Laryngeal cancer is the 11th most common form of cancer and second most common malignancy of the upper aerodigestive tract in men.
Smoking and alcohol use are frequently associated with development of the disease.
Hoarseness, dysphonia, sore throat, difficulty swallowing, referred otalgia, vocal cord lesions on indirect laryngoscopy, and neck mass/adenopathy that persists for >3 weeks are sentinel signs that should be evaluated by an otolaryngologist.
Treatment is dictated by TNM stage.
Modalities include surgical resection, radiotherapy, chemotherapy, or any combination of these.
Goals of therapy are eradication of cancer with organ preservation.
Speech therapy is appropriate after surgery, radiotherapy, chemoradiotherapy, or any combination of these modalities.
Overall mortality has not changed in nearly 30 years, but the rate of organ preservation has significantly improved.
Laryngeal cancer most often refers to squamous cell carcinoma of the larynx. Other malignant tumours of the larynx (e.g., sarcoma, lymphoma, neuroendocrine tumours) are extremely rare in comparison. This disease consists of malignant tumours of mucosal origin that originate from the supraglottis, glottis, and subglottis. Specifically, this encompasses the following structures: the epiglottis, the vocal cords (false or true), and the area immediately below the vocal cords extending below the glottis.
History and exam
Key diagnostic factors
- presence of risk factors
- age >40 years
- odynophagia (painful swallowing)
- cervical lymphadenopathy
- supraglottic or glottic mass
- lesional erythroplasia, ulceration, necrosis, or bleeding
- signs of airway obstruction
- haemodynamic instability
Other diagnostic factors
- sore throat
- middle ear effusion
- weight loss or cachexia
- general distress
- oral and pharyngeal masses or leukoplakia
- loss of laryngeal crepitus
- parotid and thyroid growths
- diminished breath sounds
- tobacco use >40 pack-years
- alcohol use >8 units/day
- history of radiotherapy
- family history of laryngeal cancer
- black ethnicity
- male sex
- vocal fold dysplasia
- asbestos exposure
- Agent Orange exposure
- immunocompromised host
- human papillomavirus (HPV) exposure
- history of respiratory papillomatosis
1st investigations to order
- neck CT with contrast
- chest CT with contrast
- fine needle aspiration of neck mass
- flexible fibre-optic laryngoscopy
Investigations to consider
- rigid videostroboscopy
- rigid direct laryngoscopy
- laryngeal biopsy
- whole-body PET/CT scan
- fluorescence endoscopy
glottic or supraglottic
treatment not effective/appropriate
Matthew Pierce, MD
Otolaryngology, Head and Neck Division
MedStar Washington Hospital Center
MP declares that he has no competing interests.
Dr Matthew Pierce would like to gratefully acknowledge Dr Clarence Sasaki, Dr Scott V. Larson, Dr Hari Deshpande, Dr Elina Kari, and Dr Amy Chen, previous contributors to this topic. Unfortunately, we have been made aware that Dr Clarence Sasaki has passed away.
SVL, HD, EK, and AC declare that they have no competing interests.
Alfio Ferlito, MD, DLO, DPath, FRCSEd
Department of Surgical Sciences
Professor and Chairman
University of Udine
AF declares that he has no competing interests.
Steven J. Charous, MD, FACS
Department of Otolaryngology
Rush University Medical Center
SJC declares that he has no competing interests.
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