Vocal cord cancer: symptoms, diagnosis, treatment

Vocal cord cancer is the most dangerous malignant tumor that affects the tissues of the ligaments and affects their performance. It has a special degree of danger because the tumor is less aggressive than others in its spread and behavior. Until the last stage it does not affect other organs and tissues. The development process is extremely slow and in the early stages, vocal cord cancer has no symptoms and absolutely does not affect the patient’s quality of life. At the same time, advanced forms of the disease threaten the patient with loss of the ability to speak, swallow food and the likelihood of death.

Types

Determining the type of vocal cord cancer is necessary to identify the prospects for surgical intervention and the effectiveness of other treatment methods.

According to the types of cells that form the tumor, vocal cord cancer is:

spindle cell – belongs to the category of sarcoma-like tumors, as it develops quickly and behaves aggressively;
squamous cell carcinoma of the vocal cords is: keratinizing - occurs slowly, does not metastasize, is not aggressive, non-keratinizing - grows quickly, affects the lymph nodes and neighboring tissues;
undifferentiated – the most dangerous form, as it is extremely aggressive and practically untreatable.

There are also such types of oncology of the vocal cords as carcinoma, papilloma, chondroma and hemangioma.

Non-steroidal anti-inflammatory drugs in the treatment of sprains of ligaments, tendons and muscles

About the article

78947

Regular issues of "RMZh" No. 7 dated 04/09/2005 p. 411

Category: General articles

Author: Mavsisyants L.A.

For quotation:

Mavsisyants L.A. Non-steroidal anti-inflammatory drugs in the treatment of sprains of ligaments, tendons and muscles. RMJ. 2005;7:411.

Well-known American specialists John Pagliano and Doug Jackson conducted a large clinical study in order to determine the nature of various running injuries and the causes that cause them. Over the course of 10 years, they examined 3,273 injured runners of varying abilities, analyzed more than 40 characteristics of injured athletes (age, gender, body weight, conditions of injury, footwear, training methods, etc.) and identified common causes, characteristics and symptoms of injuries.

Injuries were categorized into “female” and “male.” Thus, in men the most common symptoms are: inflammation of the plantar aponeurosis, damage to the tendon-ligamentous apparatus, functional insufficiency of the knee joint; in women - inflammation of the periosteum, “runner’s knee” (chondromalacia). Runners over 40 are more prone to back and foot injuries. Here are some other trends identified: Low-volume runners (less than 20 miles (32 km) per week) were more likely to be injured, 46%; the majority of injured people (66%) used only long slow running, the remaining 34% included some form of speed work; almost every (90%) athlete regularly used stretching exercises before and after running; beginners (14%) were injured less often than those who had more than 6 years of running experience (38%); men were injured twice as often as women. Among all injuries, the authors identified the 10 most common and 5 reasons for their occurrence: 1) too much volume, intensity of training, rapid increase in load; 2) running on too hard, hilly or uneven surfaces; 3) weak, inflexible muscles; 4) Running in inappropriate shoes; 5) defects in the structure of the foot. Sprains of ligaments, tendons and muscles Damage to the tendon-ligamentous apparatus is one of the most relevant and common causes that limit the physical activity of people leading an active lifestyle. The main etiological factor is acute traumatic injury, called sprain, or excessive cyclic load for a long time - overexertion. Sprains of ligaments, tendons and muscles are acute and traumatic due to damage. There are three degrees of severity of a sprain: Grade I – mild pain due to the tearing of several fibers of the ligament. Grade II – moderate pain, swelling and disability. III degree – severe pain due to ligament rupture and subsequent instability of the joint. A muscle strain, in turn, is a traumatic injury to the muscle fibers themselves or the connection between muscle and tendon and is also classified into three degrees of severity: I - moderate. II – moderate degree of damage, associated with weakness of the affected muscle and its painful contraction. III - complete rupture of the connection between muscle and tendon, manifested by severe pain and the inability to contract the damaged muscle. Overstrain is a non-acute, repeated damage to soft tissue structures due to constantly occurring microtraumas, which leads to changes in local microcirculation and, as a consequence, to degenerative processes in soft tissues, where microscopy shows a disruption of the structure of local tissues with their lysis, leukocyte infiltration and extravasation of blood . Repetitive movements during long-term work lead to “overuse” damage in some occupations. Approximately 10–20% of musicians, typists, cashiers and assembly line workers complain of relapses of sprain syndrome; among athletes, this percentage ranges from 30 to 50. Damage due to overexertion (overtraining) is divided into four degrees: I degree - pain only after physical activity . II degree – pain during and after physical activity, which does not affect the result of work. III degree – pain during and after physical activity, affecting the result of work. IV degree – constant pain that interferes with daily physical activity. It should also be noted that damage to the tendon apparatus can occur in the form of “tendonitis,” “tendinosis,” and “tenosynovitis.” Tendinitis occurs due to tendon injury and associated vascular destruction and acute, subacute or chronic inflammation. Tendinosis is a non-inflammatory atrophy and degeneration of fibers within a tendon, often associated with chronic tendinitis, which can lead to partial or complete rupture of the tendon. Tenosynovitis is an inflammation of the paratendon, which is the outer sheath of some tendons and is lined with a synovial membrane. We will focus on stress injuries caused by frequently repeated monotonous movements, that is, overexertion, and will also try to take into account mild degrees of sprain of ligaments, tendons and muscles, since injury accompanied by rupture of these structures in most cases requires surgical treatment (damage to the anterior cruciate ligament and collateral ligaments of the knee joint, rupture of the Achilles tendon). Types of damage: The most common types of damage due to overexertion (overtraining): – iliotibial tract friction syndrome, “jumper’s knee”, plantar fasciitis; – tendons – Achilles tendinitis, suprapatellar tendinitis, tibialis posterior tendinitis. Iliotibial tract friction syndrome (ITIS) is pain along the lateral aspect of the knee due to irritation and inflammation of the distal iliotibial tract as it passes over the lateral femoral condyle. The pain intensifies with palpation of the distal part of the tract at the moment of extension of the leg at the knee joint. STI occurs when running too intensely or running over rough terrain. “Jumper's knee” is the so-called patellar tendinitis. Often found in high jumpers, basketball and volleyball players, and runners. It is characterized by pain in the lower pole of the patella, at the site of attachment of the patellar ligament. It develops due to constant damage to this area when the injury does not recover and heal. Patellar bursitis is accompanied by pain, swelling and a local increase in temperature in the patellar bursa, which is located superficial to the patella. Bursitis is caused by repeated trauma or stress, such as kneeling. Inflammation of the Achilles tendon manifests itself as pain in the heel, sometimes pain along the back of the leg. Dorsal and plantar flexion of the foot increases pain, the area of greatest pain is 2-3 cm proximal to the junction of the tendon with the calcaneus. The tendon may be swollen and thickened, most often caused by spondyloarthropathy affecting peripheral joints (Reiter's disease, ankylosing spondylitis), as well as trauma. Plantar fasciitis or heel spur anatomically arises from the insertion of the flexor digitorum brevis muscle, which is localized along the anteromedial edge of the tuberosity of the calcaneus, slightly deeper than the insertion of the plantar fascia. Overexertion of one of these structures is thought to result in reactive inflammatory bone production or spur formation secondary to traction on these structures. However, it remains unclear which mechanism is responsible for this. In any case, the spur is secondary to overexertion. Also worth mentioning is shin splints, an overtraining injury caused by chronic traction on the periosteum of the tibia. In this case, either the tibial muscles or m. soleus, which is characterized by gradually onset pain along the anteromedial or posteromedial surface of the leg. Pain occurs in athletes at the start of the race, subsides during the run and intensifies again after the end of the race. On palpation, tenderness is detected along the posteromedial edge of the tibia, usually at the border of the middle and lower third. The pain intensifies with dorsal flexion of the foot against resistance. Treatment Primary therapy: • Weight-bearing protection • Rest • Ice • Pressure bandage • Elevation • Bandage support Secondary therapy • Physical therapy • Rehabilitation • Injections • Exercise therapy • Examination and re-examination • Salicylates The mainstay of treatment is early pain relief and anti-inflammatory therapy for soft tissue injury , especially in cases of concomitant myositis. Long-term inflammation impairs the healing process of soft tissues, which leads to their detraining and functional failure. With an active inflammatory process, relative rest for the affected area is important. Ice is effective as an anti-inflammatory agent only in the first hours after injury, then heat is preferable. Immobilization with a splint or bandage can be used to enhance protection of the injured limb or part of it from stress. Corticosteroid injections for chronic processes do not provide a complete cure; moreover, they increase the rate of collagen degradation, reduce the synthesis of new collagen, and reduce the tensile strength of the tendon, which leads to its rupture if injections are performed incorrectly or very often. In this regard, their use is justified only in the acute period and no more than once every 2–3 weeks. It is also necessary to use non-steroidal anti-inflammatory drugs (NSAIDs) per os. Their long-term use is recommended for chronic conditions of overstrain; for acute injury, they are effective for 72 hours. An effective method for treating traumatic injuries of soft tissue is local therapy using ointments and gels containing NSAIDs. A well-proven NSAID drug is Nurofen Plus. This is a combination drug, the effect of which is due to the effects of its constituent components ibuprofen (200 mg) and codeine phosphate (12.8 mg). Both active principles of the drug are well known and have been used in clinical practice for a long time. Their combination provides both central and peripheral effects. Ibuprofen is an NSAID, a derivative of phenylpropionic acid. Ibuprofen is widely used throughout the world, and in the last decade has become the standard against which the effectiveness and tolerability of other analgesics are compared. It has analgesic, antipyretic and anti-inflammatory effects. The excellent safety profile made it possible to distinguish ibuprofen from a number of other drugs in this group and give it the status of an over-the-counter drug. The main mechanism of action of ibuprofen is to inhibit the synthesis of prostaglandins, which leads to an increase in the pain sensitivity threshold of afferent nerve fiber receptors in relation to the corresponding mediators (histamine, substance P, serotonin, bradykinin). In addition, according to experimental studies, ibuprofen inhibits the migration of leukocytes from the bloodstream into damaged tissues. Codeine phosphate is an opium alkaloid of the phenanthrene series, an opioid receptor agonist. It has an analgesic effect; when used together with ibuprofen, it enhances its analgesic effect. Codeine, unlike ibuprofen, has a central effect. It is able to weakly bind opioid receptors, and some of it is converted into morphine. In addition, codeine inhibits the release of substance P, a neuropeptide that lowers the pain threshold. Codeine is rapidly absorbed from the gastrointestinal tract, after which it is largely metabolized in the liver. Approximately 10% of the ingested dose is converted to morphine and excreted in the urine. Composition and release form: Film-coated tablets 1 tablet. Ibuprofen 200 mg Codeine (in the form of codeine phosphate hemihydrate) 10 mg Excipients: MCC; sodium starch glycolate; hypromellose; povidone; pregelatinized corn starch. For adults and children over 12 years of age, the drug is prescribed 1–2 tablets. every 4–6 hours. The maximum daily dose is 6 tablets. The tablets should be taken with water. Nurofen in tablets and capsules has already received recognition from Russian specialists and consumers due to its high efficiency and quality. Now Nurofen gel is in great demand. The active substance of the gel, like all Nurofen products, is ibuprofen. When applied, Nurofen gel is instantly absorbed and begins to act, eliminating inflammation and pain. Clinical trials have demonstrated the high efficiency and rapidity of the therapeutic effect of Nurofen gel. Thanks to its light, pleasant texture, it is very convenient to use, as it leaves no marks on clothes and has virtually no odor. Nurofen gel is used not only for joint pain, bruises, sprains and sports injuries, but also for back pain. Release form: 50 g tube. Conclusions Injuries to the musculoskeletal system are common. And in the scheme of their treatment, NSAIDs play an important role (both per os and locally). Among this group, the drug Nurofen occupies a special place. Today it is represented in more than 120 countries and is effectively used in the treatment of various types of pain and fever by millions of people. Nurofen appeared in Russia in 1997, and quickly became one of the leading brands in the market of painkillers and antipyretics. Nurofen Plus provides targeted dual action against severe pain thanks to the appearance in Russia of the only combination of two substances - ibuprofen and codeine. It has been clinically proven that Nurofen Plus has the effectiveness and targeted action of ibuprofen and the additional benefit of codeine, which has a pronounced general analgesic effect. Nurofen gel acts directly at the site of severe pain. The use of modern topical preparations, such as Nurofen Plus and Nurofen gel, is an effective method of relieving pain and accompanying inflammation in case of traumatic injury to the tendon-ligamentous apparatus, which contributes to the rapid restoration of physical activity and improves the quality of life of patients.

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Factors provoking the disease

Vocal cord cancer is a fairly rare disease. It occurs more often in men, and older people are more susceptible to it than young people. Factors causing the development of vocal cord cancer:

polluted air, often due to living in a big city;
severe overstrain of the ligaments of a regular nature;
smoking and excessive alcohol consumption;
heredity;
excessive consumption of very hot or spicy foods;
suffered thermal or chemical burns;
regular contact with heavy metals, radioactive substances, asbestos or arsenic.

Some diseases of the mucous membrane lead to the appearance of cancer of the vocal cords:

human papillomavirus;
defect in the development of mucosal tissue;
chronic inflammation in the throat, for example, laryngitis;
severe inflammation;
infectious diseases, such as tuberculosis or syphilis;
pathologies of the mucous membrane of various nature;
change in the structure of the upper layer of ligaments, for example, keratinization or destruction.

Stages

To select the optimal therapy, it is necessary to correctly determine the stage of the disease:

1 – characterized by the absence of any signs, looks like a small ulcer and does not grow;
2 - characterized by initial growth and penetration into neighboring tissues, due to which the speed of the vocal tissues slows down, and the voice becomes hoarse and hoarse;
stage 3 vocal cord cancer – the tumor covers the entire larynx, the vocal cords cease to be mobile;
Stage 4 vocal cord cancer – a person is unable to utter a single sound, migration occurs to nearby organs: the thyroid gland, sternum, carotid artery and spinal canal.

Pathogenesis

The shoulder joint consists of the glenoid cavity located on the scapula and the head of the humerus. The socket is shallow; the spherical head is held in place by the ligaments and tendons that form the rotator cuff. The cuff includes the tendons of the teres minor, infraspinatus, supraspinatus and subscapularis muscles, which are attached to the lesser and greater tuberosities of the humerus. The tendon of the long head of the biceps runs between the tubercles.

With intense loads and injuries to the joint, the rotator cuff is injured by the coracoacromial ligament, the anterior edge of the acromion, or the acromioclavicular joint. As a rule, inflammation begins with the supraspinatus tendon and then spreads to surrounding tissues. Pain and restrictions of movement lead to the formation of adhesions.

Reference! The outcome of the inflammatory process is degeneration (thinning) of the tendons, a decrease in strength, which leads to micro-tears.

With immobilization, violations of rehabilitation rules and cervical osteochondrosis, the mechanism of occurrence of the pathology is somewhat different. Due to immobility, insufficient blood flows to the periarticular tissues; nutritional deficiency leads to degeneration and thinning.

Symptoms

In the initial stages, the disease does not manifest itself in any way, except for a slight dryness in the throat and a slight burning sensation. Further, as the disease progresses, hoarseness, hoarseness and difficulty pronouncing sounds appear. Symptoms of vocal cord cancer in women are more severe than symptoms of vocal cord cancer in men.

In the second stage, the symptoms of vocal cord cancer are as follows: dry cough without a cold, pain during swallowing and when moving the cords, lump in the throat, weight loss, weak breathing.

Signs of vocal cord cancer at stage 3 are an unpleasant rotten smell from the breath, severe enlargement of lymph nodes and lymphatic channels, blood when coughing up, constant aching pain in the throat, worsening at night.

How stage 4 vocal cord cancer manifests itself - constant and rapid fatigue, general weakness, high temperature and other signs of intoxication of the body.

Symptoms of vocal cord cancer in men who are addicted to nicotine or regularly drink strong alcohol appear much earlier and are more pronounced.

Contacting specialists

In the oncology center, located in the center of Moscow (next to the Mayakovskaya metro station), patients will be provided with the necessary medical care by highly qualified oncologists and psychologists. Here we are ready to offer you the most modern diagnostic methods - MRI, CT, SPECT, PET, radiography, fluoroscopy, ultrasound, laboratory tests. Prognosis for vocal cord cancer depends on the stage at which the disease is detected.

Symptoms of tendon pain

Symptoms of tendon pain can vary in intensity and manifestations . Soreness in the tendons can increase gradually, or it can begin suddenly. Typically, the pain in the tendons is severe, causes discomfort when moving, and the mobility of the limb is impaired (damage to the biceps tendon, calcaneal tendon), when performing various physical activities (for example, an athlete who received an injury to the heel tendon (“Achilles tendon”) may experience pain when running. feel severe pain in the injured area). Pain in the tendons is especially severe in the presence of calcium deposits.

Gradually, the pain in the tendons may intensify, or, conversely, subside (as the microtrauma heals).

Diagnostic measures

The step-by-step diagram of diagnostic measures for vocal cord cancer is as follows:

consultation with an otolaryngologist - visual examination, palpation, examination of the throat using a mirror and a flexible laryngoscope;
endoscopic examination allows us to examine keratinized cells of squamous cell carcinoma of the vocal cords;
histological and biochemical analysis of neoplasm cells;
biopsy from the area of compaction;
MRI and radiography;
Oncotest is a specific blood test.

Causes of tendon pain

The causes of tendon pain are:

Frequent, intense physical activity;
Insufficient stretching before exercise;
Injuries leading to tendon damage;
Incorrect posture;
Diseases such as: rheumatoid arthritis, gout, psoriatic arthritis

The above reasons often lead to the development of the following diseases, which also provoke pain in the tendons:

Tendinosis (causes pain in the tendon due to partial or complete tearing).
Tenosynovitis (inflammatory damage to the connective tissue membranes that surround the tendon).
Tendonitis (inflammation of the tendon, which is also accompanied by severe pain).

Fighting methods

The type of treatment for vocal cord cancer depends on the stage of the disease, age and individual contraindications. In this case, it is very important to prescribe adequate therapy. The goal of treatment for vocal cord cancer is to destroy the cancer cells as much as possible and preserve the functioning of the larynx.

Complex therapy includes the following methods of treatment for vocal cord cancer:

Radiation therapy for vocal cord cancer is radiation exposure of atypical cells, which is carried out both from the inside and from the outside. Recently it has acquired a targeted nature, which has increased its effectiveness;
chemotherapy - the destruction of atypical cells with drugs before and after surgery, after radiation therapy in order to reduce the affected area. It has many side effects - hair loss, nausea, weakness and others;
Surgery for vocal cord cancer is the main treatment method for this type of cancer.

After treatment for vocal cord cancer, a period of long-term rehabilitation begins - adaptation to new living conditions and restoration of speech.

Shock wave therapy: mechanisms of therapeutic effects

According to physical properties, a shock wave is a sound pulse with high pressure (up to 20 MPa). A generator located extracorporeally (that is, outside the human body) emits such a wave in a short period of time (1 microsecond).

In the human body, shock waves cause the following changes:

blood vessels dilate;
the formation of new capillaries is stimulated;
cell permeability to drugs improves;
compactions (fibrous and scar tissue) are softened and bone growths are loosened;
the effect on nerve endings leads to the release of endorphins, which helps relieve pain.

The complex effect of shockwave therapy is to reduce the intensity of inflammation, accelerate the processes of regeneration and tissue repair.