Persistent throat or ear pain, especially with swallowing.
Stridor or other symptoms of a compromised airway .
? General Considerations
SCC of the larynx, the most common malignancy of the larynx, occurs almost exclusively in patients with a history of significant tobacco use. SCC is usually seen in men age 50-70 years; about 13,000 new cases are seen in United States each year. There may be an association between laryngeal cancer and HPV type 16 or 18 infection, but this association is much less strong than that between HPV 16 or 18 and oropharyngeal cancer. In both cancer types, the association with HPV seems to be strongest in nonsmokers. Laryngeal cancer is very treatable and early detection is the key to maximizing posttreatment voice , swallowing, and breathing function.
? Clinical Findings
A. Symptoms and Signs
A change in voice quality is most often the presenting complaint , although throat or ear pain, hemoptysis, dysphagia, weight loss, and airway compromise may occur. Because of their early impact on vocal quality, glottic cancers are among the smallest detectable human malignancies and treatment success is very high with early lesions . Neck metastases are not common in early glottic (true vocal fold ) cancer in which the vocal folds are mobile, but a third of patients in whom there is impaired fold mobility will also have involved lymph nodes at neck dissection. Supraglottic carcinoma (false vocal folds, aryepiglottic folds, epiglottis ), on the other hand, often metastasizes to both sides of the neck early in the disease . Complete head and neck examination, including laryngoscopy, by an experienced clinician is mandated for any person with the concerning symptoms listed under Essentials of Diagnosis.
B . Imaging and Laboratory Studies
Radiologic evaluation by CT or MRI is helpful in assessing tumor extent. Imaging evaluates neck nodes, tumor volume, and cartilage sclerosis or destruction. A chest CT scan is indicated if there are level VI enlarged nodes (around the trachea and the thyroid gland) or IV enlarged nodes (inferior to the cricoid cartilage along the internal jugular vein) or if a chest film is concerning for a second primary lesion or metastases . Laboratory evaluation includes complete blood count and liver function tests. Formal cardiopulmonary evaluation may be indicated, especially if partial laryngeal surgery is being considered. All partial laryngectomy candidates should have good to excellent lung function and exercise tolerance because chronic microaspiration may be expected following the procedure. A positron emission tomography (PET) scan or CT-PET scan may be indicated to assess for distant metastases when there appears to be advanced local or regional disease.