Neoplasm of the soft tissues of the neck. Malignant tumor of the neck

Neck cancer occurs in people over the age of 59 and is very dangerous view tumors. A tumor on the neck can be very aggressive, as it grows quickly, gives a large number of metastases and is difficult to treat. Neck cancer occurs for a number of reasons. Tumors in the neck area can be benign or malignant. Malignant ones are quite difficult to treat.

More than half of patients with malignant tumors of the neck without metastases, and less than a third with a tumor that has metastasized to the lymph nodes or other organs, can live for about five years. Older people are more likely to live longer in remission of the disease and without signs of relapse than people at a younger age.

neck tumors

A tumor in the neck can be malignant or benign. These can be tumors that occur on the right or left side of the neck, or on both sides at once, do not give pain. This is a lymphangioma, which is referred to as benign tumors lymph nodes. It is easy to detect and feel, the tumor is soft, supple, does not give painful sensations. If the swelling on the neck does not decrease within a few weeks, you have an elevated body temperature, you should immediately consult a doctor and examine it. Lymphangioma can be treated with radiotherapy, but is most often removed with surgery.

Tumors on the neck can also occur in front, they are associated with diseases thyroid gland. Such formations are most often found in children. The thyroid gland is enlarged due to dysfunction endocrine system. You should seek help from the clinic, as this may be a sign diabetes or other disease. Detecting an enlarged gland is quite simple, since in healthy condition it's hard to find her.

There are several other types of benign tumors:

Papillomas - this tumor is formed from the epithelium, usually pale brown-black in color and small in size. Sometimes it can be on a wide base or a thin stem. Papilloma may be covered with a crust, but does not give painful sensations. Pain appears only in case of damage to the tumor or inflammation. Usually papilloma is removed for beauty and if it is covered with an ulcer.
Lipomas - These tumors arise from adipose tissue. May appear in the back of the neck where hair grows. They can be large. Lipoma is a soft formation with a smooth shiny or lobed surface. They do not disturb and move when probing. Deleted only surgically.
Fibromas - this tumor arises from connective tissue. The tumor is formed in the lateral triangles of the neck. Fibroma can be nodular or diffuse. This tumor is removed by surgery, sometimes radiotherapy can also be used.
Neurinomas - this tumor is extremely rare. It is formed in the upper cervical region, quite dense, often painful. Neurinoma has a dense structure and a smooth, shiny surface. When you press it, pain occurs. To detect a neuroma, the patient is biopsied. Neurinoma is removed only by surgery.

A cancerous tumor on the neck among other tumors is the most common form. Such tumors arise from epithelial tissues in the neck. Cancer tumors can be localized in any tissues and organs of the cervical region. Malignant tumors of the neck include the following types: cancer of the oropharynx - tumors affect the base of the tongue, palate, lateral and back wall pharynx, during a simple examination, the tumor is not visible; throat cancer and thyroid cancer. These tumors metastasize to other organs and are difficult to treat.

Causes of neck cancer

The main causes of neck cancer are considered to be those that lead to the development of tumors in the upper respiratory tract and departments. gastrointestinal tract. First of all, it is smoking or passive inhalation tobacco smoke. Many people know the carcinogenic effects of tobacco, which is very dangerous. Alcohol can also cause neck cancer if consumed in large quantities. A tumor on the neck may occur due to heredity and viral infections. Hazards at work can also provoke the development of a cancerous tumor in the neck. Also, among other reasons, exposure to radiation and unhealthy nutrition are distinguished.

Constantly eating too hot food can cause cancer of the larynx and pharynx. Also, studies have shown that those people who may have received low doses of radiation therapy in the past to remove facial hair or acne, enlarged tonsils and adenoids, are at a significant risk of cancer of the thyroid and salivary glands.

Neck tumor symptoms

Malignant tumors of the neck can spread primarily to the nearest lymph nodes, while within six months to three years they do not metastasize to other areas and tissues. Metastases can occur in a person with large and long-lived tumors or with weakened immune system. Symptoms of neck cancer may include the following:

difficulty swallowing food and water;
voice change, hoarseness;
pain in the neck and head;
the occurrence of edema on the neck and under the eyes;
in some patients, the doctor may find enlarged lymph nodes.

Signs of neck cancer may be different, but they all require a detailed examination and diagnosis. Modern methods diagnostics can help with this.

Tumor diagnostics

Diagnosis of neck cancer is to establish the stage of spread of a malignant tumor. The method of treatment and the life expectancy of the patient depend on the stage of the tumor. Malignant tumors of the neck are divided depending on their size and place of formation, the number and size of metastases in the lymph nodes and in distant organs. There are four stages, among which the fourth is the most difficult and gives disappointing forecasts.

To determine the extent of the process, the depth of organ damage, germination in the bones, the spread of cancer cells in the lymph nodes, you can use a variety of diagnostic methods: from a routine examination to passing computed tomography. To finally confirm the diagnosis, the doctor performs a biopsy by examining a sample of tissue under a microscope. Also in the early stages of the disease, methods such as ultrasound, x-rays and special testing of cancer cells under a microscope are used. Scanning with computed tomography allows for a more accurate assessment and prognosis.

Neck Cancer Treatment

The choice of method for treating a cancerous tumor of the neck directly depends on the stage of the neoplasm. If the tumor is in the first stage, surgery and radiation therapy are used. Most often, not only a malignant tumor is radiated, but also lymph nodes on both sides of the neck, since more than 20 percent cancerous tumors may metastasize to lymph nodes.

Tumors that grow outward respond best to treatment than those that spread into surrounding tissues, form ulcers, or are solid in structure. If a malignant tumor of the neck has grown into a muscle, cartilage or bone, the likelihood of a complete recovery is extremely small. If metastases spread in the body, a person can live up to a maximum of two years. A cancerous tumor that forms along a nerve, causes pain, numbness, and paralysis, is very dangerous and difficult to treat.

Neck tumors are treated by several methods, which are used separately and in combination:

surgical intervention- it is used in severe cases of lesions, the patient is removed not only the primary focus of the tumor, but also the lymph nodes with metastases;
irradiation method - removes the tumor in the early stages, can give side effects in the form of dry mouth, changes in taste, the occurrence of atrophic glossitis;
chemotherapy - this method is used at the very last stage of tumor development, when the operation is no longer possible to alleviate the suffering of the patient. Gives plenty side effects.

In the early stages of tumors in the neck and pharynx, endoscopic access may be used. If the formation is small, limited by the capsule and located on the surface of the mucosa, cryo or laser destruction, photodynamic treatment is used. These are the most gentle methods of therapy. After the operation, due to the location of the tumor, the patient may often need plastic surgery in the neck. A combination of radiation and chemotherapy methods is used to eliminate pain and improve the patient's well-being when a cancerous tumor cannot be removed promptly.

Cancer treatments always have side effects. After the operation, the process of swallowing and speech may be disturbed, so the patient needs a course of recovery. The irradiation method often causes skin changes, hair loss and itching, scarring, taste disturbance and dry mouth, and sometimes healthy tissue can also be affected. Chemotherapy often causes nausea, vomiting, temporary hair loss, and inflammation of the stomach lining. Also, this method can lead to a decrease in the number of erythrocytes and leukocytes and a decrease in immunity. After treatment, side effects should usually disappear.

Prevention of neck tumors consists in the exclusion of smoking and junk food, carrying out the necessary measures for the protection of hazardous production, as well as in timely treatment infectious diseases.

Stages of throat cancer

Throat cancer (laryngeal cancer) is a rather serious oncological disease, which is characterized by the formation of a malignant tumor formation based on the tissues of the throat. Throat cancer, symptoms can be triggered by a number of factors that occur among men age category ranging from 40 to 70 years.

How does throat cancer start?

On the early stage, the disease develops from the epithelium. Education may arise
any part of the larynx, but the most common cancer is over vocal cords. The disease, in all its manifestations, is quite aggressive, and if left untreated, it metastasizes to the lymph nodes and to the nearest and distant organs.

AT modern world It is customary to define four stages of throat cancer. Also, a precancerous condition, that is, stage zero, falls into a special category.

stage 0 throat cancer

The zero stage indicates the presence of a tumor formation, of small size, which does not go beyond the mucosa that covers the larynx from the inside. It is almost impossible to detect a tumor at this stage, since there are simply no symptoms of throat cancer. But, if nevertheless the tumor is found, the probability of cure is quite high. The survival rate for 5 years is 100%.

stage 1 throat cancer

The formation significantly increases in size, affects the mucous membrane, but does not touch nearby organs and tissues, metastases are not detected. Throat cancer stage 1 (degree), implies the possibility of vibration vocal folds and their generation of sounds. Present initial symptoms such as, slight wheezing or coughing. With properly selected treatment, the probability of cure for the next 5 years is about 80%.

Tumors of the head and neck include tumors originating from different tissues and organs.

larynx (including vocal folds, supra- and subglottic space);
oral cavity - lips, gums, front of the tongue, floor of the mouth, solid sky and mucous membrane of the cheeks;
pharynx (including nasopharynx, oropharynx, laryngopharynx);
nasal cavity and paranasal sinuses (maxillary, frontal, sphenoid and ethmoidal labyrinth);
salivary glands.

In the UK, tumors of each of these localizations are relatively rare. However, a total of over 3,000 head and neck tumors are diagnosed each year in England and Wales. Although the term “head and neck tumors” encompasses various diseases, the principles of diagnosis and treatment are largely similar.

Causes of swelling (cancer) of the head and neck

Smoking and alcohol abuse

Smoking and alcohol abuse remain the main disposable etiological factors in Western countries. These causes are believed to play a role in the development of head and neck tumors in 75% of patients.

These factors in their influence on carcinogenesis show synergy, potentiating each other's action.

Food

A balanced diet with adequate fruit and vegetable intake is associated with a low risk of developing head and neck tumors.

Malnutrition, especially dietary deficiencies in vitamins A and C, increase the risk of developing these tumors.

Nitrosamines, added to Chinese salted fish dishes, also increase the risk of developing these diseases.

infections

Papillomavirus infection is a factor contributing to the development of cancer of the larynx, pharynx and oral cavity.

Cancer caused by HPV has a better prognosis than cancer associated with smoking and alcohol abuse.

Virus herpes simplex type 1 and 2 plays a role in the development of oral cancer. Epstein-Barr virus plays a role in the development of undifferentiated nasopharyngeal cancer. Morphological examination of the tumor in these patients revealed this virus in all cases. Epstein-Barr virus also plays an etiological role in some tumors of the salivary glands.

hereditary predisposition

In the development of some tumors of the head and neck, hereditary predisposition plays a role.

Certain combinations of HLA complex genes increase the risk of nasopharyngeal cancer.

Other factors environment

Formaldehyde contributes to the development of cancer of the pharynx and oral cavity. Wood dust from hardwoods is an occupational hazard for sawmill workers that increases the risk of cancer of the ethmoid labyrinth by 70 times.

Wood dust from softwoods is a risk factor for squamous cell carcinoma of the nasal cavity and paranasal sinuses.

Radiation contributes to the development of tumors of the salivary glands.

Squamous cell carcinoma

In more than 90% of cases, cancer located in the head or neck area histological structure it is squamous, especially when it is localized in the larynx and oral cavity. Depending on the degree of keratinization, moderately differentiated and poorly differentiated squamous cell carcinoma is distinguished. It usually spreads by sprouting into adjacent tissues and is more likely to metastasize via the lymphatic tract to the regional lymph nodes of the neck. Distant metastases are usually characteristic of late stage disease or recurrent tumor and appear in the mediastinal lymph nodes, lungs, liver, bones.

A causal relationship has been proven between a number of diseases and conditions and squamous cell carcinoma, these diseases are considered precancerous.

Leukoplakia is hyperkeratosis with or without epithelial hyperplasia. With isolated leukoplakia, the risk of further malignant transformation reaches 5%.
Erythroplakia - superficial red plaques adjacent to the normal mucosa. Often associated with epithelial dysplasia. In 40% of cases, it is associated with cancer in situ or invasive cancer.
Dysplasia, or cancer in situ (if it affects the entire mucosa to its full thickness). Progression to invasive cancer occurs in 15-30% of cases.

Warty cancer (Ackerman's tumor) is a type of highly differentiated squamous cell carcinoma that manifests itself in the form of whitish growths resembling cauliflower. Histological examination confirms the marginal growths, surrounded by a pronounced shaft of inflammatory cells.

Spindle cell carcinoma is biologically similar to squamous cell carcinoma.

Other tumors

There are other tumors as well.

adenocarcinomas. coming from the tissue of the salivary glands, such as the oral cavity.
Melanoma.
Sarcoma, such as rhabdomyosarcoma.

Patients with cancer located in the head or neck region have a greater risk of developing a second malignant tumor than patients with tumors in other locations.

The second tumor may be different:

synchronous, developed at approximately the same time as the first;
metachronous, developing 6 months or more after the first.

The second tumor differs in origin from the first, i.e. it cannot be considered a locoregional recurrence or metastasis of the former. The high risk of multiple primary tumors reflects the carcinogenic effect of long-term exposure to the components of tobacco smoke and alcohol on the epithelium of the gastrointestinal tract, respiratory and urinary tract.

Tumors of the salivary glands

Tumors of the salivary glands are more diverse than the more common tumors of the head and neck of other localizations.

Most often (70-85% of cases) the parotid glands are affected.
In more than 75% of cases, the tumor is benign.
Small salivary gland tumors account for 5-8% of all salivary gland tumors, but in more than 80% of cases they are malignant.

The most common tumor of the salivary glands is a pleomorphic adenoma, also called a mixed tumor. It's benign epithelial tumor, it is rarely malignant. Local relapses after husking it are frequent, so parotidectomy is usually resorted to.

Malignant tumors of the salivary glands include the following:

mucoepidermoid cancer;
adenocarcinoma;
squamous cell carcinoma;
undifferentiated cancer;
metastatic cancer;
lymphoma.

Screening and prevention of tumor (cancer) of the head and neck

A national population screening program for early detection of head and neck tumors has not yet been developed. In the UK, the main focus is on raising public awareness about tumors of this localization and improving lifestyle (combating smoking, alcohol abuse) in order to reduce the number of patients with a neglected tumor process.

Symptoms and signs of tumor (cancer) of the head and neck

Tumors of the head and neck are often manifested by an increase in regional cervical lymph nodes, which is not accompanied by any painful sensations.

Cancer of the larynx

Long unproductive cough, dysphagia or odynophagia (painful swallowing) - characteristic symptoms supraglottic cancer.

Dyspnea and stridor may be a manifestation of subglottic cancer, covering the entire circumference of the larynx. These symptoms are rare (less than 5% of cases). Pain may radiate to the ear. Some patients have hemoptysis.

oral cancer

The following symptoms occur.

A long-term non-healing oral ulcer, painful ulceration of the lip, or an exophytically growing tumor.
A white or red plaque on the tongue, gums, or mucous membranes of other parts of the mouth.
Dental disease (eg, loose teeth, ill-fitting dentures).
Dysphagia, odynophagia.
Irradiation of pain in the ear.
Dysarthria with tongue involvement.
Weight loss.

Due to infiltrating growth, the tumor usually covers more than one anatomical region:

language - 60%;
floor of the mouth - 15%;
alveolar process of the jaw - 10%;
buccal mucosa - 10%;
hard palate - 5%.

throat cancer

Cancer of the nasopharynx.

"(Nasal" symptoms: bleeding, nasal congestion, discharge.
Hearing loss on the side of the lesion, associated with the germination of the tumor in auditory tube, tinnitus is also possible.
cervical lymphadenopathy.
Headache.
Damage symptoms cranial nerves associated with the germination of the tumor in the base of the skull.

Cancer of the oropharynx.

Sore throat, swelling in it.
Irradiation of pain in the ear. Cancer of the pharynx.
Dysphagia and swelling in the throat.
Sdinophagy.
Irradiation of pain in the ear.
Hoarseness of voice.

Cancer of the nasal cavity and paranasal sinuses

Nosebleeds.

Unilateral obstruction of the nasal passage; possible serous-bloody or purulent discharge. Pain and paresthesia.

Ptosis, diplopia, chemosis, as well as loss of vision in case of tumor spread to the orbit and displacement of the eyeball.

Tumors of the salivary glands

Painless knot in the tissue salivary gland.

It is often difficult to differentiate between an enlargement of the entire salivary gland and its enlargement due to a tumor node.

Signs that help to suspect a malignant tumor are as follows:

infiltration of surrounding tissues:
facial nerve injury.

Methods for studying a tumor (cancer) of the head and neck

Research objectives:

specify the location and dimensions primary tumor;
identify synchronous cancer of another localization, often occurring in this category of patients;
clarify the stage of the tumor process;

Physical research

Inspection of the affected area, including with the help of a mirror. Currently, fibroendoscopy is increasingly performed to examine the nasopharynx, laryngopharynx, base of the tongue, larynx, and vocal folds.

Bimanual examination of the oral cavity.

Palpation of regional lymph nodes: the presence of metastases in them is an important prognostic sign, however, clinical examination should be combined with scanning research methods, given the high frequency of false negative and false positive (30-40%) results.

General physical examination to detect distant metastases (often asymptomatic).

If necessary, a study with a biopsy is performed under anesthesia.

Blood test

Biochemical analysis of blood with the determination of the activity of liver enzymes and blood clotting, given that many patients abuse alcohol.

Scanning research methods

Thus, laryngeal cancer at an early stage very rarely metastasizes to distant organs, so the study is limited only to the neck area.

CT is performed to clarify the boundaries of tumor infiltration, its spread to bones and cartilage (the tumor corresponds to category T 4), metastasis to regional lymph nodes and other organs. Most often, distant metastases are detected in the lungs, less often in the liver, and even more rarely in the bones.

Head and neck MRI - more informative method assessing the condition of soft tissues.

Bone scintigraphy is performed when there is a suspicion of bone metastases, and there are no signs of them on CT. In cancer of the nasopharynx, approximately 25% of patients with an increase in the lower cervical and supraclavicular nodes and signs of bone metastases develop a second tumor.

PET is performed, for example, when squamous cell carcinoma metastasizes to the cervical lymph nodes, when the primary tumor in the ENT organs cannot be detected.

Histological examination

A biopsy is performed when the tumor is identified and accessible, with the exception of tumors of the salivary glands: in these cases, fine needle aspiration biopsy is preferable to avoid dissemination of tumor cells.

If lymph node metastases are suspected, fine needle aspiration biopsy is performed. In 15% of cases, a false negative result is obtained, however, when performing this study under ultrasonic control this figure is lower.

Stages of tumors according to the TNM system of a tumor (cancer) of the head and neck

For tumors of the head and neck, the stage of the disease is determined by the TNM system. Criteria characterizing the stage of the disease in tumors different localization, are largely the same. The details that distinguish various classifications, are taken into account only in cases where it is necessary to determine the possibility radical operation 1 update the forecast.

T - characterizes the primary tumor. Usually indicate the size of the tumor and its spread to the bone or cartilage tissue(T 4); For some tumors, the category T is divided into T 4a (the tumor is resectable) and T 4b (the tumor is unresectable).
N - characterizes the involvement of lymph nodes in the tumor process.
M - the absence of distant metastases (M 0), the presence of distant metastases (M 1) and the inability to determine metastasis to other organs (M x).

Treatment of a tumor (cancer) of the head and neck

Precancerous diseases

Patients with precancerous diseases should be referred to oncologists for the following reasons.

In many cases, precancerous changes eventually turn into cancer.
Patients with precancerous diseases have an increased risk of developing cancer of other organs, especially the lungs and gastrointestinal tract.

Treatment usually consists of removal of the altered tissue, with an obligatory otological examination by an experienced morphologist. Classification of precancerous diseases is based on the degree of dysplasia and facilitates prognosis. For frequently recurrent or diffuse lesions (eg, vocal folds), radiation therapy.

Malignant tumors

Examination and treatment of patients with tumors of the head and neck is carried out by a group of doctors, consisting of specialists of various profiles - taking into account the somatic and mental status the patient and his functional reserves. The lack of special support and low material security can negatively affect the treatment and cause insufficient patient adherence to treatment. The goal of treatment is to prolong the life of the patient as much as possible and to preserve his activity as much as possible. In cases where it is impossible to achieve a cure, the entire arsenal of means is used to suppress tumor growth.

Before starting treatment, it is important to carry out the following activities.

Assess nutritional status. To do this, determine the initial body weight and the risk of wasting during treatment, if necessary, enter nasogastric tube or impose an enterostomy, involve a nutritionist in the treatment.
Consult the patient with a dentist and, if necessary, sanitize the oral cavity. You may need to consult a dentist during and after treatment.
Eliminate anemia. The content of hemoglobin should not be lower than 120 g/l, which is especially important during radiation therapy;
Assess the patient's speech.

Most head and neck cancers are treated with surgery, radiation therapy, or a combination of the two. At the stage corresponding to categories T1-2N0M0, one of these methods can be used. The results of a retrospective analysis indicate the equivalence of both methods. With a more common tumor process, treatment is often combined.

Treatment of tumors at an early stage

In 30-40% of patients with head and neck tumors, the disease corresponds to stage I or II by the time of diagnosis, while the prognosis is generally estimated at 60-98%, depending on the location of the tumor.

Surgery

Advantages of surgical treatment:

the tumor can be completely removed;
advanced surgery, such as for early laryngeal cancer, often saves the voice;
does not interfere with the treatment of metachronous cancer;
is not accompanied by side effects that occur with radiation therapy, including the risk of developing remote period second malignant tumor;
in case of tumors of the salivary glands, preoperative biopsy is undesirable (danger of dissemination of tumor cells), therefore, the operation is performed both for the purpose of diagnosis and for the purpose of treatment.

Radiation therapy

Both remote (only photon or photon and electron radiation) and interstitial (for example, iridium wire) radiation therapy are used.

The advantages of primary radiation therapy include the following:

absence deaths possible during surgery in patients with serious concomitant diseases;
the possibility of a more complete coverage of the tissues affected by the tumor, often limited during surgical intervention;
higher chances of retaining voice and swallowing function:
the possibility of irradiating the lymph nodes with latent metastases without additional trauma, inevitable during surgical cervical lymphadenectomy;
the ability to resort to surgical treatment if radiation therapy is not effective enough, although the operation in such cases is more traumatic and is associated with a greater risk of complications (for example, performing a laryngectomy after radiation therapy that turned out to be ineffective for cancer of the larynx);
the possibility of summing up the dose of radiation simultaneously to several tumor foci.

Side effects of radiation therapy include the following:

mucositis and dry mouth, the duration of which depends on the mass of preserved salivary gland tissue;
chronic ulceration of the mucous membrane and osteonecrosis, especially with locally advanced tumor process affecting the lower jaw;
the possibility of developing dryness of the conjunctiva and cataracts, dysfunction of the pituitary gland and the development of necrosis in the central nervous system, if the dose of irradiation of the eyes, head and spinal cord exceeds the allowable.

Increasing the conformity of radiation therapy and dosimetric planning using CT allows you to reduce the exposure of normal tissues.

Surgery or Radiation Therapy?

For many tumors of the head and neck, the proportion of cured patients with surgical method treatment and radiation therapy is approximately the same. However, in some cases, radiation therapy is considered the treatment of choice.

Combination of surgery and radiotherapy

Massive tumors are usually treated with a combination surgery and radiation therapy. The goal of combined treatment is to minimize the risk of local recurrence.

The most significant factors indicating a high likelihood of recurrence and the need for radiation therapy are the following:

detection of tumor tissue at the border of the excised tissue;
germination of the capsule of the lymph node during histological examination;
compliance with the primary tumor category T 3-4;
spread of the tumor to the vessels or perineural spaces;
poorly differentiated tumor;
the defeat of the lymph nodes corresponding to category N 2 and above.

Treatment of metastases in the cervical lymph nodes

Possible following methods treatment.

Rgschalnaya radiation therapy. Suitable for lesions corresponding to category N 1, especially if the primary tumor is already being irradiated. Radiation therapy with a total focal dose of 60-65 Gy, carried out for 6 weeks, leads to the resorption of 90% of metastases corresponding to category I 1.
In a more advanced tumor process (category N 2-3 and a resectable primary tumor, the lymph nodes are excised. Prospective studies of the feasibility of subsequent adjuvant radiation therapy have not been performed, but, according to retrospective studies, it is justified if the risk of local recurrence is high.
With radical cervical lymphadenectomy, the superficial and deep sheets of the fascia of the neck are removed with the lymph nodes enclosed between them (levels I-V), as well as the sternocleidomastoid, scapular-hyoid muscles, and the internal and external muscles are resected. jugular veins, accessory nerve and remove the submandibular gland.
With a modified operation, especially important anatomical formations (for example, the accessory nerve) are preserved.
To intra- and postoperative complications cervical lymphadenectomy include the formation of hematoma, seroma, the development of lymphedema, suppuration of the wound, damage to the VII, X, XI, XII cranial nerves and carotid artery.
The value of prior sentinel lymph node evaluation and treatment of micrometastases is not yet clear.

Postoperative chemoradiotherapy

The results of two large randomized trials published in 2004 support the feasibility of postoperative chemoradiotherapy in selected high-risk patients after resection of head or neck squamous cell carcinoma. Cisplatin chemotherapy given concomitantly with radiotherapy reduced the recurrence rate and increased the relapse-free period, but overall survival was not improved by combined chemoradiotherapy. Moreover, the frequency of side effects increased by more than 2 times compared with their frequency with radiation therapy alone.

Treatment of locally advanced unresectable cancer

Chemoradiotherapy

More than 60% of patients with squamous cell carcinoma in the head or neck at the time of diagnosis corresponds to stage III / IV M0. In some of them, the tumor can be removed surgically, which, in combination with subsequent radiation therapy, provides a 5-year survival rate of 20-50% of patients. However, in many cases, surgical intervention is either not feasible or is associated with an unacceptable risk of complications (for example, with cancer of the base of the tongue, when glossectomy is fraught with loss of voice and impaired swallowing). In addition, surgical intervention may not be possible due to severe comorbidities.

After primary radiation therapy for head and neck tumors in stage III or IV, the 5-year survival rate is only 10-30%. In these patients, the combination of radiation therapy with chemotherapy allowed a slight increase in the effectiveness of treatment. Cisplatin monochemotherapy is currently the most widely used, although multi-drug combination chemotherapy is also used, which further improves survival. However, concomitant and combined therapy is accompanied by an increase in the frequency and severity of complications (for example, mucositis), it is justified only in patients with relatively satisfactory general condition who do not have serious comorbidities.

Biological treatments

Cetuximab (Erbitux) is a humanized mouse monoclonal antibody (chimeric antibody) for intravenous administration, binding to EGFR In many tumors of the head and neck, hyperexpression of this receptor is noted. The results of a recent comparative randomized study showed the following benefits complex therapy radiation and cetuximab (given weekly) for locally advanced squamous cell carcinoma:

increase in the median life expectancy of patients (from 28 to 54 months);
increase in 2-year survival (from 55 to 62%);
no increase in mucositis, although toxic skin reactions with radiation therapy in combination with the appointment of cetuximab began to occur more often.

Treatment of metastatic cancer

Chemotherapy

Some chemotherapy drugs, such as cisplatin, methotrexate, and bleomycin, show antitumor activity in advanced squamous cell carcinoma. The greatest effect is achieved with the combined administration of these drugs, although the survival rate does not increase. Nasopharyngeal cancer is especially sensitive to chemotherapy drugs, so improvement as a result of chemotherapy in this disease is noted in 70% of patients.

Chemotherapy can also be prescribed for disseminated and unresectable tumors of the salivary glands, usually sensitive to chemotherapy. Improvements in such cases are achieved in 50% of patients, although the effect lasts only a few months. The choice of drugs depends on the histological features of the tumor.

Long-term follow-up and prognosis of tumor (cancer) of the head and neck

Patients with tumors of the head and neck, who have undergone treatment, need observation, pursuing the following goals:

timely detection of local regional recurrence, as early treatment more effective;
identify new tumors, the frequency of which reaches 3-4% per year (generally 10-15%);
prescribe corrective therapy in the event of late complications.

Rehabilitation after a tumor (cancer) of the head and neck

Treatment of head and neck tumors in many patients in the long-term period is fraught with serious consequences up to disability. Patients often have to adapt to disfiguring changes in appearance and severe dysfunction.

Particular difficulties are associated with overcoming the following complications.

Speech disorders. Loss of voice is a serious injury after laryngectomy. Overcoming measures are as follows: 40% of patients acquire the skills to reproduce the esophageal voice; some patients successfully use artificial devices that replace the larynx; more and more often they resort to the imposition of a fistula into which a speech valve is inserted; during the entire period of rehabilitation, a speech therapist should also work with the patient; some patients turn to support groups or receive useful information and recommendations.
Respiratory care. Patients must learn to breathe through a stoma and learn how to remove secretions that accumulate in the airways if they have been separated from the esophagus. To prevent complications from the respiratory tract, it is desirable to use moisture and heat exchangers that can be installed in front of the stoma.
Sanitation of the oral cavity. Due to the frequent development of complications from the oral cavity, for example, after radiation therapy (caries, delayed healing of the tooth socket after its removal, the possibility of developing osteonecrosis), a dentist should monitor patients.
Food. Surgical intervention and radiation therapy can adversely affect the nutrition of patients, which may be associated with a violation of the act of swallowing, saliva secretion or taste perception. Therefore, it is very important that an experienced nutritionist also participate in the treatment.
Overcoming the psychological trauma associated with the disfigurement of appearance.
Persistent alcohol and nicotine addiction. Every effort should be made to help the patient stop smoking and drinking alcohol.

Intraocular tumors

Melanoma

Melanoma can develop in the choroid of the eye. The choroid is the most common localization of intraocular melanomas. A biopsy is not performed.

To clarify the diagnosis, the patient should be examined by an experienced ophthalmologist. The arsenal of treatment includes observation, application therapy with a ruthenium or iodine plate, resection, proton beam radiation therapy, enucleation.

Retinoblastoma

A rare tumor that affects children, the incidence is 1 case per 20,000 population.

The disease is hereditary and often affects both eyes.

Patients should be treated by ophthalmologists experienced in the treatment of retinoblastomas in specialized centers. A biopsy is not performed.

Treatment.

Small tumors growing near the macula or optic disc are treated with photocoagulation.
Small to medium-sized tumors are treated with iodine or ruthenium applicators.
For large and multiple tumors, remote therapy is used.
It may be necessary to irradiate the entire eye, it is necessary to try to preserve vision.
Sometimes if the tumor fills everything eyeball, you have to perform enucleation.
Retinoblastoma is also sensitive to chemotherapy drugs such as platinum derivatives, as well as etoposide, vincristine, doxorubicin, cyclophosphamide.
Chemotherapy is given when the prognosis is poor or as neo-adjuvant therapy.
Prognosis: 90% of patients survive, 80% of patients manage to save the eye.

Metastatic tumors

Metastatic tumors of the eye usually affect choroid eyes. Most often metastasize to the eye lung cancer and mammary gland. With the threat of loss of vision, treatment must be carried out immediately. Radiation therapy is usually prescribed.

The appearance of a tumor on the neck may signal the development a large number diseases different origin. If with right side swollen neck or on the left, it is important to urgently consult a doctor for help. An increase in lymph nodes in this area indicates the appearance of infectious diseases in the body. Treatment should be started as soon as the first signs of discomfort appear.

The appearance of swelling in any part of the body should immediately alert a person. The growth of tissues or organs in the body is in any case pathological condition. Find out the cause of the swelling and start treatment immediately.

Swelling in the neck occurs different reasons. Most often, the cause is an increase in lymphatic tissue or the thyroid gland. But there are other, more serious ones. More often, with such a problem, they turn to an oncologist. Only a doctor can determine the cause of the pathology after palpation or after various diagnostic studies.

Causes of swelling of the neck:

Diseases of the upper respiratory organs. The most common cause of a tumor in the neck is the onset of an inflammatory process in the throat or nasopharynx. For example, it happens sinusitis, tonsillitis, pharyngitis, otitis media, laryngitis and other diseases. Also, a factor in the formation of tumors is diseases of the teeth and gums. outflow pathogenic microorganisms occurs in this area, so there is a risk of developing a tumor process.
Benign formations. Swelling in the neck occurs due to inflammation of fatty tissue, the vascular system and nerves. In addition, there are inflammations in the organs.
Infectious diseases are one of the factors in the development of swelling (for example, influenza, mononucleosis, diphtheria or tuberculosis).
With injuries of the cervical region, swelling and swelling are often noted, which long time does not pass.
In case of violations of the thyroid gland, the appearance of goiter is noted. In especially severe cases, there is swelling on both sides of the neck. If nodular inflammation is noted, then in this case the tumor is noted only on one side.
During the development of malignant tumors, swelling in the neck is the most common sign of the onset of pathology. More often in this case, the presence of metastases is noted. Malignant tumors occur in any organ that is localized in the neck ( thyroid larynx, pharynx, trachea, or lymph nodes).
chronic malignant disease circulatory system- leukemia.

Symptoms of pathology depend on the origin of the neoplasm in the body. The main thing is to notice the disease in time and consult a doctor for help. Especially if the neoplasm has a malignant nature of occurrence.

How to determine the swelling on the neck?

Swelling of the neck is determined by palpation. If the swelling is too large, then it becomes visible to the naked eye. If the cause is a violation of the circulation of the lymphatic tissue, then the swelling is located on one side of the neck and when you press it, there is a feeling of pain or no sensation at all.

Such processes are easily distinguished from the development of a malignant tumor. In this case, there is no sharp decline weight and severe fatigue or deterioration of well-being.

If the swelling develops on the back of the spine, then this is due to a malfunction of the dorsal roots. Which is in no way associated with tumor neoplasms.

Necessary examinations will allow to exclude malignant or benign tumors. In children, swelling often occurs during the period of infectious diseases, when the lymphatic system begins to become inflamed.

Types of tumors on the neck benign cancer

The neck can swell for various reasons. Each type of formation in the neck is characterized distinctive features by which doctors recognize the disease during the examination.

There are several types of benign tumors in the neck:

Lipoma is a benign formation that consists of adipose tissue. The lipoma is located mainly behind the cervical region. At the initial stage, the lipoma does not manifest itself in any way, but gradually increases in size, thereby causing discomfort to the patient. Because of a lipoma, a person is tormented by insomnia, irritability and general malaise. The consistency of the lipoma is soft to the touch, smooth. When located on the right, there is a violation of hearing and speech activity. When pressed, the lipoma moves.
Papilloma belongs to oncological diseases of the hematopoietic system. Development is facilitated by the penetration of the papillomavirus into the body. The appearance of swelling is characterized, which eventually begins to become covered with a dark crust. Painful sensations does not occur. With mechanical damage to the papilloma, unpleasant painful sensations occur.
Neurinoma - localized anywhere in the cervical region, but always along the course of the nerve. More common in adults than in children. Symptoms are pronounced and characterized by general malaise, severe pain, the consistency of the neurinoma is firm, the surface is smooth and shiny. To accurately diagnose neuroma, a blood test is collected and other studies are performed. Only then is a diagnosis made.
Fibroma refers to benign formations that are formed from connective tissue. Fibroma is localized on the sides on the right or left. Fibroma is difficult to diagnose at an early stage because the symptoms vary. Fibroma is differentiated and nodular.

Only a doctor can diagnose this or that disease. As soon as the tumor is detected, you need to urgently consult a doctor for help.

Symptoms of tumors

Symptoms of inflammation when an infection enters the body can be different. The main thing is to notice their appearance in time and start therapy.

Symptoms of the disease:

Pain and sensation of the soft tissues of the tumor on palpation.
Change in the timbre of the voice or its complete disappearance.
Problems in swallowing and speaking.
Increase in the size of organs and soft tissues.
Painful sensations when turning the head to the sides.
Feelings of discomfort in the head and neck.
The appearance of swelling under the eyes, their redness and dryness.

The presence of all these symptoms indicates the beginning of the development of the inflammatory process in the body, the treatment of which cannot be delayed.

Diagnosis and treatment

Symptoms and signs of the appearance of tumors on the neck require immediate diagnosis and therapy. If it is a malignant tumor, then metastases spread very quickly throughout the body. If you do not start treatment in a timely manner, then in most cases it leads to death.

Diagnosis is limited to palpation, blood tests and taking biological material from the tumor. Next, the tumor sample is sent to cytological analysis and there reveal malignant or high-quality this education. Inflammation of the lymph nodes in the neck also needs immediate treatment.

Treatment includes surgery and subsequent conservative therapy to support a weakened body. If the tumor is caused by the appearance of a lipoma, then it is removed if it begins to grow strongly.

The sudden or gradual appearance of swelling or swelling in any part of the body should immediately alert the person. After all, the growth of organs or their parts is not the norm. A cause for concern is a swelling on the neck, which can be a symptom of many pathologies. Often, swelling of this part of the body is associated with an increase in lymph nodes or the thyroid gland. Less commonly, a tumor on the neck has a different origin. Regardless of why it appeared, it is urgent to consult a doctor. Most often, patients with such neoplasms are referred to an oncologist. After all, any swelling on the body may indicate the development of cancer. Nevertheless, you should not panic in advance, the first thing you need to do is see a doctor and undergo the necessary examinations.

Why does swelling appear on the neck?

Answer the question: "What are the symptoms, causes and treatment of a tumor on the neck?" only a specialist can. First of all, the doctor must determine what is the cause of the swelling. And also get information about the origin of the neoplasm. Hypertrophic changes in each organ located in this anatomical region can provoke a tumor in the neck. Symptoms also depend on the origin of the pathological protrusion. In most cases, to find out why swelling appeared, it is necessary to carry out. It consists in splitting off a piece of the tumor and examining it under a microscope. This method is necessary to determine the cellular composition of the formation. Thanks to such a study, you can find out what origin the tumor on the neck has, whether it is benign or malignant. Only after receiving answers to these questions, they begin to treat the disease.

Tumor on the neck: causes of appearance

Since there are several organs, vessels and nerves in the cervical region, the origin of the tumor may be different. Allocate the following reasons the appearance of a protrusion:

Inflammatory diseases of the ENT organs. Most often in acute or chronic pathologies throat, nose and ear nodes increase. This happens with pharyngitis, laryngitis, tonsillitis, sinusitis, otitis media, etc. After all, the outflow from all these organs is carried out to the lymph nodes of the neck. In addition, dental pathologies can become the cause of their hypertrophy.
Benign neoplasms of the neck. Among them, tumors of the skin and fatty tissue, blood vessels and nerves are most common. Also, benign neoplasms can be of organ origin.
Infectious diseases. These include mononucleosis, influenza, diphtheria. Also, an increase in lymph nodes is possible if they are affected by tuberculosis bacteria.
Neck injuries. In this case, there is a slight swelling or swelling of the skin.
Diseases of the thyroid gland. When the function of this organ is impaired, goiter often develops. In some cases, the neck is significantly thickened on both sides. Sometimes there is. Then there is a tumor on the neck on one side.
Malignant neoplasms. Cancer of any organ can cause the area to enlarge. Most often, metastases are found there. Also, the organs of the cervical region themselves (thyroid gland, larynx, trachea, pharynx, lymph nodes) can undergo malignant growth.
Leukemias are acute and chronic oncological diseases of the hematopoietic system.

Varieties of cervical tumors

As you can see, the etiology of neoplasms is very extensive. In this regard, there are many types of neck tumors. They are classified according to several criteria. The most important is the cellular composition of education. There is a malignant and benign tumor on the neck. The causes and origin of the neoplasm are not as important as the degree of cell differentiation. After all, the choice of treatment and the prognosis for life depend on it. Benign tumors of the neck include:

papillomas. They grow from the top layer of the skin.
Lipomas are benign formations consisting of adipose tissue.
Fibroids. Composed of fibrous connective tissue. Can be formed both from the tissues of the neck, and be organ tumors.
Neurofibromas.
Lymphangiomas.

Malignant tumors include cancer of any of the organs of the cervical region. The most common are lymphomas and Hodgkin's disease. In addition, thyroid and oral cancers are common. An increase in the neck can be observed both due to the growth of an organ malignant tumor, and due to metastasis to the lymph nodes. The second option is more common.

It should be remembered that not only neoplasms can cause swelling in the neck. Varieties of swelling also include inflammatory diseases of the lymph nodes. In most cases, they are caused by pathologies of the ENT organs. Less common is localized lymphadenitis, not associated with other diseases.

Tumor on the neck: symptoms

Symptoms depend on the cause and type of tumor. The most pronounced clinical picture observed in lymphadenitis. In diseases of the throat, symptoms such as pain on one or both sides, hyperemia of the tonsils, the appearance of pus, difficulty swallowing and fever are noted. At the same time, it is precisely the lymph node that is “responsible” for the affected organ that increases. On palpation, it is hypertrophied, not soldered to the surrounding tissues. There is local redness and fever over the lymph node.

With benign neoplasms of the neck area, symptoms are often absent. the only clinical sign is an increase in one of the sides. If hypertrophy is pronounced significantly, then symptoms of organ compression may occur. This is manifested by a change in voice, difficulty swallowing, unpleasant sensations tilting and turning the head.

Symptoms of cancerous tumors depend on the localization of the focus. Most often it is dysphagia, voice change, pain when eating. If a neck tumor arose as a result of metastasis, then symptoms of cancer intoxication are noted. These include subfebrile temperature, loss of appetite, decreased ability to work, deterioration.

Swelling on the neck of lymphoid origin

In most cases, neck tumors are of lymphoid origin. Such formations can be found in inflammatory diseases as well as in oncological pathologies. In any of these cases, it is necessary to undergo an examination. After all, an increase in lymph nodes can signal a variety of pathologies, each of which requires special approach to treatment. With multiple protrusions, one can suspect Hodgkin's disease - neck cancer. The tumor on the neck will be on both sides and in several places at once. With timely treatment, this disease has a favorable prognosis.

Neck tumors associated with thyroid disease

If a patient suffers from a thyroid disease for a long time and at the same time notes the appearance of a nodular formation, it is urgent to consult a doctor. A protrusion on the one hand is often associated with the growth of the tissue of the organ. Nonetheless nodular goiter can turn into cancer. That's why histological examination necessary in this case.

How do I diagnose neck tumors?

Swelling or swelling in the neck should be examined by an experienced specialist. Only he can determine which organ is affected. With inflammation of the lymph nodes, the diagnosis is limited to palpation. If the doctor suspects the presence of a neoplasm, it is necessary instrumental examination. It includes ultrasound of the thyroid gland, lymph node or other organs, tumor puncture. In some cases, biopsy and histological examination are indicated.

Differential Diagnosis

Distinguish inflammatory processes from oncological diseases possible due to palpation of the lymph nodes, accompanying symptoms and In the pathology of the thyroid gland, in addition to a tumor of the neck, there will be such clinical manifestations like sweating, exophthalmos, tachycardia, irritability. Benign tumors are diagnosed by ultrasound and biopsy.

Treatment

Treatment for a cervical tumor depends on the cause. At inflammatory pathologies throat prescribe antibacterial drugs(drugs "Amoxicillin", "Tsiprolet"), rinsing saline solution, decoction of chamomile. If the tumor is caused by an oncological process, combined treatment is necessary. In most cases, resort to surgical intervention, chemotherapy.