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Last reviewed: 18 Mar 2025
Last updated: 08 Apr 2025

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk 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
  • haemodynamic instability

Other diagnostic factors

  • sore throat
  • otalgia
  • 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
  • alcohol use >8 units/day
  • history of radiotherapy
  • black ethnicity
  • male sex
  • vocal fold dysplasia
  • GORD
  • achlorhydria
  • family history of laryngeal cancer
  • Agent Orange exposure
  • human papillomavirus (HPV) infection

Diagnostic investigations

1st investigations to order

  • neck CT with contrast
  • chest CT with or without contrast
  • MRI with and without contrast
  • fine needle aspiration of neck mass
  • flexible fibre-optic laryngoscopy

Investigations to consider

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

Treatment algorithm

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.

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