Malignant tumors of an ENT organs

From all cancerous neoplasms on a lobe of an ENT of organs 23 %, at men - 40 % are necessary, and the larynx cancer prevails. 65 % of all tumours of an ENT of organs are taped in the started condition. 40 % of patients die, not having lived and 1 year from the moment of diagnosis statement.

At sick the diagnosis at 34 %, a pharynx cancer - 55 % was a larynx cancer erroneous. At patients with localisation of tumours in a nasal cavity and its adnexal sinuses the erroneous diagnosis compounds 74 % of cases.

Thus it is possible to draw a conclusion, oncologic vigilance, especially in an ENT-practice should be how much great.

Proceeding from classification of 1978 excrete:

1. Not epithelial tumours:
   • Soft tissues (connective-woven)
   • The neurogenic
   • Tumours from a muscular tissue
   • Tumours from a fatty tissue
   • Neuroepithelial tumours of bones and cartilage
2. Epithelial
3. Tumours of a lymphoid and hemopoietic tissue
4. Enclavomas
5. Secondary tumours
6. Tumour-like formations

• In each of the given bunches excrete benign and malignant tumours. Also apply classification by system TNM.
• Т1 - The tumour occupies one anatomical part.
• Т2 - The tumour occupies 2 anatomical parts, or 1 anatomical part, but sprouts the next organ, amazing no more than one anatomical part.
• Т3 - The tumour occupies more than 2 anatomical parts, or 2 anatomical parts + germination in next organs.
• N0 - There are no regional metastasises
• N1 - Regional metastasises secund and displaced
• N2 - Regional metastasises bilateral displaced
• N3 - Regional metastasises secund nonmotile
• N4 - Regional metastasises bilateral nonmotile, or the secund conglomerate of metastasises sprouting in the next organs
• М0 - There are no remote metastasises
• M - is the remote metastasises

Larynx malignant tumours

The cancer, almost always planocellular prevails, is rarer basal cell cancer. The larynx sarcoma meets was rarely.

The larynx cancer occupies 4 place among all malignant tumours from men, concedes to a carcinoma of the stomach, lungs and an esophagus. A case rate interrelation, a carcinoma of a larynx at men and women 22:1.

There is a cancer of a larynx at persons more youngly 30 years and is more senior 40 years, and at women 20 years are younger.

To brake the top part of a larynx - average is amazed, is even rarer - the inferior part.

Mainly there is an exophytic form of a cancer which grows slowly. At a tumour of an epiglottis process extends upwards and to front, at have swelled up average part of a larynx through a commissure or a guttural ventricle diffusion goes on the top part. The tumour of the inferior part of a larynx grows downwards through pencil-point ligament inpours on forward parts of a neck.

Earlier metastasizes a cancer of a vestibule of the larynx more often on the lesion party, and most slowly at a tumour of forward part of a larynx.

Excrete 3 seasons of development of tumours of a larynx:

1. Initial - tickles, inconvenience at swallowing, sensation of a lump in a throat
2. The season of full development of disease - arises hoarseness up to an aphonia, difficulty of breath up to an asphyxia, disturbance of swallowing up to full impossibility
3. The innidiation season

The differential diagnosis spend with a tuberculosis, a scleroma, a syphilis. (Solving) histological research or carrying out of preventive therapy without enough good result is definitive.

Treatment of a cancer of a larynx. More often - the larynx extirpation, is rarer - its resection, is even rarer - reconstructive operations. Before to start to surgical to treatment, necessarily effect a tracheotomy, for carrying out of an incubation narcosis, and for breath maintenance in the subsequent postoperative season.

Kinds of operations at a larynx cancer:

1. Endolaryngeal the oncotomy - is shown at a tumour of 1 stage, average part
2. Oncotomy outside access: and. A thyrotomy, a laryngofissure - at 2 stages, an average floor;. pharyngotomy infrahyoid. Effect at tumours of an unstable part of an epiglottis an epiglottis extirpation.
3. Larynx resection. Effect at tumour localisation in lobbies of 2/3 vocal cords with diffusion on a precomissure; at a lesion of one vocal cord; at the circumscribed cancer of the inferior part of a larynx; at the circumscribed cancer of the top part of a larynx under a condition inaction arytenoid cartilages.

   Kinds of resections:

   • Lateral (sagittal)
   • Frontlateral (diagonal)
   • Lobby (face-to-face)
   • The horizontal
4. The laryngectomy - is effected, if the resection is impossible, or at the third stage
5. The amplate laryngectomy - leaves a larynx, a sublingual bone, a tongue root, lateral sides of a laryngopharynx. Operation invalidating. As a result the tracheostomy is formed and the esophageal probe for a food is introduced

Except surgical, use radial treatment. It start to perform before operation in 1 and 2 stages of process. If after half of sessions of treatment appreciable retrogress of a tumour radial therapy continue to a full dose (60-70 Gray) becomes perceptible. In cases when after half irradiatings retrogress of a tumour less than 50 % radial therapy interrupt and operate the patient. The cancer of an average floor of a larynx, and a cancer of the inferior part radio resistant is most radiosensitive. In case of presence of regional metastasises effect Krail's operation - the fat of lateral part of a neck, deep bulbar lymphonoduses, noddle muscles, an intrinsic bulbar vein, submandibular lymphonoduses, a submandibular sialaden leaves. In case of presence of the remote metastasises it is spent symptomatic and chemotherapy. An exception are metastasises in lungs, their operative treatment here is admissible.

Chemotherapy

It is used in addition to the basic method of treatment, or in the started cases. Use: prosed, Bleomycinum, Methotrexatum, fluorobenzoic, Sinestrolum (2500-3500 mg, use at men).

Results of treatment

At the combined treatment at a cancer of a larynx of 2 stages the five years' survival rate reaches 71-75 %, at the third stage of 60-73 %, at 4 stages of 25-35 %, at the first stage - 90 % of cases.

The basic the causes of failures - relapses.

Nasopharynx neoplasms

Benign tumours - papillomas, localise, as a rule on a back surface of a soft palate, is rarer on lateral and back sides of a nasopharynx. Treatment - surgical.

Youthful angiofibroma. It is localised in a nasopharynx crest. Through postnarises often inpours into a nasal cavity. Consists of a copulative tissue and pots. Possesses a tachyauxesis. Clinic: disturbance of nasal breath and audition depression as the acoustical tube is occluded, and also nasal bleedings. Formation expedites itself a nasal cavity and adnexal sinuses of a nose, first of all a clinoid sinus. Can blast a base of skull and inpour into its lumen. At a back rhinoscopy it is possible to see more cyanotically, hilly formation. Treatment - surgical (on Moore).

Malignant tumours. Arise at men is more senior 40 years more often. Diagnostics is accompanied by sinusitises therefore is very often erroneous. There are bloody abjections from a nose, character the occluded nasonnement, process usually secund. For surgical treatment of access practically is not present, therefore apply radial therapy.

Stomatopharynx neoplasms

The benign. Carry a papilloma, a hemangioma.

The cancerous. The cancer prevails. Excrete the differentiated radio refractory tumours, meet at young age and at children.

Initial localisation (on frequency).

Palatal tonsils of 58 % of cases

Back side of a pharynx of 16 % of cases

Soft palate of 10 % of cases

Growth prompt, quickly canker, often metastasize. The clinic depends on initial localisation of a tumour. The cachexia is connected to semiology as swallowing is broken.

Treatment: at benign processes - operation which can is effected through a mouth or at endolaryngeal pharyngotomies. In case of malignant tumours - radial therapy + operation. Before operation the tracheotomy and a dressing of an outside carotid artery on the lesion party is obligatory.

Laryngopharynx neoplasms

The laryngopharynx cancer usually educes in a bulb-shaped sine, is a little bit rarer on a back side and in behind cricoid range. Most typical an exophytic growth form.

Complaints: in an early stage a dysphagia if the tumour is localised at an orifice in an esophagus and difficulty of breath at localisation at an orifice in a larynx. Pains, hoarseness, a pneumorrhagia, an unpleasant odour further join. Treatment both surgical, and radial is ineffective.

Operation - a laryngectomy with a circular resection of cervical part of an esophagus + a trachea resection. Esophagostomaat, a tracheostomy is formed pharyngostoma, orostoma. If it is possible, the plastics nutrition of wire pathes further are spent.

Operations used at tumours of nose and adnexal sinuses

Operations by access through a mouth (on Denker). Indications - tumour localisation in the frontbottom part of a nose, a tumour at elderly - cancerous, benign tumours. Operation sparing.

Cut under a labium from a lesion proceeding on an opposite side. The facial side of the top jaw, a piriform opening, the inferior intrinsic angle of an orbit is bared. Soft tissues separate also lift upwards. Possible pathes of the approach: reday and medial genyantrum sides, the inferior and lateralis sides of a nasal cavity. From these approaches it is possible to approach to the core, frontal to sinuses, cells of a trellised labyrinth.

Operation on Moore (outside access). Indications: tumours of a trellised labyrinth, the basic sinus.

The cut is spent on suprabrow, on a lateral side of a nose, bending around a nose wing. Soft tissues separate.