Endoskopische und zyto-histomorphologische Möglichkeiten der Krebsfrüherkennung im Hypopharynx

Summary

Hypopharyngeal 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.