According to the Moscow City Clinical Hospital, the number of ENT cancer patients has increased over the past 5 years and this trend continues. In 79-84% of cases, the disease is diagnosed in stages III-IV, which adversely affects the results of treatment. The authors analyze some of the reasons for the late diagnosis of tumor diseases of the upper respiratory tract, draw attention to the need to form oncological alertness in polyclinic doctors. Modern methods of early diagnosis of oncological diseases are presented.
Key words: oncological diseases of the upper respiratory tract, cancer alertness, early diagnosis.
Like any disease, in the early stages of oncological disease is difficult to recognize, but successfully treated; on the contrary, it is much easier to diagnose a tumor at a late stage, but the effectiveness of treatment is sharply reduced and the prognosis becomes much less favorable.
According to the department of head and neck tumors at the Moscow City Oncology Center, for the period 2000-2006. 800-1190 primary patients with malignant neoplasms of the head and neck of various localizations were detected annually, and the upward trend in this indicator is steadily maintained. Unfortunately, more and more often, oncological diseases of the ENT organs are diagnosed at late stages: in 79-84% of cases, patients are referred to specialists of the oncologic dispensary in stages III-IV of the process (see table). The most frequent localization of the lesion is the larynx, laryngopharynx, oropharynx; tumors of various parts of the tongue, the floor of the mouth, the upper jaw, the nasopharynx, and rarely the ear are noted somewhat less frequently.
The unsatisfactory state of early diagnosis significantly affects the long-term results of treatment. So, according to the Institute. P.A. Herzen, in stage I laryngeal cancer, clinical cure without relapses and metastases lasting more than 5 years after radiation treatment is achieved in 83-95% of patients, in stage II - in 70-76%, 5-year survival with T3N0M0 after combined treatment is 60 %, at T4 - 34.0%. However, only 14% of patients who first applied for a malignant neoplasm had early forms of tumors.
It should be remembered that the early diagnosis of malignant neoplasms presents certain difficulties due to the similarity of the initial manifestations of diseases with benign tumors, inflammatory and other pathological processes. The duration of the disease, the prevalence of the process, the appearance of the tumor are not a sufficiently reliable criterion for establishing a diagnosis. This explains their late detection.
Nevertheless, the main reasons for the late diagnosis of cancer of the larynx and other ENT organs are the lack of oncological alertness of outpatient doctors, the lack of necessary diagnostic skills and proper clinical experience to correctly assess the condition of the ENT organs in outpatient doctors and hospitals, and the lack of proper continuity in the examination. sick.
Improving the methods of early diagnosis of oncological diseases of the ENT organs is an urgent task not only for an otorhinolaryngologist, but also for a general practitioner, to whom the patient often first of all addresses with certain complaints.
Thus, the early diagnosis of laryngeal cancer is based not on pathognomonic and persistent symptoms, but on a combination of a number of banal signs that make it possible to suspect a tumor. For example, with the development of cancer of the vestibular larynx, many patients experience dryness, itching, and a feeling of a foreign body in the throat for several months before the diagnosis is established. Somewhat later, fatigue and deafness of the voice appear, awkwardness when swallowing, and then pain.
| Stage | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 |
| I | 24/3,4 | 25/3,0 | 26/3,3 | 38/4,4 | 60/5,2 | 39/3,3 | 46/3,9 |
| II | 88/12,3 | 100/12,1 | 126/16,1 | 106/12,2 | 153/13,1 | 178/14,9 | 175/14,8 |
| III | 185/25,5 | 203/24,4 | 184/23,4 | 180/20,8 | 279/24,1 | 283/23,7 | 286/24,4 |
| IV | 427/58,8 | 501/60,5 | 442/56,3 | 531/61,4 | 668/57,6 | 692/58,1 | 665/56,8 |
| Total | 724 | 829 | 785 | 865 | 1160 | 1192 | 1172 |
Pain at first occurs only in the morning when swallowing saliva, subsequently they intensify, become permanent, and can radiate to the ear. The similarity of these symptoms with signs of chronic pharyngitis or laryngitis is often the cause of a diagnostic error.
With the localization of the tumor in the middle part of the larynx, hoarseness appears already in the early stages and the patient is referred to an otorhinolaryngologist, who, as a rule, detects the neoplasm in a timely manner. With a tumor of the subvocal region, one of the first symptoms may be an asthma attack, which often leads to an erroneous diagnosis of bronchial asthma. With tumors of the nasopharynx, hearing impairment is possible. However, these and other so-called "small signs" should alert the doctor and suspect a tumor at a very early stage.
When identifying complaints and collecting anamnesis, attention is also drawn to the duration of the course of the pathological process, the appearance of bloody discharge against this background, sometimes (at later stages) - dense, often painless regional lymph nodes, determined by palpation. The doctor should be alerted by the appearance of traces of blood in the sputum, recurrent (especially unilateral) nosebleeds, when the specific cause of the bleeding cannot be determined. The doctor should not ignore the appearance of dysphonia, especially growing and not amenable to the usual therapeutic effects, complaints of swallowing disorder.
In many cases, the development of malignant tumors of the larynx is preceded by benign diseases that last for many months, and sometimes years. To such, most authors include papillomas, pachydermia, chronic hyperplastic laryngitis and other diseases. According to the classification of the committee for the study of tumors of the head and neck at the All-Union Society of Oncologists, precancerous diseases are distinguished with a high and low frequency of malignant changes. Precancerous diseases with a high frequency of malignancy (obligate) include leukoplakia, pachydermia, papilloma in adults, and precancerous diseases with a low frequency of malignancy include contact fibroma, cicatricial processes after chronic specific infectious diseases (silifis, tuberculosis, scleroma) and burns. The period of precancerous condition in humans is considered to be one to two decades. With cancer of the larynx, it is somewhat less: according to the observations of V.O. Olshansky - from 2-4 years to 11-12 years.
The possibility of the degeneration of benign diseases into cancer indicates the extreme importance of early detection of any pathological processes in the larynx and their effective treatment, which can be considered as a secondary prevention of cancer. At the same time, it should be remembered that one of the important reasons for the late recognition of laryngeal cancer in some cases is erroneous diagnostic tactics. It consists in the fact that the doctor observes the patient for a long time, conducting inadequate treatment (anti-inflammatory, physiotherapeutic), and waits until the signs of the tumor are so typical that the diagnosis is no longer in doubt. There is information in the literature that otorhinolaryngologists of polyclinics observed 20.4% of patients with laryngeal cancer from 1 to 2 months and 50% - from 2 to 8 months.
When examining a patient who applied with any disease of the ENT organs, and during a preventive examination, the otorhinolaryngologist should follow a clear sequence so that, regardless of the presence or absence of complaints, all ENT organs are examined. It is also mandatory to examine and palpate the neck in order to detect metastases. When examining a particular organ, one should adhere to a certain scheme so as not to miss the slightest deviations from the norm. For example, during mesopharyngoscopy, attention is consistently paid to the condition of the pharyngeal mucosa, first examined on the right, then on the left, the anterior and posterior palatine arches and the palatine tonsils themselves, the soft palate and uvula. Then evaluate the condition of the back and side walls of the pharynx. If there is hypertrophy of the palatine tonsils, then to examine the posterior arch and lateral wall of the pharynx on the right and left, either the tonsil is displaced with a second spatula, or a nasopharyngeal mirror is used, and if necessary, an endoscope. In addition, palpation of the neck and oropharyngeal elementor is performed.
An otorhinolaryngologist, when examining any patient, regardless of the presence or absence of subjective manifestations of the disease, must necessarily perform an indirect laryngoscopy and examine the nasopharynx. The latter is especially important in children and adolescents, if epipharyngoscopy fails, a digital examination, endoscopy with a fiberscope or a rigid endoscope is performed, if necessary, radiography of the nasopharynx, CT or MRI.
In the early diagnosis of laryngeal cancer, laryngoscopy is of paramount importance. Examination of the larynx should be performed in such a way that all its sections are consistently visible: vallecules and the root of the tongue, epiglottis, scoop-epiglottic folds, piriform sinuses, vestibular and vocal folds, scoop and interarytenoid space, commissure, subglottic space. Laryngoscopy, especially when the neoplasm is localized on the vocal fold, makes it possible to establish the presence of a tumor even in cases where its dimensions are minimal. In these cases, on one of the vocal folds, most often in the middle of it, a thickening is noticeable, which often protrudes into the lumen of the glottis (exophytic growth). The base of the tumor is wider than the apex. This fact is of great diagnostic value. It is also important to limit the mobility of the vocal fold, depending on the cancerous infiltration of the internal vocal muscle. It appears especially quickly with endophytic growth of the neoplasm. These two signs - a wide base of the tumor and limited mobility of the fold - with a high degree of probability make it possible to suspect a malignant neoplasm of the larynx, dictate the need for unremitting monitoring of the patient and histological examination of the tumor. Even before restriction of laryngeal mobility, stroboscopy can detect a violation of the vibration of the vocal fold.
However, the informative value of laryngoscopy is reduced when the tumor is localized in the area of the fixed epiglottis, in the subvocal area. It is difficult to examine the larynx with some anatomical features: a folded or deformed epiglottis, a large tongue and a small mouth, the presence of trismus, etc.
Fibrolaryngoscopy allows you to examine in detail all hard-to-reach parts of the larynx, identify the tumor process at an early stage, and perform a targeted biopsy. This study is performed through the nose, mouth, or retrograde in the presence of a tracheostomy. However, the possibilities of this method are reduced with endophytic tumor growth.
In order to detect precancerous changes in the larynx, indirect and direct microlaryngoscopy is used. This study allows you to more accurately identify the endophytic component of the tumor due to the characteristic microlaringoscopic signs of a malignant tumor: the disappearance of the transparency of the epithelium covering the tumor, disturbances in vascular architectonics, thickening of the epithelium in the form of spikes and papillae, hemorrhages, microulcerations.
The use of a test with toluidine blue significantly increases the information content of this method for detecting early cancer of the larynx. Toluidine blue has a great affinity for amino acids contained in the nuclei of cells. In malignant degeneration, the cell nuclei contain a large amount of RNA and DNA, which leads to intense staining of these cells. The methodology is as follows. Under local anesthesia, the area of the larynx suspected of a tumor is stained with a 2% solution of toluidine blue. After 2 minutes, the color is washed off with saline and the severity of the color is assessed. A malignant tumor is intensely stained in purple, a biopsy is performed from these areas. The information content of this sample is 91%.
A lot of useful information can be provided by the use of additional research methods that expand the doctor's ability to identify and verify neoplasms. We are talking about conducting an examination using endoscopes - rigid or flexible, an operating microscope, performing x-rays, computed tomography - x-ray or magnetic resonance, ultrasound of the neck.
At present, a method of echosonography for the early diagnosis of laryngeal cancer has been developed at the Moscow City Clinical Hospital. Ultrasound examination is characterized by non-invasiveness, the absence of radiation exposure, the possibility of conducting an unlimited number of studies in one patient. An important advantage of the method was the possibility of detecting endophytic forms of laryngeal cancer (in 37% of the examined patients), as well as determining the extent of the tumor, which is extremely important when choosing the extent of surgical intervention. In addition, this method makes it possible to perform a puncture biopsy of the tumor under the control of an ultrasound monitor.
Without considering specifically the issues of the clinic and diagnosis of certain forms of neoplasms of the ENT organs, it should be noted that any neoplasm must be removed and should be sent for histological examination. However, in some cases, in order to develop optimal treatment tactics, it is necessary to determine the nature of the formation before surgery. In particular, it is very important to differentiate proliferative inflammatory and tumor processes, and in the latter case - benign or with elements of malignancy. For this purpose, a preoperative biopsy or a cytological examination is performed in a specialized medical institution (oncological dispensary).
Histological examination of biopsy material is often combined with cytological examination. In this regard, it is advisable to take an imprint or smear from its surface for cytological examination before immersing the excised piece of tissue in a fixing solution. This technique is especially valuable for emergency biopsy, when urgent histological examination is impossible or special histochemical reactions are required. In this case, the cytological examination does not replace, but complements the histological examination.
Histological examination often allows you to clarify and even change the clinical diagnosis. The final diagnostic step is a tumor biopsy for histological or cytological examination of the primary tumor or metastases. However, the diagnostic value of the biopsy results is not absolute, much depends on how well the material for the study is taken. A negative biopsy result in the presence of relevant clinical data does not completely reject the diagnosis of a tumor.
In the complex of measures that contribute to the early detection of oncological diseases of the upper respiratory tract, an important role belongs to clinical examination. Patients with laryngeal papillomatosis, chronic laryngitis, especially its hyperplastic form, with leukoplakia, recurrent polyposis of the nose and paranasal sinuses, and other benign neoplasms of the ENT organs should be under dispensary observation, they should be examined every six months, fixing changes in the course of the disease. If, according to the doctor, the course of the disease is unfavorable, the patient should be immediately referred for a consultation with an ENT oncologist in a specialized medical institution.
L.G. KOZHANOV, N.Kh. SHATSKAYA, L.A. LUCHIKHIN
Moscow City Oncology Center No. 1 (Chief Physician - Prof. A.M. Sdvizhkov), Department of ENT Diseases (Head - Corresponding Member of the Russian Academy of Medical Sciences Prof. V.T. Palchun) of the Medical Faculty of the Russian State Medical University, Moscow
BULLETIN OF OTORHINOLARYNGOLOGY, 5, 2008
LITERATURE
1. Abyzov R.A. Loroncology. St. Petersburg 2004;256.
2. Kozhanov L.G. Laryngofibroscopy and microlaryngoscopy in combined treatment of laryngeal cancer with economical operations: Abstract of the thesis. dis. ... cand. honey. Sciences. M 1983;23.
3. Kozhanov L.G., Sdvizhkov A.M., Mulyarets M.V., Romanova E.S. Vestn oto-rinolar 2008;2:56-58.
4. Matyakin E.G. Malignant tumors of the nasal cavity and paranasal sinuses. In: Otorhinolaryngology, national guide. Ed. V.T. Palchun. M 2008;502-512.
5. Olshansky V.O. Cancer of the larynx. In: Otorhinolaryngology. National leadership. Ed. V.T. Palchun. M 2008;801-811.
6. Palchun V.T., Luchikhin L.A., Magomedov M.M. Practical otorhinolaryngology. M 2006;77-94.
7. Paches A.I. Tumors of the head and neck. M 2000;324-332.
8. Chissov V.I., Daryalova S.A. Selected lectures on clinical oncology. M 2000;76, 225.
9. Chissov V.I., Starinsky V.V., Petrova G.V. The state of oncological care for the population of the Russian Federation in 2004. M 2005;227.
10. Paavolainen M., Lanerma S. Minerva Otolaryng 1976;26:4:219-221.
... the unsatisfactory state of early diagnosis significantly affects the long-term results of treatment.Relevance . Oncopathology of ENT organs is about 7.5-8% of cases of all malignant diseases. At the same time, due to the peculiarities of the localization of neoplasms and insufficient educational work, carelessness and untimely treatment of the patient to the doctor, as well as due to diagnostic errors, malignant tumors of the ENT organs are usually diagnosed at late stages, which determines the high relevance of this problem.
Like any disease, in the early stages of oncological disease is difficult to recognize, but successfully treated; on the contrary, it is much easier to diagnose a tumor at a late stage, but the effectiveness of treatment is sharply reduced, and the prognosis becomes much less favorable.
Should be remembered that the early diagnosis of malignant neoplasms presents certain difficulties due to:
with the similarity of the initial manifestations of diseases with benign tumors, inflammatory and other pathological processes: the duration of the disease, the prevalence of the process, the appearance of the tumor are not a sufficiently reliable criterion for establishing a diagnosis (this explains their late detection);
with insufficient oncological alertness of polyclinic doctors;
with the lack of the necessary diagnostic skills and proper clinical experience for the correct assessment of the condition of the ENT organs in outpatient clinics and hospitals;
with erroneous diagnostic tactics: the doctor observes the patient for a long time, conducting inadequate treatment - anti-inflammatory, physiotherapeutic, and waits until the signs of the tumor are so typical that the diagnosis is no longer in doubt;
with the lack of proper continuity in the examination of patients;
with the imperfection of the system of clinical examination and preventive examinations.
(! ) Improving the methods of early diagnosis of oncological diseases of the ENT organs is an urgent task not only for an otorhinolaryngologist, but also for a general practitioner, to whom the patient often first of all addresses with certain complaints.
Early diagnosis of laryngeal cancer is based on
not on pathognomonic and persistent symptoms, but on a combination of a number of banal signs that make it possible to suspect a tumor; for example (the so-called "small signs" that should alert the doctor and suspect a tumor at a very early stage):
with tumors of the nasopharynx, hearing impairment is possible;
with the development of cancer of the vestibular larynx, many patients experience dryness, itching, sensation of a foreign body in the throat for several months before the diagnosis is established; a little later, fatigue and deafness of the voice appear, awkwardness when swallowing, and then pain; pains initially occur only in the morning when swallowing saliva, subsequently they increase, become permanent, can radiate to the ear (the similarity of these symptoms with signs of chronic pharyngitis or laryngitis is often the cause of a diagnostic error);
when the tumor is localized in the middle part of the larynx, hoarseness appears already in the early stages (and the patient is referred to an otorhinolaryngologist, who, as a rule, detects the neoplasm in a timely manner);
with a tumor of the subvocal region of the larynx, one of the first symptoms may be an asthma attack (which often leads to an erroneous diagnosis of bronchial asthma).
When identifying complaints and collecting anamnesis Attention is also drawn to the duration of the course of the pathological process, the appearance against this background of bloody discharge, sometimes (at later stages) - dense, often painless regional lymph nodes, determined by palpation. The doctor should be alerted by the appearance of traces of blood in the sputum, recurrent (especially unilateral) nosebleeds, when the specific cause of the bleeding cannot be determined. The doctor should not ignore the appearance of dysphonia, especially growing and not amenable to the usual therapeutic effects, complaints of swallowing disorder.
In many cases, the development of malignant tumors of the larynx is preceded by benign diseases that last for many months, and sometimes years. To such, most authors include papillomas, pachydermia, chronic hyperplastic laryngitis and other diseases.
According to the classification Committee for the Study of Head and Neck Tumors at the All-Union Society of Oncologists distinguish between precancerous diseases with a high and low frequency of malignant changes:
precancerous diseases with a high frequency of malignancy (obligate) include leukoplakia, pachydermia, papilloma in adults;
precancerous diseases with a low incidence of malignancy include contact fibroma, cicatricial processes after chronic specific infectious diseases (silifis, tuberculosis, scleroma) and burns.
The period of precancerous condition in humans is considered to be one to two decades. With cancer of the larynx, it is somewhat less: according to the observations of V.O. Olshansky - from 2-4 years to 11-12 years. The possibility of the degeneration of benign diseases into cancer indicates the extreme importance of early detection of any pathological processes in the larynx and their effective treatment, which can be considered as a secondary prevention of cancer.
Early diagnosis of ENT cancer(in particular cancer of the larynx) is also based on a clear sequence of examination(examinations) so that, regardless of the presence or absence of complaints, all ENT organs are examined. It is also mandatory to examine and palpate the neck in order to detect metastases. When examining a particular organ, one should adhere to a certain scheme so as not to miss the slightest deviations from the norm. For example, during mesopharyngoscopy, attention is consistently paid to the condition of the pharyngeal mucosa, first examined on the right, then on the left, the anterior and posterior palatine arches and the palatine tonsils themselves, the soft palate and uvula. Then evaluate the condition of the back and side walls of the pharynx. If there is hypertrophy of the palatine tonsils, then to examine the posterior arch and lateral wall of the pharynx on the right and left, either the tonsil is displaced with a second spatula, or a nasopharyngeal mirror is used, and if necessary, an endoscope. In addition, palpation of the neck and elements of the oropharynx is performed.
An otorhinolaryngologist, when examining any patient, regardless of the presence or absence of subjective manifestations of the disease, must necessarily perform an indirect laryngoscopy and examine the nasopharynx. The latter is especially important in children and adolescents, if epipharyngoscopy fails, a digital examination, endoscopy with a fiberscope or a rigid endoscope is performed, if necessary, radiography of the nasopharynx, CT or MRI. In the early diagnosis of laryngeal cancer, laryngoscopy is of paramount importance, which (especially when the neoplasm is localized on the vocal cord) makes it possible to establish the presence of a tumor even in cases where its size is minimal. However, the informative value of laryngoscopy is reduced when the tumor is localized in the area of the fixed epiglottis, in the subvocal area. It is difficult to examine the larynx with some anatomical features: a folded or deformed epiglottis, a large tongue and a small mouth, the presence of trismus, etc. In these [diagnostically difficult] cases, it is possible to examine in detail all hard-to-reach parts of the larynx, to identify the tumor process at an early stage, and to perform a targeted biopsy, fibrolaryngoscopy, which is performed through the nose, mouth, or retrogradely in the presence of a tracheostomy (the diagnostic capabilities of this method are reduced with endophytic tumor growth).
To detect precancerous changes in the larynx indirect and direct microlaryngoscopy, which, among other things, makes it possible to more accurately identify the endophytic component of the tumor due to the characteristic microlaringoscopic signs of a malignant tumor:
the disappearance of the transparency of the epithelium covering the tumor;
violations of vascular architectonics;
thickening of the epithelium in the form of spikes and papillae;
presence of hemorrhages, microulcerations.
Significantly increases the information content of microlaryngoscopy(to detect early cancer of the larynx) - the use of a test with toluidine blue. Toluidine blue has a great affinity for amino acids contained in the nuclei of cells. In malignant degeneration, the cell nuclei contain a large amount of RNA and DNA, which leads to intense staining of these cells.
A lot of useful information can be provided by the use of additional research methods: examination using endoscopes (rigid or flexible), an operating microscope; performance of radiography, computed tomography - X-ray or magnetic resonance, ultrasound of the neck.
In the complex of events that contribute to the early detection of oncological diseases of the ENT organs, an important role belongs to medical examination. Patients with laryngeal papillomatosis, chronic laryngitis, especially its hyperplastic form, with leukoplakia, recurrent polyposis of the nose and paranasal sinuses, and other benign neoplasms of the ENT organs should be under dispensary observation, they should be examined every six months, fixing changes in the course of the disease. If, according to the doctor, the course of the disease is unfavorable, the patient should be immediately referred for a consultation with an ENT oncologist in a specialized medical institution.
FEDERAL AGENCY FOR EDUCATION
BALTIC FEDERAL UNIVERSITY them. I. KANTA
MEDICAL FACULTY
Report on the subject "ENT diseases" on the topic:
Oncology of ENT organs
Performed:
3rd year student LD-1 SPO
Vaganova Olga
2 subgroup
Checked:
Demchenko E.V.
Kaliningrad
2012 Respiratory tract tumors
Tumors of the upper respiratory tract - the nose and its paranasal sinuses, pharynx and larynx, as well as the ear are relatively common. They make up about 4-5% of all tumor localizations in humans. Among the organs of the upper respiratory tract, benign and malignant tumors are most often localized in the larynx, the second most common place is the nose and its paranasal sinuses, then the pharynx; relatively rare diseases of the ear. Malignant tumors, especially of the larynx, occur more often in men than in women between the ages of 40 and 70. However, they also occur in children.
In accordance with the International Classification of tumors, according to the histological structure and clinical course, they are divided into benign and malignant; they can come from epithelial, connective, muscle, nervous and pigment tissues.
The histological structure of the tumor characterizes the degree and characteristics of the degeneration of the cells of the affected tissue, their germination (infiltration) into the surrounding tissue. The clinical course reveals the features of tumor growth, its ability to metastasize and recur after treatment, etc. The histological picture usually corresponds to the clinical picture, however, sometimes a tumor that is benign in its histological structure clinically grows in a malignant variant and, conversely, a histologically malignant tumor has the clinical features of a benign one.
benign tumors
Tumors of the nose. These include papillomas, fibromas, angiomas and angiofibromas, chondromas, osteomas, neuromas, nevi, warts. Some also include mucous polyps here, however, these formations do not have a tumor structure and represent an inflammatory and allergic hyperplasia of the mucous membrane. Typical signs are persistent difficulty in breathing through that half of the nose in which the tumor is located, hyposmia or anosmia; slight bleeding is possible. In the later stages - deformation of the facial skeleton, headache, displacement of the eyeballs, visual disturbances. Diagnosis: nasal endoscopy, probing of the tumor, palpation, radiography, histological examination of a piece of the tumor. Papillomas are usually localized on the eve of the nose, grow relatively slowly, and often recur after removal. The removal must be radical. In order to prevent scarring after papilloma excision, cryotherapy is performed on the wound surface. Vascular tumors are formed on the nasal septum, the bowl in its cartilaginous part, the lower nasal concha, the nasal cavity. They grow slowly, usually bleed periodically, sometimes very strongly, gradually increase and can fill the nasal cavity, grow into the ethmoid labyrinth, orbit and maxillary sinus. Surgical treatment. Before removing the tumor, the external carotid arteries are often ligated on both sides.
The bleeding polyp resembles an angiofibroma in structure, is localized in the cartilaginous part of the nasal septum and usually has a wide pedicle. More common during pregnancy and lactation. A constant symptom is frequent bleeding, usually not in small amounts. The removal must be radical. After removal, galvanocaustics of the wound edges is performed. Fibroma of the nose is rare, usually localized in the vestibule of the nose, nasopharynx and in the region of the external nose. Surgical treatment. Osteomas of the nose and paranasal sinuses usually occur at the age of 15-25, grow slowly, most often localized in the walls of the frontal sinuses and the ethmoid bone. Long-term follow-up is underway. Sometimes small osteomas, especially on the cerebral wall of the frontal sinus, are the cause of persistent headache. After exclusion of other causes of headache, removal of such an osteoma is indicated. In some cases, they deform the facial skeleton and cause brain disorders. Treatment. Only surgical. Osteomas of medium and large sizes, even in the absence of severe symptoms, must be completely removed.
Tumors of the throat. These include: fibroma, papilloma, hairy polyp, angioma, neurinoma, neurofibroma, lipoma, cysts and retropharyngeal goiter.
More often than others, papillomas and fibromas on the leg are found.
Papillomas are usually located on the soft palate and palatine arches, are small in size and, as a rule, do not bother patients much. In some cases, papillomas originate from the nasopharynx, the lateral walls of the pharynx, and the lingual surface of the epiglottis. Treatment consists in the removal of single papillomas followed by galvanocaustics. Relapses of the disease with single papillomas are rare. With papillomatosis, relapses can occur repeatedly. Given the possibility of degeneration into cancer, timely radical treatment is necessary.
Fibroma occurs, as a rule, in young men aged 10-20 years, therefore it is called youthful. After 20-25 years, juvenile fibroma undergoes a reverse development. In the early stage of development of nasopharyngeal fibroma, its manifestations are moderately pronounced - a slight difficulty in nasal breathing, sore throat, minor catarrhal phenomena. In the future, breathing completely stops through one half of the nose and becomes difficult through the second, nasality appears, the voice changes, the most severe symptom is periodically occurring profuse spontaneous bleeding. Fibroma usually fills the nasopharynx and may hang down into the middle part of the pharynx.
Angioma is a relatively common benign neoplasm of the pharynx and can come from its various departments. Small angiomas for a long time may not increase, do not disturb the patient and are detected only during examination. Medium and large angiomas cause a sensation of a foreign body in the nasopharynx, make nasal breathing difficult, and may bleed. There are hemangiomas and lymphangiomas.
Treatment is surgical, electrocoagulation is also used. The hairy polyp belongs to congenital tumors, has a long stalk, is covered with skin with delicate hairs.
The polyp makes breathing and sucking difficult. Surgical treatment. Relapses do not occur.
Throat cysts are not true tumors. They are localized in various parts of the pharynx, more often in the tonsils. The sizes are often small, so they often do not cause much concern, but sometimes there is a feeling of a foreign body in the throat; at an early age, cysts of the root of the tongue can cause choking.
Neurinomas, mixed endothelioma tumors, and other tumors of the pharynx are rare. They have a slow non-infiltrating growth, in rare cases they can become malignant.
Tumors of the larynx. These include fibromas, papillomas and angiomas.
Fibroma (fibrous polyp) usually occurs at the free edge of the vocal fold on the border between the anterior and middle thirds, grows very slowly, often does not reach large sizes. The main symptoms of the disease are hoarseness and possibly coughing. The voice may change if the fibroma has a long stem and is easily displaced. Surgical treatment, relapses are possible if a piece of the tumor is left.
Papillomas are solitary or papillary outgrowths that look like cauliflower. Most often they are located on the vocal folds. Most often, papillomas occur between the ages of 1.5 and 5 years. By the beginning of puberty, they often disappear. The main symptoms of the disease are hoarseness, reaching aphonia, and a gradual difficulty in breathing, which can turn into suffocation with an increase in the tumor. Surgical treatment. Relapses of the disease after treatment are common, but the tendency to relapse is individual: in some cases, papillomas have to be removed several times a year, in others - after a few years.
Cysts are not common in the larynx. Usually they are localized on the laryngeal surface of the epiglottis. More often, cysts develop as a result of blockage of the mucous glands, increase slowly, and do not reach large sizes. Small cysts usually do not cause any symptoms and do not require treatment.
Angiomas of the larynx originate from dilated blood vessels (hemangiomas, lymphangiomas). They can be localized on the vocal, sometimes on the ventricular or aryepiglottic folds. They grow slowly and are usually small. Sometimes the tumor reaches a large size and hangs down into the lumen of the larynx, disrupting breathing. Angiomas of small sizes disturb only in case of localization on the vocal fold - this causes hoarseness. Medium and large angiomas violate other functions of the larynx, so they must be removed.
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GBOU VPO TSMU
Ministry of Health of the Russian Federation
Department of Ophthalmology and Otorhinolaryngology
Abstract on the topic
"Benign neoplasms of ENT organs"
Vladivostok, 2015
Benign tumors of the nose and paranasal sinuses
Benign tumors of the nose and paranasal sinuses include papillomas, fibromas, angiomas, chondromas and osteomas, neuromas, nevi (pigment tumors), and warts.
Papilloma is a relatively rare tumor equally often detected in men and women at the age of 50, but it also occurs at an earlier age. There are mushroom-shaped, inverted and transitional cell papillomas. The mushroom-shaped form is localized on the threshold of the nose (the septum of the nose, the bottom, the inner surface of the wings of the nose) and in appearance resembles a cauliflower. Inverted and transitional cell papillomas originate from the mucous membrane of deeply located parts of the nasal cavity, more often located on the side wall. The surface of such a tumor is smooth, and upon examination, the neoplasm can be mistaken for an ordinary polyp. The last two types of papilloma are capable of destroying soft tissues and bone walls, penetrating into the paranasal sinuses and even beyond them. Inverted and transitional cell papillomas are prone to malignancy, which is observed in 4-5% of patients. There is an opinion that the malignancy of benign tumors, including papillomas, contributes to irradiation
Surgical treatment. After removal of the mushroom papilloma, cryotherapy or electrocoagulation of the original site of the tumor is performed. Inverted and transitional cell papillomas are removed using the Denker approach and, if necessary, the Moore approach, while one should strive for complete removal of the tumor.
Vascular tumors of the nasal cavity (capillary and cavernous hemangiomas, lymphangiomas) are relatively rare; They grow slowly, periodically bleed, gradually increase and can fill the nasal cavity, germinate in the ethmoid labyrinth, orbit and maxillary sinus, more often they look like a rounded tuberous cyanotic tumor. It should be borne in mind that hemangiomas located on the lateral wall of the nasal cavity have an increased tendency to malignancy. Surgical treatment - removal of the tumor along with the underlying mucous membrane.
Osteoma is a benign tumor that originates from bone tissue and is characterized by slow growth. More often located in the frontal sinuses and the ethmoid bone, less often in the maxillary sinuses.
Osteomas of small size often go unnoticed and are found incidentally on the x-ray of the paranasal sinuses. In the absence of functional, cosmetic and other disorders, there is no reason for immediate surgical treatment of the osteoma.
In this case, long-term observation is carried out; a noticeable growth of the osteoma is an indication for its removal. It should be noted that sometimes small osteomas, especially on the cerebral wall of the frontal sinus, are the cause of persistent headache. After exclusion of other causes of such a headache, removal of such an osteoma is indicated. Sometimes osteomas reach large sizes, can spread into the cranial cavity, orbit, deform the facial skeleton and cause brain disorders, headache, decreased vision, impaired nasal breathing and smell. The treatment is surgical, a radical operation is performed on the frontal sinus with the removal of the neoplasm. Osteomas of medium and large sizes, even in the absence of severe symptoms, must be removed.
Benign tumors of the pharynx
The most common are papilloma, juvenile (juvenile) angiofibroma and angioma.
Papillomas are usually soft, more often located on the palate and palatine arches, sometimes on the back or side walls of the pharynx and the lingual surface of the epiglottis, and usually disturb the patient a little. They have a characteristic appearance: grayish-pink in color, on a wide base or on a leg.
Diagnosis based on the appearance of the tumor and histological findings is not difficult.
Treatment consists in the removal of single papillomas followed by galvanocaustics; possible cryoinfluence on areas of papillomatous degeneration. Sometimes papillomas are removed using an ultrasonic disintegrator, a surgical laser. With recurrence of papillomas, repeated removal is indicated, after which 30% prospidin ointment is applied to the wound surface daily for 10-15 days.
Juvenile (juvenile) angiofibroma is a tumor of the nasopharynx, emanating from its dome or the area of the pterygopalatine fossa, which has a benign histological structure, but according to the clinical course (destructive growth, severe bleeding, frequent relapses after surgery, germination into the paranasal sinuses and even into the cavity skull) manifesting itself as a malignant formation.
Angiofibroma occurs most often in young men aged 10-18 years. therefore it is called youthful; after 20 years, it usually undergoes a reverse development. It is believed that fibroma of the nasopharynx arises from the remnants of mesenchymal tissue in the nasopharynx that were abnormally laced in the embryonic period. The fibroma stroma consists of a variety of connective tissue fibers and a very large number of blood vessels. The source of tumor growth can be the body of the sphenoid bone, the pharyngeal-basic fascia and the posterior cells of the ethmoid bone - this is a sphenoethmoid type of fibroma. From here, the tumor can grow into the ethmoid labyrinth, sphenoid sinus, nasal cavity, orbit and maxillary sinus. If the tumor grows from the region of the nasopharynx, then this is the basal type of fibroma, it can grow towards the oropharynx. When the fibroma starts from the region of the pterygoid process of the sphenoid bone, it belongs to the pterygoomaxillary type of tumor and can grow into the retromaxillary space, pterygopalatine fossa, inside the skull, orbit, and nasal cavity. In accordance with the direction of fibroma growth, an asymmetry of the type occurs, the surrounding bone and soft tissues are compressed and deformed, which can lead to displacement of the eyeball, impaired blood supply to various parts of the brain, and compression of nerve formations.
The clinical picture depends on the stage of the spread of the process. In practical work, the following classification of juvenile angiofibromas is convenient (Pogosov V.S. et al. 1987):
Stage I tumor occupies the nasopharynx and (or) the nasal cavity, there is no bone destruction;
Stage II tumor corresponds to stage I, spreads into the pterygoid fossa, paranasal sinuses, bone destruction is possible;
III stage the tumor spreads to the orbit, the brain;
Stage IV tumor corresponds to stage III, but extends into the cavernous sinus, optic chiasm, and pituitary fossa.
At the beginning of the disease, the patient notes a slight difficulty in nasal breathing, sore throat, minor catarrhal phenomena. In the future, breathing through one half of the nose completely stops and becomes difficult through the other, the sense of smell is disturbed, nasality appears, the voice changes, the face takes on the appearance of an adenoid. The most severe and common symptom is recurrent nosebleeds, causing anemia and weakening of the body. The tumor may be accompanied by purulent sinusitis and otitis media, which makes timely diagnosis difficult.
With anterior and posterior rhinoscopy, one can see a rounded, smooth or tuberous tumor of a bright red color, dense with a finger examination or when palpated with a probe. Fibroma usually fills the nasopharynx and may hang down into the middle part of the pharynx. On palpation, the tumor can bleed profusely, its base is determined in the upper part of the nasopharynx.
Diagnostics. It is carried out on the basis of the noted symptoms, taking into account the data of endoscopic (including using a fibroendoscope), radiological, and in some cases angiographic examination. When determining the spread of the tumor process, the decisive role belongs to computed tomography and nuclear magnetic resonance imaging. Juvenile angiofibroma should be differentiated from adenoids, choanal polyp, papilloma, sarcoma, cancer, adenoma. The final diagnosis is established on the basis of a biopsy, which presents certain difficulties and should be performed only in an ENT hospital. where there are all conditions to stop bleeding.
Treatment is only surgical and, if possible, radical, since relapses are possible. Given the rapid growth of the tumor, the operation should be performed as soon as possible. The intervention is performed under anesthesia; surgical approaches are endooral, endonasal and transmaxillary. Modifications of radical operations according to Moore, Denker can be used. During the operation, there is usually heavy bleeding, which requires a massive blood transfusion. Before removing the tumor, the external carotid artery is often ligated, which significantly reduces blood loss. Recently, angiofibroma has been removed using endoscopic methods, which significantly reduces the invasiveness of the operation.
In the postoperative period, infusion, hemostatic, antibacterial therapy is prescribed; if necessary, radiation remote gamma therapy. In VTEK at the place of residence, a disability group is issued in inoperable cases
The prognosis for timely removal of the tumor is favorable.
nose pharynx ear papilloma
Benign tumors of the larynx
Among benign tumors of the larynx, the most common are papillomas and vascular tumors.
Papilloma is a benign fibroepithelial tumor of the upper respiratory tract, which is a single or more often multiple papillary outgrowths, leading to impaired voice and respiratory functions, often recurrent.
The etiological factor of papillomatosis is the human papillomavirus from the papovavirus family. Currently, more than 70 types of this virus have been identified, however, with papillomatosis, types 6, 11, or a combination of them are more often found. The disease occurs in children under 10 years of age, but most often at 2-5 years of age. Papilloma, like a number of other benign tumors, grows unevenly: periods of intensive growth are replaced by periods of relative calm. At puberty, there is often a cessation of growth of papillomas, however, if the tumor persists in an adult, then the probability of its malignancy increases sharply and amounts to 15-20%.
Histologically, papillomas consist of connective tissue stroma and stratified squamous epithelium, clearly separated from each other by a basement membrane. Depending on the amount of connective tissue in the tumor stroma, hard and soft papillomas are distinguished. Papillomas usually have a wide base and occasionally a small stalk. They are most often localized in the region of the commissure and the anterior third of the vocal folds. From the middle section, papillomatosis can spread to the entire larynx and beyond. In shape and appearance, the surface of the papilloma resembles a mulberry or cauliflower, the color is usually pale pink, sometimes with a grayish tint.
The main symptoms of the disease are hoarseness, reaching aphonia, and a gradual difficulty in breathing, which can turn into suffocation as a result of obturation of the lumen of the larynx by a tumor.
Diagnostics. It is based on a characteristic endoscopic picture and the results of a histological examination of the biopsy material. Examination and manipulations in the larynx in children are performed under anesthesia with direct laryngoscopy in adults, the main method of examination is indirect laryngoscopy. Currently, a highly informative method for examining the larynx is microlaryngoscopy.
Treatment. Papillomas can be removed in adults under local anesthesia endolaryngeally with indirect laryngoscopy, in children - always under anesthesia using direct endomicrolaryngoscopy followed by histological examination. Sometimes, with the defeat of all parts of the larynx, it is not possible to completely remove the tumor at a time, so the intervention is performed in several stages. It is necessary to strive for timely intervention in the larynx before the need for a tracheostomy arises, since tracheal cannulation contributes to the spread of papillomas to the trachea and even bronchi.
Ultrasonic disintegration of papillomas, as well as laser photodestruction, for which a surgical CO2 laser, YAG neodymium and YAG holmium lasers are used, turned out to be effective. The high accuracy of the laser beam exposure, the possibility of removing papillomas from hard-to-reach parts of the larynx, low bleeding, and a good functional effect were noted.
In order to reduce the recurrence of papillomatosis, a rather significant arsenal of therapeutic agents is used: prospididia intramuscularly, intravenously and locally in the form of an ointment: interferon preparations (reaferon, viferon, intron-A); leukomax, saveron (acyclovir), discrete plasmapheresis, etc.
Angioma is a benign vascular tumor of the larynx, formed from dilated blood (hemangiomas) or lymphatic (lymphangiomas) vessels, localized on the surface of the vocal, vestibular or aryepiglottic folds.
Angioma grows slowly, is usually single, small in size. The color of the hemangioma is cyanotic or red; lymphangioma has a pale yellow color. Hemangiomas can be diffuse or encapsulated.
Clinical manifestations of angioma depend on the location and extent of the tumor. When localized in the upper part of the larynx, the sensation of a foreign body, sometimes coughing, is disturbing. Gradually, over several years, the symptoms increase, hoarseness, soreness, and then an admixture of blood in the sputum appear. If the tumor comes from the vocal fold, then the first symptom is a gradual change in voice from slight weakness to aphonia. Respiratory failure is characteristic of large tumors emanating from the lower larynx.
Treatment of angiomas is surgical, more often performed by endolaryngeal access. The possibility of intraoperative bleeding should be considered. Widespread hemangiomas are removed by external access with preliminary tracheostomy.
benign tumors of the ear
Among benign neoplasms of the external vxa, papilloma is rare - a tumor of epithelial origin, usually located on the skin of the external auditory canal and on the auricle. Papilloma grows slowly, rarely reaches large sizes. Surgical treatment, diathermocoagulation, cryo- or laser destruction.
Osteoma is localized in the bone section of the external auditory canal, develops from a compact layer of the posterior, less often upper or lower walls. It can be in the form of exostosis on a thin stalk, the recognition and removal of which is usually not difficult. In other cases, it is hyperostosis, which has a wide flat base, partially or completely covering the lumen of the external auditory canal: sometimes hyperostosis is located in the annulus tympanicus region and even extends to the walls of the tympanic cavity. In these cases, its surgical removal is carried out behind the ear. Endophytic growth of the osteoma into the thickness of the mastoid process is possible.
Hemangioma in the ear area is rare. Predominantly cavernous encapsulated capillary (superficial and deep), branched (arterial and venous) hemangiomas are observed. Hemangiomas can be localized in any part of the ear, but more often they occur in the outer ear. Vascular tumors of the middle ear grow slowly, can destroy surrounding tissues and go far beyond the ear. Some of them may ulcerate and be accompanied by intense bleeding. Surgical treatment.
Of the benign tumors of the middle ear, chemodectoma deserves attention, developing from glomus bodies contained in the mucous membrane of the tympanic cavity and located along the nerve fibers and blood vessels. Glomus accumulations are localized in the adventitia of the superior bulb of the internal jugular vein and thicker than the pyramid of the temporal bone. If a chemodectoma develops from the glomus bodies of the tympanic cavity, then subjectively it already at an early stage manifests itself as pulsating noise in the ear and hearing loss; these symptoms are rapidly increasing. As the chemodectoma grows, it gradually fills the middle ear and shines through the tympanic membrane, then it can destroy it and appear in the external auditory canal as a bright red polyp. It should be noted that the initial signs of hemangioma and chemodectoma of the tympanic cavity are largely similar, however, with hemangiomas, bleeding from the ear is noted, they are not typical for chemodectoma. Tumors can destroy the bony walls of the tympanic cavity and spread to the base of the skull or penetrate into its cavity. The spread of the tumor into the cranial cavity is evidenced by the appearance of signs of irritation of the meninges and lesions of the IX, X and XI cranial nerves. These signs appear quite early if the tumor primarily arises in the area of the jugular fossa (from the jugular glomus).
With hemangiomas and chemodectomas, a positive Brown test is described: an increase in air pressure in the external auditory canal is accompanied by a pulsation of the tumor, and the patient cancels the appearance or intensification of pulsating noise in the ear. When the vessels in the neck are compressed, the pulsating noise decreases or stops, while the hemangioma sometimes turns pale, decreases in size. An additional method for diagnosing these tumors is selective angiography. It allows you to clarify the boundaries of the tumor, the state of the jugular vein, to identify the blood vessels supplying the tumor. A reliable diagnostic method is CT and MRI.
Treatment of patients with benign tumors of the middle ear is mainly surgical. Timely removal of these neoplasms is considered as an effective measure to prevent their malignancy. Operations for chemodectomas and hemangiomas are accompanied by intense bleeding. Preliminary ligation of the external carotid artery and embolization of small blood vessels for tumors of this localization proved to be ineffective. Cryotherapy during the operation also did not justify the initial hopes for the possibility of bloodless removal of the tumor. For tumors that do not extend beyond the tympanic cavity, they are limited to endaural tympanotomy or atticoanthrotomy. If the neoplasm enters the external auditory canal, a mastoid trepanation is performed.
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Hidden block WP_Term Object ( => 12 => ENT-Oncology => lor => 0 => 12 => category =>
Symptoms
- Facial skin defect;
- Difficulty in swallowing;
- Hoarseness of voice;
Diagnostics
Treatment
. This technology (IMRT) allows you to direct the beam of rays directly into the neoplasm. The entire dosage and radiation technique is based on the conformity of tumor shapes in three-dimensional space, without affecting healthy tissues. The effect on healthy cells is reduced to a minimum. In oncology centers abroad, before prescribing radiotherapy to a patient, he is examined by an oncologist-radiologist, studies all available data on the disease, and, taking into account individual characteristics, offers optimal treatment options. The patient is also examined by a pathologist and a surgeon. Before starting radiotherapy, specialists conduct a simulation of therapy using a CT machine, which allows you to accurately calculate the radiation dose and duration of treatment. After that, within 2 or 3 days, radiation therapy begins. It can be carried out 1 or 2 times a day, five times a week. Radiotherapy can last a month or two, depending on the individual capabilities of the patient's body and the needs of the treatment process. The first few procedures last about an hour, and subsequent sessions are held for several minutes. During the treatment process, the patient does not experience any pain. Side effects of radiotherapy usually do not begin until the second week of treatment. Treatment specialists warn of possible side effects that occur depending on the location of the tumor, as well as the extent of the tumor and the intensity of therapy. In modern oncology, new developments are constantly being applied in the fight against cancer of the head and neck organs. Doctors combine old methods of treatment with new ones to get the maximum effect: a combination of chemo-radiotherapy or immunotherapy for growing tumors. Recently, drugs that increase the sensitivity of malignant tumors to radiotherapy have also been effectively used. Due to the fact that many of the patients with ENT cancer begin treatment already in advanced stages, the prognosis is not always favorable. It all depends on the stage of the disease. The average five-year survival rate is 45-55%. ENT organs abroad is an opportunity to make the most of all the achievements of modern medicine for recovery. We offer treatment in the best medical centers in Israel, Germany and other countries. Contact us without delay! The medical consultant will call you back and provide detailed information on the possibilities of arrival. => 21 => 4 => raw => 8 => => 12 => 4 => Malignant neoplasms often develop in the head and neck. Of all the malignant tumors that form in the head and neck area (ENT oncology), the most common is squamous cell carcinoma. This tumor arises from the cells that cover the pharynx, as well as the inside of the mouth and nasal cavity. Also, diseases such as tumors of the salivary glands, sarcomas, and lymphomas are common. Cancer spreads in three ways:- Metastasis of cancer cells from the original focus to nearby tissues.
- Hematogenous way, when cancer cells move through the blood vessels to other organs and tissues.
- Lymphogenic - this is when the spread of the tumor is carried out through the lymphatic vessels. Tumors that form in the head or neck often metastasize in the lymphogenous way.
Symptoms
The clinical picture of neoplasms in the head and neck area depends on the location of the tumor and the stage of the disease. The most commonly observed symptoms are:- The presence of a defect in the mucous membrane of the oral cavity, nose;
- Facial skin defect;
- Enlargement of regional lymph nodes;
- Difficulty in swallowing;
- Hoarseness of voice;
- Unmotivated weakness, loss of appetite, emaciation and fever.
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