely used in the study of the larynx. The root of the tongue, hyoid bone, vallecules, epiglottis, lumen of the larynx and cervical trachea are clearly visible on the radiograph. Computed tomography (Fig. 4,5,6) makes it possible to timely determine the tumor already at stages I and II of the process, assess the shape and size of the neoplasm, determine the state of the bone, cartilage and soft tissue structures surrounding the tumor, and clarify the level of invasion into neighboring organs.

Fig.4. Cancer of the vestibular larynx

(Formation of the scoop-epiglottic fold on the right, extending to the pyriform sinus).

pathological calcification of the plate of the thyroid and arytenoid cartilages).

Fig.6. Cancer of the subglottis of the larynx (Spread to the soft tissues of the neck,

severe destruction of the cricoid cartilage.

Treatment. The main methods of treatment of laryngeal cancer are surgical, radiation and combined (radiation and surgery). In surgical treatment, depending on the stage of the disease, localization and prevalence of the process, operations of different volumes are used:

2. Resection of the larynx (removal of part of the larynx while maintaining the function of the organ) - is performed when the tumor is localized in the anterior 2/3 of the vocal folds with spread to the anterior commissure; with damage to one vocal fold; with limited cancer of the lower larynx; with limited cancer of the upper larynx, provided that the arytenoid cartilages are intact.

Lateral resection of the larynx - indicated for tumors of the vocal fold, extending to the laryngeal ventricle and vestibular fold, and also to the infraglottic region on one side and causing restriction of vocal fold mobility. Contraindications - spread to the epiglottis, commissure and arytenoid cartilages.

Anterolateral resection is the same with the transition to the anterior commissure and anterior parts of the larynx wall of the opposite side.

Horizontal resection of the larynx - for tumors of the vestibular larynx.

Combined resections of the larynx - with the spread of tumors to neighboring organs.

3. Laryngectomy (extirpation of the larynx) - complete removal of the larynx with the formation of a tracheostomy on the front surface of the neck (an anastomosis with airways).

4. Treatment of metastatic lesions of regional lymph nodes:

Fascial-case excision of the tissue of the neck.

Crile operation.

Radiation therapy for malignant tumors of the larynx consistently ranks second after surgical treatment. Chemotherapy is gradually introduced, the possibilities of immunotherapy are being studied.

Tumors affecting the throat include tumors of the pharynx and larynx, which have their own characteristic symptoms and should be considered separately. Among the tumors of these localizations, both benign and malignant variants of these tumors are found.

Tumors of the larynx

A benign tumor of the larynx in the population is much more common than cancer. Such tumors do not limit the mobility of the vocal cords.

Among the benign neoplasms of the larynx are often found:

• papillomas;
• Fibroids;
• Leiomyomas.

More rare benign formations of the larynx include:

• Mixoms;
• Hemangiomas;
• Lymphangiomas.

Fibroma together with papilloma take over 85% of all benign tumors of the larynx. In terms of tissue structure, their structure is similar. Fibroma with a high content of interstitial fluid is called a polyp. Papilloma also has a connective tissue basis, however, it contains a developed vascular network, and is covered with squamous epithelium on the outside. On examination, it resembles a papilla or "cauliflower".

The exact cause of papillomas is unknown. Doctors often associate the appearance of such tumors in the throat with HPV (human papillomavirus).

These types of throat tumors are significantly more common in children under the age of five. Symptoms characteristic of papillomas of the larynx:

• hoarseness;
• Hoarseness;
• Violation of phonation;
• Aphonia;
• Difficulty breathing;
• Dyspnea.

Fibromas, hemangiomas, lymphangiomas and mixomas are characterized by symptoms similar to papillomas. The listed variants of tumors are different only according to the results of laryngoscopy and according to biopsy data.

Treatment of benign tumors of the throat

The main method of treatment is surgery. It is worth mentioning that often after the intervention, the tumor can recur. Recurrent papilloma in adults is a dangerous harbinger of laryngeal cancer. If possible, they tend to avoid open operations, mainly try to carry out endolaryngeal access. At the risk of asphyxia, especially in young children, a tracheostomy is used.

For hemangiomas and lymphangiomas, sclerosing therapy is used.

Malignant neoplasms of the larynx.

To malignant neoplasms of the throat include cancer of the larynx. For laryngeal cancer, scientists have identified the following risk factors:

• Papillomatosis in adults;
• recurrent fibroma;
• Leukoplakia;
• Cicatricial changes of tuberculous genesis;
• Burn scars.

The clinical picture of cancer is diverse. The main symptoms of laryngeal cancer:

• Dryness in the throat;
• Perspiration, sensation of a foreign body in the throat;
• Hoarseness, hoarseness, aphonia. Violation of phonation, mainly occurs due to the loss of function of the vocal cord on the left side. The left vocal cord is statistically affected much more often than on the right side;
• Difficulty breathing, with large tumors;
• Determination of a tumor-like formation in the region of the Adam's apple. Increasing in size, the tumor in women can create the appearance of an "imaginary Adam's apple";
• Complaints of patients about the change in the mobility of the Adam's apple. Reaching a large size, the tumor infiltrates neighboring tissues (Adam's apple, thyroid gland);
• Pain syndrome;
• Complaints from the heart are possible. In cases where the tumor irritates the trunk of the vagus nerve lying nearby, patients may experience a feeling of palpitations, interruptions in the work of the heart, arrhythmia;
• Rarely there are complaints from the stomach. When the vagus nerve is irritated, the secretory and motor functions of the stomach are disturbed.

Diagnosis of cancer of the larynx

Primary diagnosis includes history taking and physical examination. Then proceed to oropharyngoscopy. Direct and indirect laryngoscopy techniques are used.

• Fibroscopic examination with targeted biopsy;
• Ultrasound of the throat;
• X-ray examination;
• CT scan;
• Magnetic resonance imaging.

Treatment of laryngeal cancer

In the treatment of laryngeal cancer, two main methods are used - surgical and radiation methods. Chemotherapy can complement both proposed methods. Laryngeal cancer is characterized by recurrence, in which case patients undergo repeated treatment. In the later stages of the disease, if radical treatment is not possible, palliative care is applicable.

For the treatment of metastases, surgery is performed with the support of drug and radiation therapy. The operation of removal of lymph nodes (dissection) with metastatic foci is performed after a detailed examination of the patient. An integrated approach in oncology is the key to a good prognosis.

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Tumors of the pharynx

Benign tumors of the pharynx are up to ten times more common than malignant neoplasms.

Benign tumors of the pharynx include:

• papillomas;
• adenomas;
• Hemangiomas;
• Fibroids;
• Lipomas;
• Neurinomas;
• Other.

Clinical manifestations of benign tumors of the pharynx:

• Feeling of a foreign body in the throat;
• Sore throat;
• Complaints from the respiratory organs. Difficulty or impossibility of nasal breathing;
• Change of voice, nasality.

Diagnosis of a benign tumor of the pharynx

Diagnosis occurs on the basis of collected complaints, anamnesis of the disease and general examination data. The preliminary diagnosis is confirmed by the use of additional research methods. Rhino- and pharyngoscopy is performed. A biopsy is taken to confirm that the tumor is benign. Targeted biopsy is the gold standard in tumor diagnosis. Carrying out computed and magnetic resonance imaging is advisable for large tumor sizes. Ultrasound is also rational for advanced benign neoplasms.

Treatment of a benign tumor of the pharynx:

The method of choice is elective surgery. Operations are performed by intrapharyngeal access, the patient most often does not need general anesthesia, local anesthesia is used. Cryotherapy is often used for papillomas. In relation to hemangiomas, a sclerotherapeutic technique and diathermal coagulation are indicated.

In exceptional cases, when the size of the tumor does not allow intrapharyngeal access, surgeons resort to the use of lateral pharyngotomy. This type of intervention requires general anesthesia.

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Malignant tumors of the pharynx

The pharynx is characterized by many types of neoplasms, but squamous cell carcinoma is the most common. Squamous cell carcinoma accounts for up to 70% of all malignant tumors of the pharynx. Non-epithelial malignant neoplasms include lymphosarcomas and lymphomas, which take up to 20% of the malignant tumor pathology of the pharynx.

Clinical symptoms are largely determined by the nature of tumor growth and its localization in the pharynx.

The main symptoms of pharyngeal cancer:

• From the side of the nose and ear:
  • Difficulty breathing;
  • The occurrence of nasality;
  • Pain in the ears;
  • Headache;
  • Ear popping symptom
  • If the tumor grows beyond the nasopharynx, the following may occur:
  • exophthalmos;
  • Horner's syndrome (ptosis, miosis, enophthalmos);
  • Damage to the facial nerve manifested by asymmetry of the face;
  • Deviation of the tongue to the side;
  • Symptoms of damage to the oculomotor nerve. Strabismus, disturbance of accommodation;
  • Violation of the act of swallowing;
  • Other.

Diagnosis of cancer of the pharynx

Conducting primary diagnostics. Clarification of complaints, collection of anamnesis of the disease and examination. After establishing a preliminary diagnosis, they proceed to an additional study.

Spend:

• Oto-, rhino-, pharyngoscopy;
• Biopsy, for histological examination;
• Ultrasound procedure;
• Computer and magnetic resonance imaging of the body.

Therapy of a low-quality tumor process of the pharynx.

When the tumor is located in the nasopharynx, treatment is possible only by conservative methods. Chemotherapy drugs and radiation therapy are used. For tumors of the oropharynx, it is possible to use surgical therapy in the early stages of the disease. However, early diagnosis is often difficult and the methods of choice remain the same radiation and chemotherapy.

For the treatment of metastases in the lymph nodes, a surgical method is applicable. Surgical intervention is supported by radiation and drug therapy.

An integrated approach to the treatment of malignant neoplasms gives better results compared to the isolated use of one of the methods.

Prognosis for throat tumors

In general, the prognosis for benign tumors of the throat, with proper therapy, is always favorable. With frequent recurrence of a benign formation, the doctor should think about the precancerous condition and study such a patient in depth.

For malignant neoplasms of the larynx and pharynx, the prognosis is less favorable. Today, medicine does not stand still, and even for seriously ill patients, treatment options are found. With early detection and properly selected complex therapy, the prognosis in such patients is significantly improved.

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Benign tumors of the larynx are tumor formations that are localized in the larynx. Characterized by the absence of metastasis or ulceration, slow non-invasive growth. Quite often, benign tumors of the larynx are asymptomatic. Sometimes they are manifested by hoarseness and hoarseness of voice, respiratory failure, cough. The significant size of the tumor causes asphyxia and even aphonia. An otolaryngologist is responsible for diagnosing benign tumors of the larynx, who performs endoscopic biopsy, histological examination and laryngoscopy. The most effective is the surgical method for the treatment of benign tumors of the larynx. The characteristics of the course of treatment are influenced by the nature, type and growth of the tumor.

Benign tumors of the larynx are based on various tissue structures - a vessel, cartilaginous and connective tissue, glandular components of the mucosa, nerve endings and trunks. They may appear during the life of the patient or be congenital. In otolaryngology, among all benign tumors of the larynx, angioma, fibroma, papilloma and polyps are most common. Lipoma, chondroma, cyst, neurofibroma of the larynx and neurinoma are diagnosed much less frequently. Benign tumors of the larynx are much more common in men than in women.

Types of benign tumors of the larynx

Fibromas are benign tumors of the larynx that have a connective tissue origin. In most cases, this is a single formation of a spherical shape, which is localized on the upper surface or on the free edge of the vocal fold. The size of the fibroma ranges from 0.5-1.5 cm. Laryngeal fibromas have a smooth surface, gray color and can be pedunculated. A large number of blood vessels in the fibroma structure can change its color to red (angiofibroma). These benign tumors of the larynx are clinically manifested by various changes in the voice. This type of tumor can cause breathing problems if it reaches a large size.

Laryngeal polyps are called a separate type of fibroma, the structure of which, in addition to connective tissue fibers, also consists of a large amount of fluid and cellular elements. These benign tumors of the larynx have a broad base or thick stalk and can be as large as a pea. In addition, polyps may have a less dense consistency than fibromas. These formations are localized in the anterior part of one of the vocal folds. The only manifestation of a polyp, as a rule, is hoarseness. Cough or breathing changes are usually not observed.

Angiomas are benign tumors of the larynx that are of vascular origin. Angiomas are single formations and are congenital. Tumors from blood vessels (hemangiomas) bleed heavily when injured, can grow into surrounding tissues, and are red in color. Tumors from the lymphatic vessels (lymphangiomas) do not tend to grow and have a yellowish color.

Papillomas of the larynx are a special type of benign tumors. In adults, papillomas of the larynx are single or multiple (rarely) dense outgrowths with a wide, mushroom-shaped base. They are pinkish or whitish in color, may be dark red with an intensive blood supply. Papilloma can be affected by the tracheal mucosa, but this is observed only in some cases. Juvenile papillomas are observed in children. These formations most often appear in the period from 1 to 5 years. During the period of puberty of the child, juvenile papillomas are prone to spontaneous disappearance. Multiple papillomas often develop in childhood, they occupy entire sections of the mucosa. Otherwise, this phenomenon is called papillomatosis. Such benign tumors of the larynx outwardly resemble cauliflower. Usually the lesion is localized on the vocal folds. True, in some cases, the process can extend to the subglottic region, epiglottis, trachea, scoop-epiglottic folds. Papillomatosis of the larynx is clinically manifested by hoarseness turning into aphonia. Chronic stenosis of the larynx occurs if there is a significant growth of the tumor.

Chondromas are benign tumors of the larynx of a dense structure, originate from cartilage tissue. After some time, malignant degeneration can be observed, followed by the development of chondrosarcoma.

Laryngeal cysts develop from embryonic gill slits, in turn, the occurrence of which is due to violations of embryogenesis. Retention cysts are diagnosed in children. These cysts are formed from the glands of the mucous membrane of the larynx. Laryngeal cysts rarely cause any symptoms because they are rarely large.

Lipomas are benign tumors of the larynx, ovoid in shape, yellow in color, often with a stalk. Lipomas of the larynx, like lipomas of the second localization, consist of adipose tissue.

The aforementioned benign tumors of the larynx require surgical intervention, because in the future they can be harmful to health.

Causes of benign tumors of the larynx

Congenital benign tumors of the larynx arise due to exposure to the fetus of various teratogenic factors and genetic predisposition. Teratogenic factors are infectious diseases of the mother during pregnancy (measles, rubella, chlamydia, viral hepatitis, mycoplasmosis, HIV, syphilis), the intake of embryotoxic drugs by a pregnant woman, radiation exposure, and the like.

The main causes of the appearance of benign tumors of the larynx of an acquired nature can be called some viral diseases (herpetic and adenovirus infection, measles, influenza, HPV), prolonged exposure to irritants (inhalation of tobacco smoke, fine dust, work in a smoky room), chronic inflammatory diseases (tonsillitis, adenoids, chronic pharyngitis and laryngitis), severe voice loads, changes in the endocrine system.

Symptoms of benign tumors of the larynx

In patients with benign tumors of the larynx, the voice changes markedly. He becomes hoarse or hoarse. Benign tumors of the larynx with long stalks are characterized by frequent coughing and changes in voice. The complete absence of voice (aphonia) can be observed when the tumor is localized in the region of the vocal cord and prevents it from closing. Large benign tumors of the larynx cause difficulty in breathing. Sometimes they become a prerequisite for asphyxia, especially a small child can suffer from this.

Diagnosis of benign tumors of the larynx

Small benign tumors of the larynx do not interfere with the closing of the vocal cords, are asymptomatic. In most cases, the otolaryngologist discovers them by chance when examining a patient for a disease of a different origin.

Benign tumors of the larynx clinically have fairly typical symptoms, thanks to which they can be diagnosed. However, the doctor must differentiate benign tumors from malignant processes, scleroma and foreign bodies, which may have similar symptoms.

To confirm the diagnosis of a "benign tumor of the larynx", microlaryngoscopy is performed, which allows you to examine the appearance of the tumor in more detail. The exact type of formation can be determined after its histological examination. Histology of a benign tumor of the larynx is carried out after its removal. Sometimes an endoscopic biopsy of the formation is additionally prescribed. The study of the degree of mobility and closure of the vocal cords, voice function is carried out using stroboscopy, phonetography, electroglottography and determining the time of maximum phonation. Diagnosis of the prevalence of benign tumors of the larynx is carried out using ultrasound, MRI or CT, X-ray of the skull. At this stage, it is important to determine the area of ​​\u200b\u200bdistribution of education, without which it will not be possible to start treatment.

Treatment of benign tumors of the larynx

Benign tumors of the larynx, due to the likelihood of malignancy and due to the development of complications (respiratory and voice disorders), are subject to surgical removal. Endoscopic removal with laryngeal forceps or a special loop is performed with small sizes of polyps and fibromas. Small cysts of the larynx can be excised along with their membrane. Large cysts of the larynx are pierced before removal and all fluid is extracted from them. To avoid recurrence of the cyst, cryotreatment of the base is performed after the operation.

The method of removal of benign tumors of the larynx directly depends on the nature of the growth and prevalence of the tumor. Local hemangiomas, which are characterized by exophytic growth, are excised, anti-relapse treatment is carried out at the affected site by cryotherapy, laser irradiation or diathermocoagulation. Sclerosis or occlusion of the supply vessels is used for endophytic growth of benign tumors and their widespread nature.

The most difficult thing is to treat papillomatosis of the larynx, since it is necessary to remove those parts of the mucosa that have changed. Carrying out such an operation is impossible to imagine without a surgical microscope, the only way to leave healthy tissue or a certain vessel intact.

Limited areas of papillomatosis are removed using laser or cryodestruction, diathermocoagulation. Surgical intervention to prevent relapse should be accompanied by immunomodulatory and antiviral therapy. In order to increase immunity, children with papillomatosis are given autovaccination. If necessary, a second course of treatment can be carried out. Recurrence of papillomatosis and a significant increase in papilloma growths after the operation requires a special course of chemotherapy. Otherwise, a benign tumor will develop into a malignant one, which is much more difficult to fight.

Prognosis of benign tumors of the larynx

Timely treatment of benign tumors of the larynx gives a favorable prognosis for recovery. True, there is a risk of frequent recurrence of certain types of tumors. The most unfavorable in this sense of all benign tumors of the larynx is papillomatosis of the larynx, especially for young children. In adults, such relapses occur very rarely. However, after the operation, complete restoration of the voice does not always occur.

Benign tumors of the larynx are tumor formations that are localized in the larynx. Characterized by the absence of metastasis or ulceration, slow non-invasive growth. Quite often, benign tumors of the larynx are asymptomatic. Sometimes they are manifested by hoarseness and hoarseness of voice, respiratory failure, cough. The significant size of the tumor causes asphyxia and even aphonia. An otolaryngologist is responsible for diagnosing benign tumors of the larynx, who performs endoscopic biopsy, histological examination and laryngoscopy. The most effective is the surgical method for the treatment of benign tumors of the larynx. The characteristics of the course of treatment are influenced by the nature, type and growth of the tumor.

Benign tumors of the larynx are based on various tissue structures - a vessel, cartilaginous and connective tissue, glandular components of the mucosa, nerve endings and trunks. They may appear during the life of the patient or be congenital. In otolaryngology, among all benign tumors of the larynx, angioma, fibroma, papilloma and polyps are most common. Lipoma, chondroma, cyst, neurofibroma of the larynx and neurinoma are diagnosed much less frequently. Benign tumors of the larynx are much more common in men than in women.

Types of benign tumors of the larynx

Fibromas are benign tumors of the larynx that have a connective tissue origin. In most cases, this is a single formation of a spherical shape, which is localized on the upper surface or on the free edge of the vocal fold. The size of the fibroma ranges from 0.5-1.5 cm. Laryngeal fibromas have a smooth surface, gray color and can be pedunculated. A large number of blood vessels in the fibroma structure can change its color to red (angiofibroma). These benign tumors of the larynx are clinically manifested by various changes in the voice. This type of tumor can cause breathing problems if it reaches a large size.

Laryngeal polyps are called a separate type of fibroma, the structure of which, in addition to connective tissue fibers, also consists of a large amount of fluid and cellular elements. These benign tumors of the larynx have a broad base or thick stalk and can be as large as a pea. In addition, polyps may have a less dense consistency than fibromas. These formations are localized in the anterior part of one of the vocal folds. The only manifestation of a polyp, as a rule, is hoarseness. Cough or breathing changes are usually not observed.

Angiomas are benign tumors of the larynx that are of vascular origin. Angiomas are single formations and are congenital. Tumors from blood vessels (hemangiomas) bleed heavily when injured, can grow into surrounding tissues, and are red in color. Tumors from the lymphatic vessels (lymphangiomas) do not tend to grow and have a yellowish color.

Papillomas of the larynx are a special type of benign tumors. In adults, papillomas of the larynx are single or multiple (rarely) dense outgrowths with a wide, mushroom-shaped base. They are pinkish or whitish in color, may be dark red with an intensive blood supply. Papilloma can be affected by the tracheal mucosa, but this is observed only in some cases. Juvenile papillomas are observed in children. These formations most often appear in the period from 1 to 5 years. During the period of puberty of the child, juvenile papillomas are prone to spontaneous disappearance. Multiple papillomas often develop in childhood, they occupy entire sections of the mucosa. Otherwise, this phenomenon is called papillomatosis. Such benign tumors of the larynx outwardly resemble cauliflower. Usually the lesion is localized on the vocal folds. True, in some cases, the process can extend to the subglottic region, epiglottis, trachea, scoop-epiglottic folds. Papillomatosis of the larynx is clinically manifested by hoarseness turning into aphonia. Chronic stenosis of the larynx occurs if there is a significant growth of the tumor.

Chondromas are benign tumors of the larynx of a dense structure, originate from cartilage tissue. After some time, malignant degeneration can be observed, followed by the development of chondrosarcoma.

Laryngeal cysts develop from embryonic gill slits, in turn, the occurrence of which is due to violations of embryogenesis. Retention cysts are diagnosed in children. These cysts are formed from the glands of the mucous membrane of the larynx. Laryngeal cysts rarely cause any symptoms because they are rarely large.

Lipomas are benign tumors of the larynx, ovoid in shape, yellow in color, often with a stalk. Lipomas of the larynx, like lipomas of the second localization, consist of adipose tissue.

The aforementioned benign tumors of the larynx require surgical intervention, because in the future they can be harmful to health.

Causes of benign tumors of the larynx

Congenital benign tumors of the larynx arise due to exposure to the fetus of various teratogenic factors and genetic predisposition. Teratogenic factors are infectious diseases of the mother during pregnancy (measles, rubella, chlamydia, viral hepatitis, mycoplasmosis, HIV, syphilis), the intake of embryotoxic drugs by a pregnant woman, radiation exposure, and the like.

The main causes of the appearance of benign tumors of the larynx of an acquired nature can be called some viral diseases (herpetic and adenovirus infection, measles, influenza, HPV), prolonged exposure to irritants (inhalation of tobacco smoke, fine dust, work in a smoky room), chronic inflammatory diseases (tonsillitis, adenoids, chronic pharyngitis and laryngitis), severe voice loads, changes in the endocrine system.

Symptoms of benign tumors of the larynx

In patients with benign tumors of the larynx, the voice changes markedly. He becomes hoarse or hoarse. Benign tumors of the larynx with long stalks are characterized by frequent coughing and changes in voice. The complete absence of voice (aphonia) can be observed when the tumor is localized in the region of the vocal cord and prevents it from closing. Large benign tumors of the larynx cause difficulty in breathing. Sometimes they become a prerequisite for asphyxia, especially a small child can suffer from this.

Diagnosis of benign tumors of the larynx

Small benign tumors of the larynx do not interfere with the closing of the vocal cords, are asymptomatic. In most cases, the otolaryngologist discovers them by chance when examining a patient for a disease of a different origin.

Benign tumors of the larynx clinically have fairly typical symptoms, thanks to which they can be diagnosed. However, the doctor must differentiate benign tumors from malignant processes, scleroma and foreign bodies, which may have similar symptoms.

To confirm the diagnosis of a "benign tumor of the larynx", microlaryngoscopy is performed, which allows you to examine the appearance of the tumor in more detail. The exact type of formation can be determined after its histological examination. Histology of a benign tumor of the larynx is carried out after its removal. Sometimes an endoscopic biopsy of the formation is additionally prescribed. The study of the degree of mobility and closure of the vocal cords, voice function is carried out using stroboscopy, phonetography, electroglottography and determining the time of maximum phonation. Diagnosis of the prevalence of benign tumors of the larynx is carried out using ultrasound, MRI or CT, X-ray of the skull. At this stage, it is important to determine the area of ​​\u200b\u200bdistribution of education, without which it will not be possible to start treatment.

Treatment of benign tumors of the larynx

Benign tumors of the larynx, due to the likelihood of malignancy and due to the development of complications (respiratory and voice disorders), are subject to surgical removal. Endoscopic removal with laryngeal forceps or a special loop is performed with small sizes of polyps and fibromas. Small cysts of the larynx can be excised along with their membrane. Large cysts of the larynx are pierced before removal and all fluid is extracted from them. To avoid recurrence of the cyst, cryotreatment of the base is performed after the operation.

The method of removal of benign tumors of the larynx directly depends on the nature of the growth and prevalence of the tumor. Local hemangiomas, which are characterized by exophytic growth, are excised, anti-relapse treatment is carried out at the affected site by cryotherapy, laser irradiation or diathermocoagulation. Sclerosis or occlusion of the supply vessels is used for endophytic growth of benign tumors and their widespread nature.

The most difficult thing is to treat papillomatosis of the larynx, since it is necessary to remove those parts of the mucosa that have changed. Carrying out such an operation is impossible to imagine without a surgical microscope, the only way to leave healthy tissue or a certain vessel intact.

Limited areas of papillomatosis are removed using laser or cryodestruction, diathermocoagulation. Surgical intervention to prevent relapse should be accompanied by immunomodulatory and antiviral therapy. In order to increase immunity, children with papillomatosis are given autovaccination. If necessary, a second course of treatment can be carried out. Recurrence of papillomatosis and a significant increase in papilloma growths after the operation requires a special course of chemotherapy. Otherwise, a benign tumor will develop into a malignant one, which is much more difficult to fight.

Prognosis of benign tumors of the larynx

Timely treatment of benign tumors of the larynx gives a favorable prognosis for recovery. True, there is a risk of frequent recurrence of certain types of tumors. The most unfavorable in this sense of all benign tumors of the larynx is papillomatosis of the larynx, especially for young children. In adults, such relapses occur very rarely. However, after the operation, complete restoration of the voice does not always occur.