Contents
Tumor-like formations and benign tumors
Of the benign tumors, papillomas are the most common. They are often localized on the palatine arches, tonsils, mucous membrane of the soft palate and rarely on the posterior wall of the pharynx. Papillomas of the pharynx – these are single formations, the diameter of which rarely exceeds 1 cm.
Papilloma among benign tumors of the pharynx is quite common. Squamous cell papillomas of the palatine arches, tonsils, uvula and free edge of the soft palate are usually single.
Pharynx papilloma – a formation with a grayish tint, uneven edges and a granular surface, mobile, since most often it has a thin base (pedicle). The mucous membrane around the papilloma is not changed.
The final diagnosis is made based on the results of histological examination.
Frequent tumor – oropharyngeal hemangioma.
It has many varieties, but in the middle part of the pharynx cavernous diffuse and deep capillary hemangiomas predominate. Branched venous or arterial vascular tumors can be found much less frequently.
Oropharyngeal hemangioma in the middle part of the pharynx is somewhat less common than papilloma.
Deep capillary hemangioma is covered with unchanged mucous membrane, its contours are unclear.
In appearance, the tumor is difficult to distinguish from neuromas and other neoplasms localized in the thickness of the tissue. Cavernous and venous hemangiomas are most often located superficially. They are bluish, the surface of these tumors is lumpy, and the consistency is soft.
Encapsulated cavernous hemangiomas have clear boundaries. Branched arterial hemangioma, as a rule, pulsates, and this pulsation is noticeable during pharyngoscopy. The surface of the tumor may be lumpy. Arterial hemangioma must be differentiated primarily from an aneurysm (using angiography).
The boundaries of a hemangioma are difficult to determine. This is due to the fact that the tumor spreads not only over the surface, but also deep into the tissues, often reaching the neurovascular bundle of the neck, filling the jaw area or appearing as a swelling, often anterior to the sternocleidomastoid muscle.
Mixed tumor of the oropharynx found in the middle part of the pharynx as often as hemangioma. It develops from the minor salivary glands. In terms of frequency of occurrence, this neoplasm is second only to papilloma. Due to its large polymorphism, it is usually called a mixed tumor or polymorphic adenoma.
In the oropharynx, a mixed tumor can be localized in the thickness of the soft palate, on the lateral and, less commonly, on the posterior wall of the middle part of the pharynx. Since the tumor arises and develops deep in the tissues, on the surface of the walls of the pharynx it looks like a well-defined swelling of dense consistency, painless on palpation, with an uneven surface. The mucous membrane over the tumor is not changed. By appearance, it is not possible to distinguish a mixed tumor from other neoplasms of this localization (neurinoma, neurofibroma, adenoma). The final diagnosis is made based on the results of histological examination.
Tumors such as lipoma, lymphangioma etc., are rare in the middle part of the pharynx. Of these tumors, only osteoma can be diagnosed without histological examination. It is radiopaque, but the final diagnosis is still established based on the results of a histological examination, which makes it possible to determine the morphological structure of the tumor focus.
Signs of an oropharyngeal tumor
In most patients with oropharyngeal tumors, the first signs of the disease are the sensation of a foreign body in the pharynx, soreness or other paresthesia. Patients often complain of dryness in the throat, and sometimes of mild pain in the morning when swallowing saliva (“empty throat”).
Neoplasms such as papillomas, fibromas, cysts localized on the palatine arches or tonsils may not cause any symptoms for years; Only when the tumor reaches a large size (1,5-2 cm in diameter) does a sensation of a foreign body in the pharynx occur.
Dysphagia is more typical for tumors of the soft palate. Violation of the tightness of the nasopharynx during a swallow leads to a disorder in the act of swallowing, and liquid food entering the nose. Such patients sometimes make nasal noises.
The sensation of a foreign body in the pharynx and other paresthesias appear very early with neoplasms of the root of the tongue and vallecules. These tumors can cause difficulty swallowing, including choking on liquid foods.
Pain is not typical for benign neoplasms of the oropharynx. Pain during swallowing or regardless of swallowing can occur with neuromas, neurofibromas, and very rarely with ulcerated vascular tumors.
Bleeding and the admixture of blood in sputum and saliva are characteristic only of hemangiomas, as well as ulcerated disintegrating malignant tumors.
Diagnosis of benign tumors of the oropharynx
Instrumental studies
The main method of examining the pharynx is pharyngoscopy. It allows you to determine the location of the tumor focus, the appearance of the tumor, and the mobility of individual fragments of the pharynx.
Angiography, radionuclide studies and CT can be used as auxiliary research methods for hemangiomas.
The most informative is angiography, which allows you to determine the vessels from which the tumor receives blood. In the capillary phase of angiography, the contours of capillary hemangiomas are clearly visible. Cavernous and venous hemangiomas are better visible in the venous phase, and branched arterial hemangiomas are better visible in the arterial phase of angiography. The diagnosis of hemangiomas is usually made without histological examination, since a biopsy can cause intense bleeding. The histological structure of the tumor is most often determined after surgery.
Malignant tumors of the oropharynx
Symptoms of a malignant tumor of the oropharynx
Malignant tumors of the middle part of the pharynx grow quickly. They may remain unnoticed for some time, usually several weeks, much less often months. The first symptoms of malignant tumors depend on their primary location. Subsequently, as the tumor grows, the number of symptoms increases rapidly.
One of the early signs of a tumor is the sensation of a foreign body in the throat. Soon it is accompanied by pain in the throat, which, like the sensation of a foreign body, is strictly localized. Epithelial tumors are prone to ulceration and decay, as a result of which the patient develops bad breath and blood in the saliva and sputum. When the tumor process spreads to the soft palate, its mobility is impaired and a nasal sound develops; liquid food may get into the nose. Since swallowing disorders occur quite early and the passage of food is disrupted, patients begin to lose weight early.
In addition to local symptoms, due to intoxication and inflammation accompanying the tumor, general symptoms also develop, such as malaise, weakness, and headache. When the lateral wall of the pharynx is affected, the tumor quickly penetrates deep into the tissues towards the neurovascular bundle of the neck, and therefore there is a danger of profuse bleeding.
Among malignant tumors of the oropharynx, neoplasms of epithelial origin predominate. Epithelial exophytically growing tumors have a wide base, their surface is bumpy, in places with foci of decay; pink color with a grayish tint. There is an inflammatory infiltrate around the tumor. The tumor bleeds easily when touched.
A tumor ulcer is quite often localized on the palatine tonsil. The affected tonsil is enlarged compared to the healthy one. A deep ulcer with uneven edges, the bottom of which is covered with a dirty gray coating, is surrounded by an inflammatory infiltrate.
Diagnosis of malignant tumor of the oropharynx
Laboratory research
Cytological examination of smears-imprints or reprints. The final diagnosis of a tumor, determining its type, is established by studying its histological structure.
Instrumental studies
Biopsy – excision of a piece of tissue for histological examination – is one of the important diagnostic methods in oncology.
It is well known that a piece of tissue should be taken at the border of the tumor process, but it is not always possible to determine this border, especially with tumors of the ENT organs.
Neoplasms of the palatine, pharyngeal and lingual tonsils, especially connective tissue ones, arise deep in the tonsil tissue. The amygdala enlarges. An enlarged tonsil should be alarming and requires targeted research, including a biopsy. In case of asymmetry of the palatine tonsils, if a tumor process is suspected, if there are no contraindications, it is necessary to perform a unilateral tonsillectomy or tonsillotomy as a biopsy. Sometimes such a tonsillectomy can be a radical surgical intervention in relation to the tumor.
Differential diagnosis of malignant tumors of the oropharynx
An ulcerated tumor of the tonsil must be differentiated from ulcerative membranous tonsillitis Simanovsky-Vincent, syphilis and Wegener’s disease. For this purpose, it is necessary to examine smears taken from the edges of the ulcer and perform the Wasserman reaction.
Treatment of oropharyngeal tumors
The main method of treatment for patients with benign tumors of the middle part of the pharynx is surgical. The extent of surgical intervention depends on the extent, histological structure and location of the tumor. Limited tumors, such as palatine papilloma, can be removed in the clinic using a loop, scissors or forceps.
After its removal, the original site of the tumor is treated with galvanocauter or a laser beam. In a similar way, you can remove a pedunculated fibroma, a small, superficial cyst of the tonsil or palatine arch.
A small mixed tumor of the soft palate can be removed through the mouth under local anesthesia. More often, when removing tumors of the oropharynx, anesthesia is used, using a sublingual pharyngotomy as access, which is often supplemented by a lateral one. Wide external access allows you to completely remove the tumor and ensure good hemostasis.
External access is also required when removing vascular tumors of the pharynx. Before removing hemangiomas, the external carotid artery is first ligated or embolization of the afferent vessels is performed. Intervention for these tumors is always associated with the risk of severe intraoperative bleeding, which may require ligation of not only the external, but also the internal or common carotid artery to stop. Considering the possibility of intraoperative bleeding and the severity of the consequences of ligation of the internal or common carotid artery, in patients with parapharyngeal chemodectomas and hemangiomas, “training” of intracerebral anastomoses is carried out 2-3 weeks before surgery.
It consists of pinching the common carotid artery on the side of the tumor localization with a finger 2-3 times a day for 1-2 minutes. Gradually, the duration of clamping is increased to 25-30 minutes. At the beginning of the “training” and then when the duration of clamping of the common carotid artery is increased, the patient feels dizzy. This sensation serves as the criterion by which the duration of clamping of the artery is determined, as well as the duration of the “training” course. If clamping the artery for 30 minutes does not cause a feeling of dizziness, then after repeated clamping for another 3-4 days, you can begin the operation.
Cryotherapy as an independent method of treating patients with benign tumors is indicated mainly for superficial (located under the mucous membrane) diffuse hemangiomas. It can be used in the treatment of deep hemangiomas in combination with surgery.
Basic treatment methods for malignant tumors of the oropharynx, as with neoplasms of other localizations, surgical and radiation. The effectiveness of surgical treatment is higher than the effectiveness of radiation and combined treatment, the first stage of which is radiation.
Through the mouth, it is possible to remove only limited tumors that do not extend beyond one of the fragments of this area (soft palate, palatoglossal arch, palatine tonsil). In all other cases, external approaches are indicated – transhyoid or sublingual pharyngotomy in combination with a lateral one; sometimes, to gain wider access to the root of the tongue, in addition to pharyngotomy, resection of the lower jaw is performed.
Surgeries for malignant tumors are performed under anesthesia, after ligating the external carotid artery and performing a tracheotomy. Tracheotomy is performed under local anesthesia, and subsequent stages of the intervention are performed under intratracheal anesthesia (intubation through a tracheostomy).
If the palatine tonsil is affected by a tumor that does not extend beyond its limits, they are limited to removing the tonsil, palatine arches, paratonsillar tissue and part of the root of the tongue adjacent to the lower pole of the tonsil. The supply of unaffected tissue around the tumor focus should not be less than 1 cm. This rule is also followed when removing common tumors using external access.
Radiation treatment of patients with pharyngeal tumors should be carried out according to strict indications. This therapeutic effect can only be used for malignant tumors. As an independent method of treatment, irradiation can be recommended only in cases where surgery is contraindicated or the patient refuses surgery. We recommend combined treatment, the first stage of which is surgery, for patients with stage III tumors. In other cases, you can limit yourself only to surgery.
For tumors occupying the middle and lower parts of the pharynx, spreading to the larynx, a circular resection of the pharynx is performed with removal of the larynx. After such extensive intervention, an orostoma, tracheostomy and esophagostomy are formed. After 2-3 months, plastic surgery of the lateral and anterior walls of the pharynx is performed, thereby restoring the path of food passage.
The five-year survival rate of patients after surgical treatment is 65+10,9%, after combined treatment (surgery + radiation) – 64,7±11,9%, after radiation therapy – 23+4,2% [Nasyrov V.A., 1982 ].