H.-J. Pesch

Endoskopische Therapie von Krebsfrühstadien im Larynx — vorläufige Ergebnisse

SummaryDuring the last 8 years 118 patients of the ENT Department of the University Erlangen, presenting with leukoplakia, hyperplastic, papillomatous or ulcerative processes of the larynx, were treated by endolaryngeal microsurgery — some with the CO2 laser — under intubation anaesthesia. Histologically, these lesions were classified as carcinoma in situ or invasive squamous cell carcinoma (T1, T2 with no loss of vocal cord mobility).In addition to this local treatment also a systematic antiinflammatory treatment up of the upper airways aimed at the elimination of chronic mucosal irritation. Additionally the patient was always urged to strictly avoid contact with exogenous noxae and inhalative carcinogens, in particular cigarette smoking.With this etiology-oriented regimen, compromising endoscopic microsurgery and supporting measures, recurrences occurred in only 11 patients out of 118. In every case, the recurrent lesion was successfully treated by function-preserving endoscopic (9) or extralaryngeal (2) partial resections. To date, no patient has had to be subjected to aggressive cancer therapy (radiation, laryngectomy or neck dissection). Four patients died from causes other than the primary tumour, all others are still alive.

Simultanes Wachstum von Carcinom und Präcancerose im Kehlkopf — eine stratigraphische histomorphologische Analyse

SummaryChronic and diffuse contact between inhalation noxae and the mucosa plays an important role in the pathogenesis of cancer of the larynx and lead us to expect a multilocular development of carcinoma and precancerous changes. This supposition was examined in some 100 larynx resection preparations.After standardized stratigraphic sub-divisioning of the larynx, it was lamellated and the individual zones studied histologically for epithelial dysplasias, varying degrees of differentation up to an including carcinoma, and for inflammatory changes.Certain relationships were found to exist between certain characteristics of growth of the carcinoma and the site, extent and histological classification of the tumour. The fact that, frequently, a macroscopically non-verifiable coexistance of precancer and carcinoma can be found, is taken account of in the modified conception for the taking of biopsies.

Endoskopische Krebsnachsorge im oberen Aero-Digestiv-Trakt

SummaryBetween 1975 and 1980, at the ENT Department of the University Hospital of Erlangen, more than 900 patients were treated for malignant lesions in mouth, pharynx and larnyx. About 40% of these lesions were laryngeal carcinomas.Long range after-care serves to ensure early recognition of residual, recurrent or second carcinomas. It rises particular demands with respect to organization and methods. Prerequisite is a good cooperation between patient and doctor. A tumour register in connection with a precise patient-summoning system, permits expedient patient follow-up at regular intervals.The ENT examination always includes endoscopy of the nose, pharynx and larynx in the awake patient. In addition to the routine photographic (and video-) documentation, a cytological swab is always obtained from the area of primary tumour manifestation. All visible proliferations are subject to a thorough cytological and histological (biopsy) investigation, irrespective of size or clinical significance. In the case of changes produced by irradiation or surgery, which can be difficult to evaluate, a different methodical approach may sometimes be required.Provided that the patient is properly instructed and is willing to cooperate, this standardized concept enables the detection of recurrences at an early stage — in particular in the larynx — and to ensure improved treatment with respect both to the functional result and the subsequent prognosis.

Simultanes Vorkommen von Präkanzerosen und Karzinomen in Mund, Rachen und Kehlkopf. Vorläufige Ergebnisse einer interdisziplinären Studie

SummaryThe incidence of two simultaneous carcinomas within the organism is 5%, in the region of the upper airways and alimentary tract, less than 1%. With the aid of systematized clinical endoscopic and cyto-histomorphological screening procedures for carcinomas along the “smokers pathway“, concomitant carcinomas and pre-cancerous states are being detected more and more frequently and at an earlier stage.Between 1976 and 1978, 210 patients presenting with oral leukoplakia of varying genesis and localization, and both benign and malignant, were subjected to systematic dermatological, dental and ENT examinations. A therapy-relevant finding in the ENT region was found in every third patient. In 41 patients with oral pre-cancerous conditions and carcinomas, similar concomitant findings were seen in the larynx in 15%, localized in the glottis in 90% of the cases. — Etiologically particularly high-risk patients proved to be men over 30, with oral leukoplakia and poor oral hygiene and a history of regular smoking and consumption of considerable quantities of alcohol.The basis for the detection of concomitent or consecutive pre-cancerous conditions and early cancers in the region of the upper airways and alimentary tract is the interdisciplinary cooperation covering the inspection of the oral cavityand pharynx and larynx.

Endoskopische und zyto-histomorphologische Möglichkeiten der Krebsfrüherkennung im Hypopharynx

SummaryHypopharyngeal carcinomas are usually diagnosed in stage 3 and 4 and, even when subjected to combined radiological and surgical therapy, have a very poor prognosis. An improvement in this lamentable therapeutic and diagnostic situation can be expected only from early detection. Therefore, for the detection of precancerous and early stages of hypopharyngeal carcinoma, the proven techniques employed for early detection and grading of precancers and early carcinomas in the larynx were employed.Within the framework of this prospective study, a total of 328 patients have been examined since the beginning of 1978. Following the completion of a computer-compatible questionnaire covering pre-history, symptoms and smoking and drinking habits, a complete endoscopic investigation of the head and neck regions was carried out. For the examination of the pharynx and larynx, the v. Stuckrad zoom endoscope has proved its value, since, with it, even concealed regions of mucosa, as in the hypopharynx, can be reliably inspected. Thus, the visual early detection of very minute and early changes of the mucosa is also possible in this area. Cytological material is obtained from the various topographical regions, stained in accordance with Papanicolaou and evaluated. In the case of suspicious findings (Pap. III) an endoscopic-cytological check is carried out, or tissue biopsy taken for histomorphological work-up.The analysis of the cytological findings showed that, in particular, six cases with Pap. III, manifesting no visible changes in the mucosa of the hypopharynx, were of interest. Since multiple check cytological examinations indicated the moderate dysplasia, these patients were classed as being at particular risk and are now being monitored endoscopically and cytologically, every 3 months.In the examination of etiologically high-risk groups and patients with precancerous conditions of the upper airways and alimentary tract, cytologically suspicious cases indicating dysplasia or early tissue changes in the mucosa, may be more frequently expected in the hypopharynx, too. Only long-term observation will reveal how a cytological finding with dyscaryosis (Pap. III), in the presence of a clinically and endoscopically normal mucosa is to be classified.

Endoskopische Grobnadelbiopsie in Rachen und Kehlkopf

SummaryThe needle-biopsy taken in the pharynx and larynx is a simple and reliable procedure for the histological diagnosis of submucosal tumours. It can be performed either in local anaesthesia using the zoom-endoscope by v. Stuckrad or during microlaryngoscopy under general anaesthesie. This method however does neither replace the single biopsy of exophtic tumours nor the microlaryngoscopic excision of suspicious, precancerous lesions.The needle-biopsy taken in the pharynx and larynx is a simple and reliable procedure for the histological diagnosis of submucosal tumours. It can be performed either in local anaesthesia using the zoom-endoscope by v. Stuckrad or during microlaryngoscopy under general anaesthesie. This method however does neither replace the single biopsy of exophtic tumours nor the microlaryngoscopic excision of suspicious, precancerous lesions.