Summary
Definition
History and exam
Key diagnostic factors
- age >40 years
- hoarseness
- dysphagia
- odynophagia (painful swallowing)
- cervical lymphadenopathy
- supraglottic or glottic mass
- lesional erythroplasia, ulceration, necrosis, or bleeding
- signs of airway obstruction
- hemodynamic instability
Other diagnostic factors
- sore throat
- otalgia
- dyspnea
- middle ear effusion
- stridor
- weight loss or cachexia
- general distress
- oral and pharyngeal masses or leukoplakia
- loss of laryngeal crepitus
- parotid and thyroid growths
- diminished breath sounds
Risk factors
- tobacco use
- alcohol use >8 units/day
- history of radiation therapy
- black ethnicity
- male sex
- vocal fold dysplasia
- GERD
- achlorhydria
- family history of laryngeal cancer
- Agent Orange exposure
- human papillomavirus (HPV) infection
Diagnostic tests
1st tests to order
- neck CT with contrast
- chest CT with or without contrast
- MRI with and without contrast
- fine needle aspiration of neck mass
- flexible fiberoptic laryngoscopy
Tests to consider
- rigid videostroboscopy
- rigid direct laryngoscopy
- immunohistochemistry testing
- laryngeal biopsy
- FDG-PET/CT scan
- fluorescence endoscopy
Treatment algorithm
glottic or supraglottic
subglottic
treatment not effective/appropriate
Contributors
Authors
Matthew Pierce, MD
Otolaryngologist
Otolaryngology, Head and Neck Division
MedStar Washington Hospital Center
Georgetown University
Washington, DC
Disclosures
MP declares that he has no competing interests.
Acknowledgements
Dr Matthew Pierce would like to gratefully acknowledge Dr Scott V. Larson, Dr Hari Deshpande, Dr Elina Kari, Dr Amy Chen, and the late Dr Clarence Sasaki, previous contributors to this topic.
Disclosures
SVL, HD, EK, and AC declare that they have no competing interests.
Peer reviewers
Alfio Ferlito, MD, DLO, DPath, FRCSEd
Director
Department of Surgical Sciences
Professor and Chairman
ENT Clinic
University of Udine
Udine
Italy
利益声明
AF declares that he has no competing interests.
Steven J. Charous, MD, FACS
Assistant Professor
Department of Otolaryngology
Rush University Medical Center
Chicago, IL
利益声明
SJC declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: head and neck cancers [internet publication].全文
Forastiere AA, Ismaila N, Lewin JS, et al. Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2018 Apr 10;36(11):1143-69.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Laryngitis
- Fungal laryngitis
- Sarcoidosis
更多 鉴别诊断指南
- NCCN clinical practice guidelines in oncology: head and neck cancers
- Expert consensus statement: management of dysphagia in head and neck cancer patients
更多 指南患者教育信息
Quitting smoking
更多 患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明