Principles of early diagnosis of oncological pathology of ENT organs. Malignant tumors of ENT organs Oncological ENT diseases

21.10.2019 -

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GBOU VPO TSMU

Ministry of Health Russian Federation

Department of Ophthalmology and Otorhinolaryngology

Abstract on the topic

"Benign neoplasms of ENT organs"

Vladivostok, 2015

Benign tumors of the nose and paranasal sinuses

Benign tumors of the nose and paranasal sinuses include papillomas, fibromas, angiomas, chondromas and osteomas, neuromas, nevi (pigment tumors), and warts.

Papilloma is a relatively rare tumor equally often detected in men and women aged 50 years, but it also occurs in more early age. There are mushroom-shaped, inverted and transitional cell papillomas. The mushroom-shaped form is localized on the threshold of the nose (septum of the nose, bottom, inner surface of the wings of the nose) and along appearance recalls cauliflower. Inverted and transitional cell papillomas originate from the mucous membrane of deeply located parts of the nasal cavity, more often located on the side wall. The surface of such a tumor is smooth, and upon examination, the neoplasm can be mistaken for an ordinary polyp. The last two types of papilloma are capable of destroying soft tissues and bone walls, penetrating into the paranasal sinuses and even beyond them. Inverted and transitional cell papillomas are prone to malignancy, which is observed in 4-5% of patients. There is an opinion that malignancy benign tumors, including papillomas, contributes to irradiation

Surgical treatment. After removal of the mushroom papilloma, cryotherapy or electrocoagulation of the original site of the tumor is performed. Inverted and transitional cell papillomas are removed using the Denker approach and, if necessary, the Moore approach, while one should strive to complete removal tumors.

Vascular tumors of the nasal cavity (capillary and cavernous hemangiomas, lymphangiomas) are relatively rare; They grow slowly, bleed periodically, gradually increase and can fill the nasal cavity, germinate in the ethmoid labyrinth, orbit and maxillary sinus, more often they look like a rounded tuberous cyanotic tumor. It should be borne in mind that hemangiomas located on the lateral wall of the nasal cavity have an increased tendency to malignancy. Surgical treatment - removal of the tumor along with the underlying mucous membrane.

Osteoma is a benign tumor that originates from bone tissue and is characterized by slow growth. More often located in the frontal sinuses and the ethmoid bone, less often in the maxillary sinuses.

Osteomas of small size often go unnoticed and are found incidentally on the x-ray of the paranasal sinuses. In the absence of functional, cosmetic and other disorders, there is no reason for immediate surgical treatment osteomas.

In this case, long-term observation is carried out; a noticeable growth of the osteoma is an indication for its removal. It should be noted that sometimes small osteomas, especially on the cerebral wall of the frontal sinus, are the cause of persistent headache. After exclusion of other causes of such a headache, removal of such an osteoma is indicated. Sometimes osteomas reach large sizes, can spread into the cranial cavity, orbit, deform the facial skeleton and cause brain disorders, headache, decreased vision, impaired nasal breathing and smell. The treatment is surgical, a radical operation is performed on the frontal sinus with the removal of the neoplasm. Osteomas of medium and large sizes, even in the absence of severe symptoms, must be removed.

Benign tumors of the pharynx

The most common are papilloma, juvenile (juvenile) angiofibroma and angioma.

Papillomas are usually soft, more often located on the palate and palatine arches, sometimes on the back or side walls of the pharynx and the lingual surface of the epiglottis, and usually disturb the patient a little. Have characteristic appearance: Greyish-pink, broad-based or pedunculated.

Diagnosis based on the appearance of the tumor and histological findings is not difficult.

Treatment consists in the removal of single papillomas followed by galvanocaustics; possible cryoinfluence on areas of papillomatous degeneration. Sometimes papillomas are removed using an ultrasonic disintegrator, a surgical laser. With recurrence of papillomas, repeated removal is indicated, after which 30% prospidin ointment is applied to the wound surface daily for 10-15 days.

Juvenile (juvenile) angiofibroma - a tumor of the nasopharynx, emanating from its dome or the region of the pterygopalatine fossa, according to histological structure having a benign character, however, according to the clinical course (destructive growth, severe bleeding, frequent relapses after surgery, germination in the paranasal sinuses and even in the cranial cavity) manifesting itself as a malignant formation.

Angiofibroma occurs most often in young men aged 10-18 years. therefore it is called youthful; after 20 years, it usually undergoes a reverse development. It is believed that fibroma of the nasopharynx arises from abnormally laced in embryonic period remnants of mesenchymal tissue in the nasopharynx. The fibroma stroma consists of a variety of connective tissue fibers and very a large number blood vessels. The source of tumor growth can be the body of the sphenoid bone, the pharyngeal-basic fascia and the posterior cells of the ethmoid bone - this is a sphenoethmoid type of fibroma. From here, the tumor can grow into the ethmoid labyrinth, sphenoid sinus, nasal cavity, orbit and maxillary sinus. If the tumor grows from the region of the nasopharynx, then this is the basal type of fibroma, it can grow towards the oropharynx. When a fibroma starts from an area pterygoid process in the sphenoid bone, it belongs to the pterygoomaxillary type of tumor and can grow into the retromaxillary space, pterygopalatine fossa, inside the skull, orbit, and nasal cavity. In accordance with the direction of fibroma growth, an asymmetry of the type occurs, the surrounding bone and soft tissues are compressed and deformed, which can lead to displacement eyeball, impaired blood supply to various parts of the brain, compression of nerve formations.

The clinical picture depends on the stage of the spread of the process. AT practical work The following classification of juvenile angiofibromas is convenient (Pogosov V.S. et al. 1987):

Stage I tumor occupies the nasopharynx and (or) the nasal cavity, there is no bone destruction;

Stage II tumor corresponds to stage I, spreads into the pterygoid fossa, paranasal sinuses, bone destruction is possible;

III stage the tumor spreads to the orbit, the brain;

Stage IV tumor corresponds to stage III, but extends into the cavernous sinus, optic chiasm, and pituitary fossa.

At the beginning of the disease, the patient notes a slight difficulty in nasal breathing, sore throat, minor catarrhal phenomena. In the future, breathing through one half of the nose completely stops and becomes difficult through the other, the sense of smell is disturbed, nasality appears, the voice changes, the face takes on the appearance of an adenoid. The most severe and common symptom is recurrent nosebleeds, causing anemia and weakening of the body. The tumor may be accompanied purulent sinusitis and otitis media, which makes timely diagnosis difficult.

With anterior and posterior rhinoscopy, one can see a rounded, smooth or bumpy tumor of a bright red color, dense with a finger examination or when palpated with a probe. Fibroma usually fills the nasopharynx and may hang down into the middle part of the pharynx. On palpation, the tumor can bleed profusely, its base is determined in upper section nasopharynx.

Diagnostics. It is carried out on the basis of the noted symptoms, taking into account the data of endoscopic (including using a fibroendoscope), radiological, and in some cases angiographic examination. In determining the spread of the tumor process, the decisive role belongs to computed tomography and nuclear magnetic resonance imaging. Juvenile angiofibroma should be differentiated from adenoids, choanal polyp, papilloma, sarcoma, cancerous tumor, adenoma. The final diagnosis is established on the basis of a biopsy, which presents certain difficulties and should be performed only in an ENT hospital. where there are all conditions to stop bleeding.

Treatment is only surgical and, if possible, radical, since relapses are possible. Considering fast growth tumors, surgery should be performed as soon as possible. The intervention is performed under anesthesia; surgical approaches are endooral, endonasal and transmaxillary. Modifications can be used radical surgery according to Moore, Denker. During surgery, there is usually heavy bleeding necessitating a massive blood transfusion. Before removing the tumor, the external carotid artery is often ligated, which significantly reduces blood loss. AT recent times removal of angiofibroma is performed using endoscopic methods, which significantly reduces the morbidity of the operation

AT postoperative period infusion, hemostatic, antibacterial therapy is prescribed; if necessary, radiation remote gamma therapy. In VTEK at the place of residence, a disability group is issued in inoperable cases

The prognosis for timely removal of the tumor is favorable.

nose pharynx ear papilloma

Benign tumors of the larynx

Among benign tumors of the larynx, the most common are papillomas and vascular tumors.

Papilloma is a benign fibroepithelial tumor of the upper respiratory tract, which is a single or more often multiple papillary outgrowths, leading to a violation of the voice and respiratory functions often recurrent.

The etiological factor of papillomatosis is the human papillomavirus from the papovavirus family. Currently, more than 70 types of this virus have been identified, however, with papillomatosis, types 6, 11, or a combination of them are more often found. The disease occurs in children under 10 years of age, but most often at 2-5 years of age. Papilloma, like a number of other benign tumors, grows unevenly: periods of intensive growth are replaced by periods of relative calm. At puberty, there is often a cessation of growth of papillomas, however, if the tumor persists in an adult, then the probability of its malignancy increases sharply and amounts to 15-20%.

Histologically, papillomas consist of a connective tissue stroma and a multilayer squamous epithelium, clearly separated from each other by the basement membrane. Depending on quantity connective tissue in the stroma of the tumor, hard and soft papillomas are distinguished. Papillomas usually have a wide base and occasionally a small stalk. They are most often localized in the region of the commissure and the anterior third of the vocal folds. From the middle section, papillomatosis can spread to the entire larynx and beyond. In shape and appearance, the surface of the papilloma resembles a mulberry or cauliflower, the color is usually pale pink, sometimes with a grayish tint.

The main symptoms of the disease are hoarseness, reaching aphonia, and a gradual difficulty in breathing, which can turn into suffocation as a result of obstruction of the lumen of the larynx by a tumor.

Diagnostics. Based on characteristic endoscopic appearance and histological findings biopsy material. Examination and manipulations in the larynx in children are performed under anesthesia with direct laryngoscopy in adults, the main method of examination is indirect laryngoscopy. Currently, a highly informative method for examining the larynx is microlaryngoscopy.

Treatment. Papillomas can be removed in adults under local anesthesia endolaryngeally with indirect laryngoscopy, in children - always under anesthesia using direct endomicrolaryngoscopy followed by histological examination. Sometimes, when all parts of the larynx are affected, it is not possible to completely remove the tumor at a time, so the intervention is performed in several stages. It is necessary to strive for timely intervention in the larynx before the need for a tracheostomy arises, since tracheal cannulation contributes to the spread of papillomas to the trachea and even bronchi.

Ultrasonic disintegration of papillomas, as well as laser photodestruction, for which a surgical CO2 laser, YAG neodymium and YAG holmium lasers are used, turned out to be effective. The high accuracy of the laser beam, the possibility of removing papillomas from hard-to-reach parts of the larynx, low bleeding, and a good functional effect were noted.

In order to reduce the recurrence of papillomatosis, a rather significant arsenal is used medicinal products: prospididia intramuscularly, intravenously and locally in the form of an ointment: interferon preparations (reaferon, viferon, intron-A); leukomax, saveron (acyclovir), discrete plasmapheresis, etc.

Angioma is a benign vascular tumor of the larynx, formed from dilated blood (hemangiomas) or lymphatic (lymphangiomas) vessels, localized on the surface of the vocal, vestibular or aryepiglottic folds.

Angioma grows slowly, is usually single, small in size. The color of the hemangioma is cyanotic or red; lymphangioma has a pale yellow color. Hemangiomas can be diffuse or encapsulated.

Clinical manifestations of angioma depend on the location and extent of the tumor. When localized in the upper part of the larynx, the sensation of a foreign body, sometimes coughing, is disturbing. Gradually, over several years, the symptoms increase, hoarseness, soreness, and then an admixture of blood in the sputum appear. If the tumor comes from the vocal fold, then the first symptom is a gradual change in voice from slight weakness to aphonia. Respiratory failure is characteristic of large tumors emanating from the lower larynx.

Treatment of angiomas is surgical, more often performed by endolaryngeal access. The possibility of intraoperative bleeding should be considered. Widespread hemangiomas are removed by external access with preliminary tracheostomy.

benign tumors of the ear

Among benign neoplasms external vxa rarely occurs papilloma - a tumor of epithelial origin, usually located on the skin of the external auditory canal and on the auricle. Papilloma grows slowly, rarely reaches large sizes. Surgical treatment, diathermocoagulation, cryo- or laser destruction.

The osteoma is located in bone department external auditory canal, develops from a compact layer of the back, less often the upper or bottom walls. It can be in the form of exostosis on a thin stalk, the recognition and removal of which is usually not difficult. In other cases, it is hyperostosis, which has a wide flat base, partially or completely covering the lumen of the external auditory canal: sometimes hyperostosis is located in the annulus tympanicus region and even extends to the walls of the tympanic cavity. In these cases it surgical removal carried out behind the ear access Possible endophytic growth of the osteoma in the thickness of the mastoid process.

Hemangioma in the ear area is rare. Predominantly cavernous encapsulated capillary (superficial and deep), branched (arterial and venous) hemangiomas are observed. Hemangiomas can be localized in any part of the ear, but more often they occur in the outer ear. Vascular tumors of the middle ear grow slowly, can destroy surrounding tissues and go far beyond the ear. Some of them may ulcerate and be accompanied by intense bleeding. Surgical treatment.

Of the benign tumors of the middle ear, chemodectoma deserves attention, developing from glomus bodies contained in the mucous membrane of the tympanic cavity and located along nerve fibers and vessels. Glomus accumulations are localized in the adventitia of the superior bulb of the internal jugular vein and the thickness of the pyramid temporal bone. If a chemodectoma develops from the glomus bodies of the tympanic cavity, then subjectively it is already on early stage manifested by pulsating noise in the ear and hearing loss; these symptoms are rapidly increasing. As the chemodectoma grows, it gradually fills the middle ho and shines through eardrum, then it can destroy it and appear in the form of a bright red polyp in the external auditory canal. It should be noted that initial signs hemangiomas and chemodectomas of the tympanic cavity are similar in many respects, however, with hemangiomas, bleeding from the ear is noted, they are not typical for chemodectomas. Tumors can destroy the bony walls of the tympanic cavity and spread to the base of the skull or penetrate into its cavity. The appearance of signs of irritation indicates the spread of the tumor into the cranial cavity. meninges and lesions IX, X and XI cranial nerves. These signs appear quite early if the tumor primarily arises in the area of the jugular fossa (from the jugular glomus).

With hemangiomas and chemodectomas, a positive Brown test is described: an increase in air pressure in the external auditory canal is accompanied by a pulsation of the tumor, and the patient cancels the appearance or intensification of pulsating noise in the ear. When the vessels in the neck are compressed, the pulsating noise decreases or stops, while the hemangioma sometimes turns pale, decreases in size. An additional method for diagnosing these tumors is selective angiography. It allows you to clarify the boundaries of the tumor, the state of the jugular vein, to identify the blood vessels supplying the tumor. A reliable diagnostic method is CT and MRI.

Treatment of patients with benign tumors of the middle ear is mainly surgical. Timely removal of these neoplasms is considered as effective measure prevention of their malignancy. Operations for chemodectomas and hemangiomas are accompanied by intense bleeding. Preliminary ligation of the external carotid artery and embolization of small blood vessels for tumors of this localization proved to be ineffective. Cryotherapy during the operation also did not justify the initial hopes for the possibility of bloodless removal of the tumor. For tumors that do not extend beyond the tympanic cavity, they are limited to endaural tympanotomy or atticoanthrotomy. If the neoplasm goes outside ear canal, trepanation of the mastoid process is performed.

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Risk factors for ENT oncology

To date, the final causes of oncology of ENT organs are not fully known. Large-scale studies are underway, thanks to which doctors plan to develop a scheme of preventive measures.

It is known that cancer of the nose, pharynx and ear most often affects the elderly (mainly men).

It is also of great importance genetic predisposition. The likelihood that a child will get cancer of the ENT organs, like his parent, is quite high. Although, today there are active disagreements about this. Most physicians are confident that malignant neoplasms have nothing to do with heredity.

It is worth saying that a tumor of the ENT organs often occurs in those who abuse alcohol or smoke. This factor can and should be influenced to reduce the likelihood of cancer.

Fans of holding a cigarette between their teeth, connoisseurs of a tobacco pipe should remember that such a hobby at times brings the appearance of malignant tumors on the lip, cheek and gums.

Poorly fitted and improperly fitted prostheses and implants also lead to malignant neoplasms.

Oral cancer in people who do not include fresh fruits and vegetables in their diet.

As for lip cancer, here the causative factor in the occurrence of the disease is long exposure to the sun or exposure to ultraviolet rays.

Cancer occurs when a person is frequently exposed to "hazards" at work (inhaling chemicals).

It is worth saying that close attention is also paid to the presence of the human papillomavirus, since it has been proven that it can cause nasopharyngeal cancer.

Even if you are not at risk, carefully monitor your health. If you have any suspicious symptoms, contact your doctor immediately.

Diagnosis of ENT diseases

The diagnosis begins with a questioning of the patient. During the consultation, the doctor asks about the pain and medications that the patient is currently taking.

This is followed by an examination of the patient, during which the doctor examines the condition of the nasal cavity, pharynx and hearing organs. Nasopharyngoscopy will help to carefully examine the pharynx. For a more thorough examination, the otolaryngologist performs an endoscopy. This procedure takes 4-5 minutes and requires you to administer pain medication. After that, the doctor prescribes other more detailed studies and tests.

An accurate diagnosis allows you to make a biopsy (a piece of tissue is taken from the area designated by the doctor).

In some cases, the doctor prescribes an ultrasound (sonography), a complete blood count and an x-ray with a barium suspension.

Types of diseases of the ENT organs

A couple of decades ago, ENT cancer sounded like a death sentence for people. Today, we can confidently assert that oncological diseases can be defeated. The only condition in this case is early diagnosis.

So what are the types of cancer and what are they?

Cancer of the nose and nasal sinuses. The disease occurs most often in old age (in men). A tumor in the nose is diagnosed by conducting endoscopic examination and rhinoscopy. The symptoms of the disease are bloody issues from the nose pain in the area of the hearing organs, heavy breathing, the appearance of a tumor from the outside.
Cancer of the nasopharynx. This diagnosis is often made to men after 45 years. Symptoms are frequent sinusitis (at the initial stage of cancer), purulent and bloody discharge from the nose, incomplete paralysis of the nerve of the face, clogging of the Eustachian tube, unusual voice tone (on later dates). In the treatment, radiation exposure is used, since surgical intervention in this case is impossible.
Cancer of the larynx. This condition is most common in women. Symptoms are persistent sore throat, difficulty breathing, feeling of having foreign object in throat, hoarseness.
Cancer of the mouth and throat. It occurs quite often in young people and children. Unfortunately, if cancer of the mouth and pharynx is not detected in time, then there is a possibility of rapid spread to other organs.
Cancer of the middle and outer ear. It is diagnosed visually and with the help of histological analysis. Symptoms are itching in the organ of hearing, hearing loss, purulent discharge, pain, headaches, facial paralysis.

It is worth saying that if you start the disease, then the probability of a cure is very small. Therefore, if you find suspicious symptoms, consult a doctor.

The word is given to the chief freelance otorhinolaryngologist of the Ministry of Health of the Russian Federation, First Deputy Chairman of the Commission of the Civic Chamber of the Russian Federation for the Protection of Citizens' Health and Health Development, Director of the Federal Scientific and Clinical Center for Otorhinolaryngology of the FMBA of Russia, Professor, Corresponding Member of the Russian Academy of Sciences Nikolai Daihes.

There is a contact!

Alexandra Tyrlova, AiF Health: Nikolay Arkadyevich, in your opinion, what is the main direction in the development of otorhinolaryngology today?

Nicholas Daihes: Today, all over the world, otorhinolaryngology is developing as an interdisciplinary specialty - head and neck surgery. And, of course, we should not lag behind in this respect. Of course, this became possible only after the new Federal Scientific and Clinical Center of Otorhinolaryngology was opened. This is the largest center not only in Russia, but also in the world. Here on one site we provide all types of high-tech medical care associated with diseases of the ear, throat and nose in both adults and children, we treat patients who need the help of oncologists, maxillofacial and plastic surgeons, ophthalmologists, occupational pathologists, and much more related to the pathology of the head and neck.

- But oncology is a separate field of medicine, isn't it?

Indeed, this has been the case for years. Unfortunately, in the late 1980s and early 1990s, specialized clinicians were excluded from the structure of cancer care. This led to poor results. For example, there is currently an increase oncological diseases ENT organs not only in Russia, but throughout the world, which is about 15-20% in the total structure of oncological diseases, and this is a fairly high percentage. For example, 60-70% of patients with laryngeal cancer who first applied for help already have the third or fourth stage of the disease. How can such statistics be explained? There are several reasons. Firstly, this is the low oncological alertness of doctors leading initial appointment in polyclinics, when inadequate treatment is prescribed and the disease becomes neglected. It is important that, first of all, a narrow specialist always remembers the possibility of a hidden oncological process. I always remind polyclinic otorhinolaryngologists: examine the patient and make sure there is no oncological problem, then treat an inflammatory or other pathology. After all, malignant tumors, as a rule, are always preceded by background or precancerous conditions.

But this is not always only the fault of non-oncologists, since in the process of obtaining a postgraduate medical education they are not properly trained in oncology. Conversely, clinical oncologists are not sufficiently trained in the skills of one or another narrow specialty. As a result, it is not always possible to perform a sparing oncosurgery that would preserve the functionality of a vital organ.

- What should be done to establish contact between oncologists and doctors of other specialties?

Now the Ministry of Health of Russia has an understanding that such interaction is necessary, - the development of joint clinical guidelines for oncologists and doctors of other specialties, educational programs for postgraduate education of doctors aimed at advanced training in oncology. Many heads of leading cancer centers are ready to cooperate with medical centers in other areas. I hope that an interdisciplinary working group will be created that will deal with the problems of oncology in all directions.

Fight for Patients

- It is not possible to make a complex operation everywhere. How to increase the availability of high-tech medical care?

One of the directions of development and availability of high-tech medical care is the creation of branches of leading institutions. We, for example, have branches in Khabarovsk and Astrakhan. In addition, over the past year and a half, we have traveled to 50 regions of the country to sign agreements that provide for the possibility of directly referring patients for treatment to our center through the CHI system. high technology.

- How much effort does the patient need to make to knock out a referral to high-tech operation? Is there competition between medical institutions here?

High-tech medical care in the Russian Federation consists of two parts - basic program OMS of high technologies (HT MHI) and non-basic, or federal, program of high-tech medical care (HMP).

The difference between them lies in the methods of financing, the amount of assistance and the structure of tariffs for the provision of services. VMP is de facto a direct government investment that gives a certain clinic a guaranteed volume of patients. The question is different.

For example, our federal center annually conducts more than 7,000 complex operations, and the allocated volumes of VMP are clearly not enough for us. Therefore, we travel to the regions to invite patients for treatment under the basic high-tech compulsory medical insurance program.

I believe that in order to maintain a balance, it is necessary to expand the possibility of providing VMP within the framework of the MHI of the basic program and unify the tariffs of the basic BT MHI and the non-basic VMP OMS program.

This will create for patients real opportunities self-selection medical institution to receive high-tech care, ensure competition between medical institutions, and thus improve the quality of medical care.

Among all patients with oncology, the proportion of patients with ENT cancer is 23%, while the most common type of such cancer is laryngeal cancer, which occurs in 55% of patients.

Cancer of the ENT organs is usually diagnosed already at quite advanced stages of development. Misdiagnosis is very often made, for example, when diagnosing cancer of the nasal cavity, the percentage misdiagnosis is 74%.

Cancers of the ENT organs are a whole group of oncological diseases, which can be divided depending on the location of the malignant tumor. This group includes cancer of the oropharynx, nasopharynx, larynx, nose and paranasal sinuses, external and middle ear.

The success of treatment directly depends on the stage at which ENT cancer is detected. So, for example, when laryngeal cancer is detected at the first stage of development, the five-year survival rate of patients is 83-98%, and at the second stage it already ranges from 70% to 76%. However, the percentage of patients who consulted a doctor in the initial stages of the disease is only 14%.

The main difficulty in diagnosing ENT cancer is the strong similarity of its manifestations with the symptoms of other diseases. Therefore, in the diagnosis, one cannot fully rely on the results of a visual examination of the tumor and the degree of prevalence of the process. In addition, another serious reason for late diagnosis is the lack of alertness of doctors due to the lack of diagnostic skills and oncological experience.

Diagnosis of nasopharyngeal cancer

visual examination, in which the doctor feels cervical lymph nodes and, using a small mirror, examines the throat;
rhinoscopy, which requires the insertion of a rhinoscope into the nose of the patient. The device is a tube-shaped thin instrument with a lens and light. Sometimes there may be a special device on the rhinoscope that allows you to take a piece of tissue for subsequent microscopic examination;
examination of the chest and skull using X-ray equipment;
PET detects malignant cells by injecting a small amount of radioactive glucose into a patient's vein. During this procedure, the scanner, rotating around the patient, reveals the places of the greatest accumulation of sugar, i.e. places of accumulation of malignant cells;
a neurological examination is an examination of the nerves, as well as the spinal cord and brain;
MRI allows you to get a detailed image of the selected area of the patient's body using a magnetic field;
CT using x-rays allows you to get a detailed image of a selected area of the body. In some cases, patients may be injected with contrast to obtain the most accurate results;
laboratory tests such as urinalysis, blood tests, etc.
A biopsy is still the most accurate way to diagnose cancer.

Diagnosis of oropharyngeal cancer

When diagnosing cancer of the oropharynx, first of all, a visual examination is performed using a lamp, a mirror and an endoscope. The most accurate way to make a diagnosis is a biopsy, during which the doctor removes part of the affected tissue for microscopic examination for the presence of cancer cells.

Other diagnostic methods include MRI, X-ray chest, CT, as well as a bone scan, which makes it possible to detect any pathological neoplasms in the bones. To assess the general condition of the patient, a blood test is performed.

Diagnosis of cancer of the nose and paranasal sinuses

When diagnosing cancer of the nose and paranasal sinuses, the doctor makes initial inspection and draws up an anamnesis, during which he finds out the presence of risk factors and patient complaints. During the examination, the doctor probes the lymph nodes and paranasal sinuses. Next, rhinoscopy is performed, that is, an examination of the nasal cavity, requiring the introduction of a rhinoscope into each nostril to expand the area of examination.

If an even more detailed examination is necessary, it is possible to use an endoscope with a lamp and a video camera. The image obtained with its help is displayed on the monitor screen. An endoscope is also often used to perform a biopsy.

In addition, CT, MRI and radiography are possible.

Diagnosis of cancer of the larynx

Diagnosis of laryngeal cancer also begins with the collection of anamnesis and clarification of the patient's complaints. Next, an inspection Special attention, during which the area of \u200b\u200bthe lymph nodes is given, the throat is examined with a spatula.

Next, laryngoscopy is performed, which is divided into two types: direct and indirect. AT last case a small mirror is inserted into the patient's throat, the doctor pushes the tongue away with a spatula. Direct laryngoscopy, also called fibrolaryngoscopy, examines the larynx with a flexible laryngoscope through the nose. This procedure allows you to see vocal cords and walls of the larynx.

A biopsy, as the main method for diagnosing cancer, allows you to identify pathological cells in tissue taken for examination during laryngoscopy.

Diagnosis of outer and middle ear cancer

It is sometimes possible to diagnose cancer of the outer ear with a visual examination of the patient, however, in some cases, this disease can be confused with diseases such as chronic suppurative otitis media. The most recognizable malignant tumors in this case are tumors auricle. However, a definitive diagnosis can only be made after a histological examination.

In the diagnosis of the outer and middle ear, one of the main values is differential diagnosis with such diseases as specific granulomas, benign tumors, eczema, psoriasis, frostbite, ulcers, dyskeratosis.