Last reviewed: December 2018
Last updated: January  2018



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 >40 pack-years
  • alcohol use >8 units/day
  • GERD
  • achlorhydria
  • hx of radiation therapy
  • FHx of laryngeal cancer
  • black ethnicity
  • male sex
  • vocal fold dysplasia
  • asbestos exposure
  • Agent Orange exposure
  • immunocompromised host
  • human papillomavirus (HPV) exposure
  • hx of respiratory papillomatosis

Diagnostic investigations

1st investigations to order

  • neck CT with contrast
  • chest CT with contrast
  • FNA of neck mass
  • flexible fiberoptic laryngoscopy
Full details

Investigations to consider

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

Treatment algorithm


Authors VIEW ALL

Professor of Surgery

Yale Cancer Center

Yale School of Medicine

New Haven



CS declares that he has no competing interests.

Head and Neck Fellow

Yale University

New Haven



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. SVL, HD, EK, and AC declare that they have no competing interests.

Peer reviewers VIEW ALL


Department of Surgical Sciences

Professor and Chairman

ENT Clinic

University of Udine




AF declares that he has no competing interests.

Assistant Professor

Department of Otolaryngology

Rush University Medical Center




SJC declares that he has no competing interests.

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