Diagnosis of laryngeal cancer by indirect rigid endoscopy and flexible tube biopsy

HANOI NATIONAL UNIVERSITY

UNIVERSITY OF MEDICINE AND PHARMACY

HOANG VAN PHUC

DIAGNOSIS OF LARYNGEAL CANCER

BY INDIRECT RIGID ENDOSCOPY AND FLEXIBLE BIOPSY

UNIVERSITY THESIS IN GENERAL MEDICINE

HANOI NATIONAL UNIVERSITY

UNIVERSITY OF MEDICINE AND PHARMACY

HOANG VAN PHUC

DIAGNOSIS OF LARYNGEAL CANCER

BY INDIRECT RIGID ENDOSCOPY AND FLEXIBLE BIOPSY

UNIVERSITY THESIS IN GENERAL MEDICINE

KEY: QH.2016Y

INSTRUCTOR: DR. DAO DINH THI

Dr. NGUYEN TUAN SON

ACKNOWLEDGEMENTS

During the process of studying, researching and completing this thesis, I have received a lot of help from teachers and seniors. With deep gratitude, I would like to sincerely thank: The Board of Directors, teachers of the Department of Otorhinolaryngology, University of Medicine and Pharmacy, Vietnam National University, Hanoi; The Board of Directors of the Hospital, the General Planning Department - Central Otorhinolaryngology Hospital for creating favorable conditions for me in the process of studying and researching.

I would like to thank the Professors, Associate Professors, and Doctors in the scientific council that approved the outline and the scientific council that defended the thesis for giving me valuable comments during the research and completion of my graduation thesis in General Medicine.

I would like to thank the staff of the Endoscopy Department, Central Ear, Nose and Throat Hospital for creating favorable conditions for me during my study and thesis research.

I would like to express my sincere thanks to the patients who have contributed significantly to the success of this thesis.

I would like to express my respect and gratitude to:

Dr. Dao Dinh Thi, the teacher who has wholeheartedly guided, helped and guided me throughout my studies and research.

Dr. Nguyen Tuan Son, the teacher has always cared, wholeheartedly helped, and kindly instructed throughout the learning and research process.

Finally, I would like to express my gratitude to my parents, siblings, and friends who have encouraged and shared with me throughout my studies and research.

COMMITMENT

I am Hoang Van Phuc, a student of QH.2016.Y course, majoring in General Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi. I hereby declare that:

1. This is a thesis that I directly conducted under the guidance of Dr. Dao Dinh Thi and Dr. Nguyen Tuan Son at the Central Ear, Nose and Throat Hospital.

2. This work does not overlap with any other research published in Vietnam.

3. The data and information in the study are completely accurate, honest and objective, and have been confirmed and approved by the research facility.

Hanoi, June 6, 2022

Student

Hoang Van Phuc

INDEX

ACKNOWLEDGEMENTS COMMITMENTS TABLE OF CONTENTS

LIST OF ABBREVIATIONS LIST OF TABLES

LIST OF CHARTS, IMAGES

PROBLEM STATEMENT 1

CHAPTER 1. OVERVIEW 3

1.1. Research history 3

1.1.1. In the world 3

1.1.2. In Vietnam 3

1.2. Epidemiological characteristics and risk factors of laryngeal cancer 4

1.2.1. Epidemiology 4

1.2.2. Risk factors 5

1.3. Anatomy and physiology of the larynx 6

1.3.1. Anatomy of the larynx 6

1.3.2. Laryngeal physiology 13

1.4. Diagnosis of laryngeal cancer and assessment of local lesions 14

1.4.1. Systemic symptoms 14

1.4.2. Functional symptoms of UTTQ 14

1.4.3. Examination and assessment of local lesions of laryngeal cancer 16

1.4.4. Histopathology of laryngeal cancer 17

1.4.5. Definitive diagnosis 19

1.4.6. Differential diagnosis 19

1.4.7. Stage 19 Diagnosis

1.4.8. Treatment 22

CHAPTER 2: RESEARCH SUBJECTS AND METHODS 25

2.1. Research subjects 25

2.1.1. Patient selection criteria 25

2.1.2. Exclusion criteria 25

2.2. Research location and time 25

2.3. Research design 25

2.4. Sample size 25

2.5. Research variables 26

2.6. Research process 27

2.7. Research means 28

2.8. Data collection and processing 28

2.9. Ethics in research 28

CHAPTER 3: RESEARCH RESULTS 29

3.1. Clinical features, endoscopic images, histopathology 29

3.1.1. General characteristics of the research group 29

3.1.2. Functional symptoms and time course of 32

3.1.3. Endoscopic images of laryngeal cancer 34

3.1.4. Histopathological results of laryngeal cancer 37

3.1.5. Correlation between endoscopic images and histological grading 37

CHAPTER 4: DISCUSSION 41

4.1. Clinical features, rigid endoscopic images 41

4.1.1. General characteristics of the research group 41

4.1.2. Clinical characteristics of the study group 43

4.1.3. Endoscopic images of laryngeal cancer 45

4.2. Histopathological results 48

4.2.1. Histopathological classification 48

4.2.2. Histological grading 48

4.2.3. Correlation between endoscopic images and histological grading results... 49

CONCLUSION 50

PROPOSAL 51

REFERENCES

APPENDIX 1. MEDICAL RECORDS FOR RESEARCH APPENDIX 2. LIST OF PATIENTS

LIST OF ABBREVIATIONS

UTTQ:

Laryngeal cancer
CT:	CT scan
MRI:	Magnetic resonance
TQTP:	Total laryngectomy
TQBP:	Partial larynx

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LIST OF TABLES

Table 1.1. Disease stage according to TNM 22

Table 2.1. Some research variables 26

Table 3.1. Distribution of patients by age 29

Table 3.2. Distribution by occupation 30

Table 3.3. Distribution by territory 31

Table 3.4. Reasons for hospitalization 32

Table 3.5. Functional symptoms 32

Table 3.6. Hoarseness duration 33

Table 3.7. Morphology of laryngeal cancer 34

Table 3.8. Location of primary tumor by endoscopy 34

Table 3.9. Spread of tumor 35

Table 3.10. Vocal cord mobility 36

Table 3.11. Mobility of the arytenoid cartilage 36

Table 3.12. Condition of nose, palate, throat 37

Table 3.13. Histopathological classification 37

Table 3.14. Histological grading 38

Table 3.15. Correlation between endoscopic images and histological grading 39

Diagnosis of laryngeal cancer by indirect rigid endoscopy and flexible tube biopsy - 1

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