Signs & Symptoms
If any of the following persists for more than 2 weeks it can be concerning for laryngeal cancer:
- Hoarseness
- Sore Throat
- Unilateral Ear Pain
- Dysphagia
- Odynophagia
- Neck mass
- Weight loss
- Dyspnea on exertion or shortness of breath
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Signs & Symptoms
Shepherd et al. evaluated symptom recognition for laryngeal cancer by primary care providers
- Hoarseness was the most sensitive symptom
- When combined with a second symptom the risk increases > 3%
- Highest Positive Predictive Values (PPV) are for hoarseness with sore throat or elevated inflammatory markers
Workup by the Primary Care Provider
For any patient who presents with a “warning symptom” of laryngeal cancer, a thorough head and neck exam should be completed.
Physical Exam
- Note voice quality
- Note any stridor or concern for increased work of breathing
- Evaluate oral cavity and oropharynx for lesions both visually and by palpation
- Palpate for cervical lymphadenopathy
- Refer to otolaryngologist for laryngeal exam
Additional Considerations
Biopsy
- Consider Fine Needle Aspiration (FNA) for persistent cervical lymphadenopathy greater than 2 weeks
Imaging
- Consider a CT Neck with contrast if neck mass is present or suspicion for laryngeal cancer is high based on symptoms
- Consider PET/CT if an FNA is positive for malignancy
When to Refer
When signs and symptoms of laryngeal cancer have been persistent for 2 WEEKS or MORE.
High risk groups:
- Age > 50
- Male sex
- African American race
- History of tobacco or alcohol use (also remember that laryngeal cancer can occur in patients without these risk factors)
Quiz
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