Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- idade >40 anos
- rouquidão
- disfagia
- odinofagia (deglutição dolorosa)
- linfadenopatia cervical
- massa supraglótica ou glótica
- eritroplasia lesional, ulceração, necrose ou sangramento
- sinais de obstrução das vias aéreas
- instabilidade hemodinâmica
Other diagnostic factors
- faringite
- otalgia
- efusão no ouvido médio
- estridor
- perda de peso ou caquexia
- sofrimento geral
- massas orofaríngeas ou leucoplasia
- perda de crepitação laríngea
- crescimentos na parótida e tireoide
- murmúrio vesicular diminuído
Risk factors
- tabagismo
- uso de álcool >8 unidades/dia
- história de radioterapia
- etnia negra
- sexo masculino
- displasia das pregas vocais
- Doença do refluxo gastroesofágico (DRGE)
- acloridria
- história familiar de câncer laríngeo
- exposição ao Agente Laranja
- infecção por papilomavírus humano (HPV)
Diagnostic tests
1st tests to order
- tomografia computadorizada (TC) de pescoço com contraste
- TC de tórax com ou sem contraste
- RNM com e sem contraste
- aspiração por agulha fina (AAF) da massa cervical
- laringoscopia com fibra óptica flexível
Tests to consider
- videoestroboscopia rígida
- laringoscopia direta e rígida
- teste de imuno-histoquímica
- biópsia da laringe
- PET/TC do corpo inteiro
- endoscopia de fluorescência
Treatment algorithm
glótico ou supraglótico
subglótico
tratamento ineficaz/inadequado
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: head and neck cancers [internet publication].Full text
Forastiere AA, Ismaila N, Lewin JS, et al. Use of larynx-preservation strategies in the treatment of laryngeal cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2018 Apr 10;36(11):1143-69.Full text Abstract
American College of Radiology. ACR Appropriateness Criteria: retreatment of recurrent head and neck cancer after prior definitive radiation. 2014 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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