Читать книгу Hypopharyngeal Cancer - Группа авторов - Страница 31

The prime function of the hypopharynx is the safe transfer of a food bolus to transit from the oral cavity/oropharynx into the oesophagus without significant hold-up or delay, and to avoid overspill of swallowed substances (fluids and/or solids) into the laryngeal airway.

Throat symptoms (hypopharynx) that are considered significant (hard symptoms) [1] and should be considered likely to be associated with hypopharyngeal cancer are listed below. These are most frequently reported by male patients, most of whom are likely to admit to a prolonged history (years) of heavy smoking of tobacco, excessive drinking of alcohol, and may be chewers of betel quid. Whereas women (> 55 years, in the developed world) are more likely to present with problems with their swallowing, who admit to social cigarette smoking and moderate drinkers of alcohol, some of these women may have been associated with sideropenic anaemia:

•A neck mass – enlarged neck lymph nodes

•Persistent sore throat

•Unexplained otalgia (ear pain): unlike laryngeal cancer, otalgia tends to be an early symptom in hypopharyngeal cancer, whereas hoarseness tends to be a late symptom

•Dysphagia: usually early in postcricoid cancer and late in piriform sinus/posterior pharyngeal wall cancers

•Odynophagia (pain on swallow)

•Altered or hoarse voice

•Increasing dyspnoea

Uncommon symptoms but have been reported:

•Cough

•Haemoptysis

•Neck abscess [2]

•Enlargement of the thyroid gland [3, 4]

Some symptoms are considered “soft symptoms” [1] have been reported as early suggestive of hypopharyngeal cancer but are equally common in benign conditions. But such symptoms that are unremitting and increasing in severity, more so in tobacco users, should suggest that something serious may be amiss and examination of the pharynx by a specialist should ensure an accurate diagnosis.

The term “globus pharyngeus” is a common symptom in the middle-aged population and accounts for approximately 3–4% of new referrals to ORL-HNS outpatients. It has been described as a symptom or a condition, in its own right (primary) or secondary as a symptom of another disease, experienced or expressed as a feeling of a “lump in the throat” [5]. A definition of “globus” has been proposed to be the persistence or intermittent, non-painful sensation of a “lump of foreign body in the throat” between meals, the absence of dysphagia or odynophagia, the absence of evidence of gastro-oesophageal reflux and the absence of histopathology-based oesophageal disorders [6]. The history alone is essentially diagnostic, with reassurance in resistant cases to outpatient flexible endoscopy and reassurance [6, 7]. Symptoms resolve spontaneously in > 50% over a number of years. Patients whose throat symptoms remain troublesome and recalcitrant should seek the advice of a Speech and Language Therapist who over time using relaxation techniques and reinforced reassurance is likely to achieve success [7]. It is been proposed that the term “Troublesome Throat Awareness” be used as an alternative diagnosis as it is clear, unambiguous with an inherent and therefore therapeutic reassurance to the patient [8]. A single report of natural history of globus followed up 72 patients for an average of 91 months – during the follow-up period, 55% of patients were asymptomatic and 45% had persistent symptoms. During the follow-up period patients developed other medical conditions, but no patient developed a head and neck malignancy [9].