CLINICAL OBSERVATION ON MALIGNANT LARYNGOPHARYNX TUMORS IN OKINAWA PREFECTURE

Abstract

Statistical observation of 226 cases of head and neck tumors, during the period of April, 1973, when Department of Ear, Nose and Throat was commenced, through March, 1978, was done at the Department of Otolaryngology, University Hospital of the Rytikyfis, College of Health Science, Okinawa.The head and neck tumors were found in approximately 4. 0% of all the ENT patients in each year. The number of the patients and the locations of the malignant tumors were as follows: 38 cases(16.8%) in the oral cavity, 76 cases(33.6%) in the pharynx, 53 cases(23.5%) in the larynx, 42 cases (18. 6%) in the nasal and paranasal cavities, 2 cases (0.9%) in the acoustic organs and 15 cases (6. 6%) in the other head and neck region. The statistical details of malignant pharyngeal tumors were as follows:1) Epipharyngeal tumors were found in 18 cases (23.7%), oropharyngeal tumors in 38 cases (50. 0%) and laryngopharyngeal tumors in 20 cases (26. 3%) out of total 76 cases. Epipharyngeal tumors (18 cases) occupied 8. 0% of the malignant head and neck tumors.2) The ratio between males (14 cases) and females (4 cases) was 3.5 and 1.3) The age was distributed from 20 to 66 years. Its incidence had two peaks. One was in the second decades and the other was in the fifth to sixth decades. The average age was 39.8 years, which was younger than that of other malignant tumors.4) Nasal symptoms were noted in 36.8% of all initial symptoms of the malignant epipharyngeal tumors, aural symptoms in 23.7%, cranial symptoms in 21.0%, cervical symptoms in 15.8% and pharyngeal symptoms in 2.6%. Cervical lymphadenopathy was found in 66.7% of the patients, unilaterally in 10 subjects (83.3 %) and bilaterally in 2 subjects (16.7%).5) Cranial nerve symptoms were noted in 3 cases.6) The primary tumor sites were the posterior superior wall of the epiphrynx (10 cases, 55. 6%), lateral wall (7 cases, 38. 9%), anterior wall (0 cases, 0%) and unknown (1 cases, 6.6%).7) Histopathologically, carcinomas were found in 19 cases (83. 3%), mostly squamous cell carcinoma, and sarcomas were found in 3 cases (16.7%), mostly reticulum cell sarcoma.8) According to TNM classification (UICC) and stage classification (The American Joint Committee), 3 cases (16.7%) were in stage I, 2 cases (11, 1%) in stage II, 5 cases (27.8%) in stage III, 7 cases (38. 9%) in stage IV and last one (5. 6%) was unknown. The advanced stages of III and IV were seen in 12 cases (66.7%).9) Most patients were treated by external radiation (mainly cobalt 60 irradiation), chemotherapy and immuno-chemotherapy.10) The 3 year crude survival rate in 9 patients with malignant epipharyngeal tumors was approximately 44.4%.11) Okinawa Prefecture is closely located to Formosa, where numerous cases of malignant epipharyngeal tumor are found. However, the incidence of malignant epipharyngeal tumors in Okinawa Prefecture was less than in Formosa.