Laryngeal cancer

Last reviewed: 28 Aug 2022
Last updated: 22 Apr 2021

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
More key diagnostic factors

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
Other diagnostic factors

Risk factors

  • tobacco use >40 pack-years
  • alcohol use >8 units/day
  • GERD
  • achlorhydria
  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • neck CT with contrast
  • chest CT with contrast
  • fine needle aspiration of neck mass
  • flexible fiberoptic laryngoscopy
More 1st investigations to order

Investigations to consider

  • rigid videostroboscopy
  • rigid direct laryngoscopy
  • laryngeal biopsy
  • whole-body PET/CT scan
  • fluorescence endoscopy
More investigations to consider

Treatment algorithm

ACUTE

glottic or supraglottic

subglottic

ONGOING

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 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.

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.

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