喉癌

病因(etiology)
No definite causes known, possible risk factors
1. 吸烟(tobacco use)饮酒(alcohol) 2. 化学因素（chemical factors)空气污染(air
pollution) 生产性粉尘、废气 3. 病毒感染（HPV）
Supraglottic carcinoma: More aggressive than the glottic carcinoma Metastasis earlier and readily (35%) Readily invades the preepiglottic space, but rarely involves the true cords, rarely
图X3、P9
治疗(treatment)：
原发灶以手术、放疗为主，可单独或联 合使用。（体积＜1cm者单独放疗，尤其 是声带癌。
4. 癌前期病变(precancerous lesions)
5. 性激素及其受体(hormone, receptor)
6. Radiation 7、微量元素 Zn Se
病理(Pathology)
鳞状细胞癌占95%左右，且多为分化好的 Ⅰ~Ⅱ级。 Squamous cell carcinoma 95%(usually moderately to well differentiated), Adenocarcinoma very rare, 2% Sarcoma, extremely rare, mainly in young
direct spread to the thyroid gland Prognosis is the worst in three type
颈淋巴转移 (cervical metastases )
淋巴图
喉癌的三种类型 (three types of laryngeal
carcinoma)
诊断(diagnosis)
分型（Classification）
声门区癌：glottic, the commonest type (60-70%)
声门上型: supraglottic, mainly on the epiglottis, next common (30-40%)
声门下型: subglottic, rare, less than 5%
fibre laryngoscopy) 喉部有无肿块、溃 疡、结节、双声带和 披裂运动情况、声带与室带是否对称、 喉室是否空虚。
特别要注意会厌喉面、前联合、喉室及 声门下区
⑶影象学检查： 颈侧位照片 喉CT扫描或MRI
⑷ 活检：(biopsy) 确定肿瘤性质 是诊断的依据
鉴别诊断 (differentiate diagnosis)
喉癌
（Carcinoma of larynx）
耳鼻咽喉-头颈外科 贺湘波
概述Baidu Nhomakorabeaoutline)
Epidemiology: 1-5% of all carcinoma 15-20% of head and neck cancers 80% in 50-70 year-old age group A high incidence in men and smokers A high incidence in north-east China
1、症状（symptoms)：声嘶 (hoarseness)，呼吸困难（dyspnea)， 咽喉疼痛(sore throat and dysphagea)， 咳嗽（cough ) 尤其是40岁以上男性。
2、颈部视诊与触诊 (palpation in neck)、 喉外形 颈部淋巴结
★3、喉镜检查(indirect laryngoscopy
临床特点（Clinical features）
Glottic carcinoma: Usually unilateral true cord, Early hoarseness Cord fixation and laryngeal obstruction in late cancers No neck node metastasis in early tumors Prognosis is much better
Subglottic carcinoma: Hard to find in early stage May be subglottic extension of glottic cancer Often seen initially as airway obstruction with stridor in late stage Early metastasis to paratracheal nodes and
with early hoarseness Asymptomatic until a large tumor causes painful dysphagia, dyspnea and a metastatic neck node Prognosis is worse than glottic carcinoma
喉结核(tuberculosis of larynx)： 主要症状为声嘶与剧烈喉痛。
检查见喉部粘膜苍白水肿，有 浅溃疡和分泌物， 多患有肺结核。 确诊靠病理学检查。
喉乳头状瘤(papilloma of larynx)： 症状：声嘶，病程长。 成人者多为单个带蒂，且发展慢。 儿童则多为多发、复发、发展较快。 肿瘤呈乳头状突起、声带运动好（病 变仅在粘膜层。） 多次复发的成人喉乳头状瘤要警惕癌变
症状和体征 (symptoms and signs)
声嘶(hoarseness)， 呼吸困难（dyspnea)， 咽喉疼痛(sore throat and dysphagia)， 咳嗽（cough), 咽喉异物感(a feeling of something foreign
in the throat) 痰血