Last reviewed:September 2019
Last updated:February  2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk 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
  • haemodynamic instability

Other diagnostic factors

  • sore throat
  • otalgia
  • 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 >40 pack-years
  • alcohol use >8 units/day
  • GORD
  • achlorhydria
  • 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

Diagnostic investigations

1st investigations to order

  • neck CT with contrast
  • chest CT with contrast
  • fine needle aspiration of neck mass
  • flexible fibre-optic laryngoscopy
Full details

Investigations to consider

  • rigid videostroboscopy
  • rigid direct laryngoscopy
  • laryngeal biopsy
  • whole-body PET/CT scan
  • fluorescence endoscopy
Full details

Treatment algorithm

Contributors

Professor of Surgery

Yale Cancer Center

Yale School of Medicine

New Haven

CT

Disclosures

CS declares that he has no competing interests.

Otolaryngologist

Otolaryngology, Head and Neck Division

MedStar Washington Hospital Center

Georgetown University

Washington

DC

Disclosures

MP declares that he has no competing interests.

Dr Clarence Sasaki, and Dr Matthew Pierce would like to gratefully acknowledge Dr Scott V. Larson, Dr Hari Deshpande, Dr Elina Kari, and Dr Amy Chen, previous contributors to this topic.

Peer reviewersVIEW ALL

Director

Department of Surgical Sciences

Professor and Chairman

ENT Clinic

University of Udine

Udine

Italy

Disclosures

AF declares that he has no competing interests.

Assistant Professor

Department of Otolaryngology

Rush University Medical Center

Chicago

IL

Disclosures

SJC declares that he has no competing interests.

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