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, radiation therapy, chemotherapy, or any combination of these.
Goals of therapy are eradication of cancer with organ preservation.
Speech therapy is appropriate after surgery, radiation therapy, chemoradiotherapy, or any combination of these modalities.
Overall mortality has not changed in nearly 30 years, but the rate of organ preservation is significantly improved.
Laryngeal cancer most often refers to squamous cell carcinoma of the larynx. Other malignant tumors of the larynx (e.g., sarcoma, lymphoma, neuroendocrine tumors) are extremely rare in comparison. This disease consists of malignant tumors 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
- age >40 years
- 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
- 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 radiation therapy
- 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 fiberoptic 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
- Fungal laryngitis
- NCCN clinical practice guidelines in oncology: head and neck cancers
- Cetuximab for treating recurrent or metastatic squamous cell cancer of the head and neck
Middle ear infection
Outer ear infectionMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer