Early diagnosis of laryngeal cancer

Any unexplained hoarseness or foreign body sensation in the throat that does not improve after symptomatic treatment, especially if the patient is over 46 years old, accompanied by an irritating dry cough, blood in the sputum, throat pain, headache, earache, dyspnea, neck mass, or variations in the contour of the thyroid cartilage, thyrohyoid membrane, superior angle of the thyroid cartilage, cricothyroid membrane, and thyroid gland, should all lead to suspicion of laryngeal cancer. The diagnosis can usually be confirmed with the help of X-ray, CT, laryngoscopy, local cell smears of laryngeal lesions, and cytopathology examination.

1. Physical examination of the neck

It includes inspection and palpation of the laryngeal shape and cervical lymph nodes. Palpation of the cervical lymph nodes should be carried out according to the distribution pattern of the cervical lymph nodes, from top to bottom and from front to back.

2. Laryngoscopy

Indirect laryngoscopy is a commonly used method in clinical practice. Direct laryngoscope and fiberoptic light guide can only be used when the indirect laryngoscopy examination is unsatisfactory or it is difficult to obtain pathology. This can further understand the situation of tumor invasion in the larynx and timely obtain tissue from suspicious lesions for pathological examination.

3. Imaging examination

(1) X-ray examination: X-ray lateral laryngeal films and anteroposterior laryngeal tomographic films can clarify the general location, size, shape, and changes in the cartilaginous trachea or anterior cervical soft tissue of the lesion. Laryngography can be performed if necessary.

(2) CT and MR examinations: They are helpful in determining the extent of tumor growth in the larynx, the extent of external invasion, and the status of cervical lymph node metastasis, which is especially helpful for patients in the advanced stage.

(3) Ultrasound: A method used to detect enlarged lymph nodes in the neck, locate their location and their relationship with surrounding tissues, and conduct follow-up examinations after postoperative radiotherapy. It has the advantages of being non-destructive, convenient, accurate, low-cost, and can be performed repeatedly.

Common pathological classification: Squamous cell carcinoma is the most common laryngeal cancer, accounting for 95% to 98%. Adenocarcinoma is rare, accounting for about 2%, and undifferentiated carcinoma, lymphosarcoma, and fibrosarcoma account for 2%.

Laryngeal squamous cell carcinoma can be divided into three types according to its development stage: carcinoma in situ, early invasive carcinoma and invasive carcinoma.

Sometimes the tumor is mainly composed of spindle cells, which is called spindle cell carcinoma. The cancer cells are arranged in a disorderly manner and do not form cancer nests, which is quite similar to sarcoma.

Verrucous carcinoma is a subtype of laryngeal invasive squamous cell carcinoma. It is rare, accounting for 1%-2% of laryngeal cancer. The tumor grows in a warty manner into the laryngeal cavity, forming a cauliflower-like mass. Under the microscope, it often has a papillary structure and is a well-differentiated squamous cell carcinoma. It can be seen with varying degrees of local infiltration, slow growth, and rare metastasis.