Carcinoma of the larynx (carcinomaofthelarynx) is a malignant tumor arising from the epithelial tissue of the laryngeal mucosa and is one of the common malignant tumors of the head and neck. Depending on the location, its early symptoms are different.
I. Supraglottic carcinoma
Most of them originate from the root of the laryngeal surface of the epiglottis, and there are no symptoms in the early stage. When the lesion develops to a considerable extent, symptoms will start to appear.
1. Foreign body sensation in larynx.
Most patients with supraglottic laryngeal cancer have this as the first symptom. This symptom is often ignored by patients and they do not seek medical treatment in time.
2.Laryngeal pain.
Most of them appear when the tumor infiltrates deeper or ulcers appear. At first, there is only a feeling of “scraping” when swallowing, especially when taking the first few bites of food. After a few more bites, the symptoms will disappear. If the tumor progresses, the laryngeal pain may become persistent and may radiate to the ipsilateral ear.
3.Heartiness of voice.
Most patients with supraglottic laryngeal cancer have hoarseness. It often draws patients’ attention and leads to medical consultation. Hoarseness in supraglottic laryngeal cancer does not always mean that the tumor has developed to the vocal cords. The common causes of hoarseness are.
(1) Tumor invades the ventricular zone and compresses the laryngeal chambers and vocal folds downward.
(2) Tumor falls into the vocal folds.
(3) Vocal cord venous reflux obstruction and vocal cord edema.
(4)The tumor invades into the vocal fold area (invades the vocal folds and nail arytenoids).
(4) Dyspnea is a late symptom of supraglottic carcinoma, accounting for about 11.5%.
The common causes of dyspnea are
(1) Large size of tumor blocking the entrance of larynx.
(2) Tumor falls into the vocal fissure.
(3) The tumor invades the vocal folds or the vocal folds cannot be abducted and the vocal folds are narrowed.
(4) Swelling of laryngeal mucosa.
5.Other symptoms
(1) Swelling of larynx: It indicates that the tumor has developed to invade the belt muscle outside the larynx, or the anterior space of the epiglottis has been widely involved.
(2) Difficulty in swallowing: It indicates that the tumor has widely invaded the root of tongue or hypopharynx.
(3) Neck mass: The metastasis of cervical lymph nodes has developed to a considerable extent, without pain and gradually increasing in size.
(4) Blood in sputum: the tumor has ulcers, and there may be a small amount of blood in the sputum, and rarely a large amount of blood in the sputum.
2.Vocal cord cancer
Almost all patients have hoarseness as the first symptom, which is easy to attract patients’ attention and early diagnosis. Vocal tract cancer has better differentiation, slower development and later metastasis of lymph nodes in the neck, so the early diagnosis rate is higher. All middle-aged and elderly people over 40 years old, especially long-term smokers, should be alerted to the possibility of laryngeal cancer if they have persistent hoarseness for more than 4 weeks. According to the statistics of Iwae et al, among 472 cases of laryngeal cancer of vocal fold type, T1aN0 accounted for 38.8%, T1bN0 accounted for 26.9%, T2N0 accounted for 14.8%, and T1N0 and T2N0 together accounted for 80.5%. As the tumor progresses, dyspnea; fullness or mass in the larynx; lymph node metastasis in the neck often occurs on the side of the lesion, and it can also appear bilaterally in the advanced stage; therefore, ipsilateral neck or bilateral neck lymph node enlargement can appear.
Subacromial carcinoma
Most of them are asymptomatic in early stage. Because of the hidden nature of the tumor, it is not easy to be detected early. As the lesion progresses, it can involve the vocal cords upward and appear hoarseness; as the tumor expands downward, with the increase of tumor volume, it can appear respiratory difficulty. Iwae counted 37 cases of subglottic carcinoma, T1N0 only 2 cases, accounting for 5.4%, and T2N010 cases, accounting for 27%.
4.Transvocal hilar carcinoma
It originates from one side of the laryngeal chambers, and the tumor is deep and hidden, so it is not easy to be detected in early stage; its course is long and the tumor develops slowly, and it takes more than six months from the first hoarseness to the definite diagnosis. The cancer can invade the thyroid cartilage pterygoid plate and the outer lower cricothyroid membrane through the paraphrenic space, and invade the thyroid cartilage through the anterior joint tendon in the forward direction, and involve the pyriform fossa in the backward direction.