The most important risk factor is smoking, and in the majority of cases the patients have been abusive smokers over a long period of time. The recent findings in the molecular medicine have shown that neoplasm is a genetic disease, the development squamous papilloma hypopharynx the neoplastic cells being a consequence of the disruption of the proliferation, differentiation and apoptosis mechanisms.
It can be generally encountered on adulthood, with a maximum frequency at the age group of years old. In half of the cases the primary lesion is associated with a satellite metastasis adenopathy in the lymphatic cervical ganglions, which leads to a very unpleasant treatment prognosis.
Keywords hypopharyngeal cancer, risk factors, tumour dissemination Rezumat Lucrarea reprezintă o trecere în revistă a factorilor de risc și a modalităților prin care aceștia intervin în etiopatogenia cancerului de hipofaringe.
Cel mai important factor de risc este fumatul, marea majoritate a pacienților fiind fumători o perioadă lungă.
De cele mai multe ori, se constată și asocierea cu consumul cronic excesiv de alcool. Descoperirile recente din medicina moleculară au arătat că, în neoplasmul de hipofaringe, squamous papilloma hypopharynx celulelor neoplazice se produce ca urmare a dereglării mecanismelor de proliferare, diferențiere și squamous papilloma hypopharynx celulară.
Cancerul de hipofaringe se întâlnește, în general, la vârsta matură, cu un maximum al frecvenței la de ani. În jumătate din cazuri, leziunea primară este asociată unei adenopatii satelite metastatice squamous papilloma hypopharynx ganglionii limfatici cervicali, care conduce la un prognostic foarte rezervat al tratamentului.
Cuvinte cheie cancer de hipofaringe etiopatogenie diseminare tumorală Introduction The malignant tumours of the hypopharynx represent 0. This disease has caused quite a stir among oncologists, this illness tending to continually increase in morbidity 1,2. Several factors contribute to the outbreak of hypopharyngeal cancer risk factors : smoking, alcohol consumption, the increase of the environmental pollution, untreated enduring pathological processes chronic pharyngitis, dyskeratosis of the pharyngeal mucosa 3,4.
The most squamous papilloma hypopharynx risk factor is smoking. It can be generally encountered on adulthood with a maximum frequency at the age of years old. The features of the cancer cell are: autonomous proliferation, inhibition of cell growth suppressors, apoptosis avoidance, unlimited replication, angiogenesis, tissue invasion and metastasis 5,6.
Some harmful eating habits, such as the ingestion of concentrated alcoholic drinks, associated with the consumption of food with oncogenic potential, inappropriately prepared squamous papilloma hypopharynx, fried and canned foodto which the squamous papilloma hypopharynx smoke is added, increase the incidence of hypopharyngeal cancers. Tobacco - the tars resulting from tobacco burning contain carcinogenic hydrocarbons involved in the appearance of the pharyngolaryngeal cancers.
Squamous papilloma of vocal cord -
When smoking, approximately chemical substances are released as gas or particles which present a carcinogenic potential. Polycyclic aromatic hydrocarbons, nitrosamines, aldehydes, benzene and butadiene have the greatest carcinogenic risk.
Recent statistics show that a non-smoker wife living next to a husband who smokes 20 cigarettes a day has the same possibilities of developing cancer as her smoker husband. Although smoking is a risk factor unanimously accepted, not all the people exposed will develop the disease, which leads to the idea that there are individual varieties with respect to the cancer likeliness and a genetic polymorphism which modulate the association between exposure and cancer.
The fight against smoking aims at persuading people that not smoking is the normal state, and society must know that tobacco and its squamous papilloma hypopharynx are one of the avoidable causes of disease and death 7.
Alcohol represents an independent and synergic smoking factor, with the role of promoting the mutagenic effects of the tobacco carcinogenic substances, supporting their dissolving in the body through the vasodilatations it produces. Generally, due to the fact that alcohol metabolism implies a great consumption of vitamins, vitamin deficiencies, malabsorption and nutritional deficiencies appear. Thus, we can explain the propensity for multiple primary tumours in squamous papilloma hypopharynx and alcoholics 3,4.
The gastro-oesophageal and laryngopharyngeal reflux, a frequent pathology of modern man, has been associated with the development of malignant tumours in the postcricoidian region. The existence of an esophagitis facilitates the action of carcinogenic chemicals following the pattern: esophagitis - mucosal atrophy - dysplasia - cancer.
squamous papilloma hypopharynx In women with Plummer-Vinson syndrome, coming from Scandinavia and Ireland, a growth of the incidence of the oesophageal and hypopharyngeal cancer has been noticed through a mechanism of a chronic irritation associated with the deficiency of C vitamin and iron 1,2.
The Human Papilloma Virus types 16 and 18 show their carcinogenetic effect through the viral oncoproteins E6 and E7, which inactivate the tumour suppressor proteins p53 and Prb. The role of the HPV virus type 16 can be independent from the action of other carcinogens. The HPV-positive tumours are more frequently encountered in non-smoker persons who do not drink alcohol and do not present immunosuppression, being basaloid or poorly differentiated tumours 5,8,9.
The association between HPV and laryngeal cancer highly influences its prevention, treatment squamous papilloma hypopharynx prognosis. The presence of the HPV virus represents a factor of positive prognosis through the immune supervision it determines, the tumours responding better to irradiation, chemotherapy or both of them 5, At present, the contribution of the genetic factor to the development of the hypopharyngeal cancer is investigated.
The modifications of the genotype and aggressive cancer in bladder phenotype linked to the tobacco metabolism, the abnormalities of the DNA repair mechanism, as well as other carcinogens can be susceptibility factors to hypopharyngeal cancer. For cancer to develop, six fundamental phenomena must be present: self-sufficient proliferation, insensitivity to anti-proliferation signals, and tissue invasion with metastasis.
Genetic events such as mutations, gene deletions, chromosomal rearrangements, which lead to some papilomas frământate recenzii genetic modifications, have been highlighted 1,2. The psycho-emotional factor is unanimously admitted in the multifactor complex of oncogenesis. Violent psychic traumas, stress, negative inner states of low intensity but repeated, and permanent conflict states induce negative modifications on the general adaptation syndrome of the organism to hormonal and immunological disturbances, very significant in the increase of the oncogenetic potential.
All the resources call on the psychic balance which can be obtained through determination, education and wisdom 1,2. Nutrition - epidemiological and experimental studies recognize that nutrition plays a direct role in the etyology of digestive cancers.
Some food, especially of animal origin, can contain a series of oncogenic factors. To these we add the ones resulting from the methods of preparing and preserving food smoked and fried food, additives, used in food preserving, such as aflatoxins, nitrosamines and cyclamates A fat-laden nutrition, the abuse of calories, the lack of milk-based products, cereals, vegetables and fruits, the lack of vegetal fibres in the food ration play an important role in oncogenesis.
A squamous papilloma hypopharynx of food have cancer protection: food of vegetal origin, squamous papilloma hypopharynx, milk-derived products, bran cereals, high fibre germinated cereals, food high in vitamin A, beta-carotene and vitamin C. The protective anti-cancer effect of vitamin A has been proven.
Citrus fruits and vitamin C protect the mucosa of digestive pathways against cancer. Vitamin E and B are given a carcinogen role, but totally unproven up to present 1,2.
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The professional risk factors can be: the asbestos, wood dust, paints, nickel, and glass wool. Usually, in the organism appear daily about 1 million mutant cells. These are normal cells with antigenic attributes and with oncogenic potential.
They are hpv virus kako se dobija - destroyed by the normal immune apparatus of the organism, this way leading to a healthy balance. But under the influence of one or several from the aforementioned factors, squamous papilloma hypopharynx destruction of the mutant cells becomes impossible or is incompletely done.
Thus, the cells which are not destroyed become malignant Pathogeny of hypopharyngeal cancer The hypopharynx is covered on the whole surface by a Malpighian epithelium, therefore most of the cancers at this levels are differentiated Malpighian carcinoma spinocellular epithelioma.
Macroscopically, the tumours of the hypopharynx start with an infiltrative process which can ulcerate the ulcero-infiltrative form and it is characterized by an invasion of the mucosa, with more or squamous papilloma hypopharynx profound destruction of the subjacent structures glands, muscles, membranes, cartilages or by the appearance of adenoid growths the vegetant form.
This form develops at the surface without affecting profound tissues, being a carcinoma isolated at the mucosa, but which spreads at the distance, affecting squamous papilloma hypopharynx or only part of the pharyngeal epithelium.
Etiopathogenesis of the hypopharyngeal cancer
We can encounter a combination of these processes, the ulcero-vegetant form The tumour dissemination is realized contiguously, by lymphatic, or rarely hematogenous pathway. The squamous papilloma hypopharynx direction of the hypopharyngeal cancer is determined by squamous papilloma hypopharynx existence of some zones of adherence which constitute an obstacle to the tumour growth 6. The cancer of the anterior angle of the pyriform sinus extends towards the sinus slopes and towards the aryteno-epiglottic fold or to the lateral wall of the pharynx.
The cancer with the starting point on the external side of the aryteno-epiglottic fold extends towards the ventricle bands inside the larynx and to the profound part of the pyriform sinus.
The retro arytenoid and retro cricoid carcinomas extend towards the aryteno-epiglottic folds and to the endolaryngeal mucosa of the cricoid signet ring. The cancer of the external wall of the pyriform sinus extends upwards to the pharyngoepiglottic fold and the posterior pillar and downwards to the pharyngoesophageal junction.
The cancer of the aryteno-epiglottic fold extends backwards to the pyriform sinus, frontwards to the glossoepiglottic vallecula and outside towards the side wall of the pharynx.
The epidemiology of hypopharynx and cervical esophagus cancer
The cancer with the starting point at the posterior side of the hypopharynx extends upwards to the oropharynx or downwards to the pharyngoesophageal junction. The most important tumour dissemination way is the lymphatic squamous papilloma hypopharynx. When there is an invasion of a cervical lymph nodes group, which makes them clinically distinguishable, it is possible that the cancer cells have seized other lymph nodes which are not yet palpable, by contiguity, and the fact of not removing them squamous papilloma hypopharynx to evolutions and clinical stages with more guarded prognosis.
The distant metastasis of the hypopharyngeal neoplasm can develop in the liver and the lungs. Cancer is a genetic disease in which the genes involved in the cell functions undergo point squamous papilloma hypopharynx, deletions, chromosomal rearrangements, which lead to the appearance of some genetically irreversible modifications. This genetic damage comprises the activation of proto-oncogenes and the inactivation of the suppressor genes.
The oncogenes, when activated, determine the malignant phenotype, and when inactive, they are called proto-oncogenes, and they play a role in the normal activity of the cells. The oncogenes activation is produced after some qualitative functional modifications such as the development of an unaltered or qualitative factor, such as the production of an altered factor.
The suppressor genes prevent the uncontrolled growth and differentiation of the cells. Cancer development requires the concomitance of six fundamental phenomena: autonomous proliferation, inhibition of the cell growth suppressor, apoptosis avoidance, unlimited replication potential, angiogenesis, tissue invasion and metastasis. The autonomous proliferation is realized by the expression of some EGFR Epidermal Growth Factor Receptor growth factors squamous papilloma hypopharynx receptors of the aberrant growth factors.
Squamous papilloma oropharynx.
The growth signals are produced through diffusible signalling molecules growth factorsextracellular matrix components, and cell-cell interactions. The growth signals are transmitted from the cell surface towards the squamous papilloma hypopharynx through different pathways 13, The inhibition of cell growth suppressor - the cell cycle is the process through which the cell duplicates its DNA and divides under the control of a group of molecules called cyclins.
Every molecule that affects and regulates the cyclins will interfere with cell growth process and it is a potentially carcinogenic mediator. The TP53 gene is the most analysed gene involved in carcinogenesis.
It is located on the short arm of chromosome 17, the presence of deletions at this level leading to a progression towards cancer. The apoptosis avoidance - the gene p53 has an important function in cell cycle regulation, DNA repair and the apoptosis mechanism.
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The mutation appearing at the level of the gene TP53 leads to the survival of the DNA altered cells and to the genome instability. The apoptosis effector cells are proteases squamous papilloma hypopharynx the caspase family, divided in three groups: the caspases without apoptotic role 1, 4, 5, 11, 12, 13initiator apical caspase 8, 9, 10 which initiate and amplify the cascade and effector executioner caspases 2, 3, 6, 7final effectors of apoptosis The unlimited replication potential - tumour cells have the ability to maintain the length of the telomeres, indefinitely multiplying.
Angiogenesis is fundamental for tumour growth and for metastasis. Angiogenesis and neovascularisation process encompassed several stages which are regulated by stimulating and inhibitory factors.
Tissue invasion and metastasis imply three important steps: tumour cell attachment to the basal membrane, proteolysis of extracellular matrix and migration of tumour cells.
Both normal squamous epithelial cells and neoplastic cells present on their surface specific receptors for the basal membrane: integrins, E-cadherins and catenins. The proteolysis of extracellular matrix is a stage of the tumour invasion and depends on a series of proteolytic enzymes 13,14,16,17 : the matrix metalloproteinases MMPs ; the urokinase-type plasminogen activator uPA ; the family squamous papilloma hypopharynx serpins. Conclusions Together with the laryngeal cancer, the hypopharyngeal cancer represents one the most common neoplastic pathologies from otorhinolaryngology.
The epidemiologic worldwide studies show that smoking is a very important risk factor involved in the outbreak of this cancer. The genetic factor is essential in the appearance of the squamous papilloma hypopharynx.
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Bibliografie Forastiere A.