Laryngeal cancer is a relatively common clinical tumor, with an incidence rate of 1-5% of the whole body, and ranks third after nasopharyngeal cancer and sinus cancer in ear, nose and throat diseases. The age of onset is 50-70 years old, and it is more common in men. The cause of the disease is not clear, and most of the patients have a long-term smoking history.
Clinical manifestations
1. Hoarseness may appear in the early stage, or it may be manifested as discomfort in the throat or foreign body sensation, which is easy to delay the diagnosis. Zhang Shuguang, Department of Head and Neck Surgery, Shandong Institute of Cancer Control
2.Coughing up sputum and blood in sputum: it mostly occurs after cancer infiltrates mucous membrane and is a frequent symptom.
3.Difficulty in breathing or swallowing: It is a symptom of late stage, cancer has developed to block the larynx and esophagus.
4.Metastasis of cervical lymph nodes: it can be metastasized to ipsilateral cervical lymph nodes, and in advanced stage, it can be metastasized to contralateral cervical lymph nodes or distant tissues and organs.
Auxiliary examination
Neck examination to observe the appearance of the larynx and the presence of enlarged lymph nodes in the neck. Blood tumor markers, indirect laryngoscopy, laryngeal X-ray, laryngeal CT and MRI can determine the location, size and extent of laryngeal mass lesions. Indirect laryngoscopy or fiberoptic laryngoscopy and pathological biopsy of laryngeal masses are the methods to confirm the diagnosis of laryngeal cancer.
Site typing of laryngeal cancer
1.Supraglottic type
2.Vocal hilar type
3.Subglottic type
Pathological classification of laryngeal cancer
1.Squamous cell carcinoma: there are cauliflower type, infiltrative type and ulcerative type.
2.Adenocarcinoma: adenoid cystic carcinoma, mucinous epidermis-like carcinoma, adenosquamous carcinoma, etc., which are less common.
3.Keratinized carcinoma or warty carcinoma of larynx: it occurs mostly in the vocal cords and is often highly differentiated squamous cell carcinoma.
4.Mucosal self-plaque and laryngeal papilloma carcinoma: it occurs in the vocal cords and is usually highly differentiated squamous cell carcinoma.
5.Malignant granuloma, malignant lymphoma or undifferentiated carcinoma of the larynx: commonly found in the supraglottis region, with high malignancy, rapid development and prone to distant organ metastasis.
6.Malignant melanoma and sarcoma: relatively rare.
7.Metastatic cancer of larynx: tumors from other parts metastasize to larynx.
Treatment methods of laryngeal cancer
1.Surgical treatment
A supported laryngoscopic laryngectomy, mainly suitable for early cases.
B partial laryngectomy: including laryngeal laceration vocal cord resection, horizontal hemilaryngectomy, vertical hemilaryngectomy, and some corresponding surgical modifications, which are chosen according to the extent of vocal cord cancer invasion.
C total laryngectomy: it is suitable for advanced laryngeal cancer.
D palliative laryngectomy for laryngeal tumor: to improve the patient’s respiratory function and other local symptoms.
2.Radiation therapy
For early stage laryngeal cancer, the cure rate and 5-year survival rate of radiotherapy are comparable to the effect of surgical treatment. The disadvantage is that the treatment period is long and clinical symptoms such as loss of taste and smell and dry mouth may appear early. There are reports in the literature that long-term complications after radiotherapy are still more frequent.
3.Surgery and radiotherapy combined therapy
Pre- or post-operative radiotherapy plus surgery can increase the 5-year survival rate of surgical treatment by about 10-20%.
4.Chemotherapy
It is divided into induction chemotherapy, adjuvant chemotherapy, palliative chemotherapy, etc.
5.Biological gene therapy
Although it has been reported, most of the biological treatments are in the experimental stage, and the efficacy is not yet confirmed.
6.Chinese herbal medicine treatment