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
- whole-body 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
Disclosures
AF declares that he has no competing interests.
Steven J. Charous, MD, FACS
Assistant Professor
Department of Otolaryngology
Rush University Medical Center
Chicago
IL
Disclosures
SJC declares that he has no competing interests.
Differentials
- Laryngitis
- Fungal laryngitis
- Sarcoidosis
More DifferentialsGuidelines
- NCCN clinical practice guidelines in oncology: head and neck cancers
- Expert consensus statement: management of dysphagia in head and neck cancer patients
More GuidelinesPatient information
Quitting smoking
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