Laryngeal Cancer

Condition

SCC is the overwhelming majority of laryngeal cancers. Risk factors: smoking or history of smoking; moderate-heavy alcohol use; poor nutrition; workplace exposure to irritants (wood dust, paint fumes, chemicals); asbestos exposure. Larynx and hypopharyngeal cancers are more common among African American and Caucasian populations than Asian and Latino populations.

History

Chronic laryngitis; hoarseness; stridor; haemoptysis; dysphagia.

Symptoms suggestive of malignancy: new throat pain or referred otalgia; new progressive dysphagia to solids or liquids; stridor or upper airway noise; new nasal obstruction; weight loss; persistent unilateral mid-cervical lymphadenopathy.

Examination

Palpate the neck for lumps and lymph nodes.

Investigations

Fibre-optic laryngoscopy and biopsy.

Management

All hoarseness persisting >3 weeks should be referred for laryngoscopy — consider more urgent referral if other malignancy symptoms are present, or if the patient has multiple risk factors.

Small local tumours can be treated with radiotherapy or laser therapy. Larger tumours usually require laryngectomy ± lymph node dissection. Post-surgical support in speech, eating, and tracheostomy care is required.

Survivorship and surveillance (post-treatment)

After formal head and neck cancer surveillance ends (typically discharge from oncology follow-up around the 5-year mark), GPs take on longer-term surveillance. Red flags warranting urgent re-referral in a previously-treated patient: new odynophagia, dysphagia, haemoptysis, dysphonia, otalgia without an obvious cause, or a new neck lump. Patients with a cutaneous primary (e.g. skin SCC of the head/neck) should have 6–12-monthly skin checks. Late treatment effects (radiotherapy-related hypothyroidism, xerostomia, lymphoedema, second primary malignancy risk from shared risk factors) also need ongoing GP awareness.