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Key Features

Essentials of Diagnosis

  • New and persistent (> 2 weeks duration) hoarseness in a smoker

  • Persistent throat or ear pain, especially with swallowing

  • Neck mass

  • Hemoptysis

  • Stridor or other symptoms of a compromised airway

General Considerations

  • Head and neck examination, including laryngoscopy, in patients with concerning symptoms or signs or unexplained weight loss, especially in those over 45 who smoke tobacco

  • Examination components include

    • Systematic intraoral, pharyngeal, and laryngeal examination (including the lateral tongue, floor of the mouth, gingiva, buccal area, palate, tonsillar fossae, and indirect or fiberoptic examination of the pharynx and larynx)

    • Palpation of the neck for enlarged lymph nodes

Demographics

  • Occurs predominantly in heavy smokers and/or those with significant alcohol use

  • Most common in men between ages 50 and 70

  • An estimated 13,490 new cases in both sexes (10,550 in men) were seen in United States in 2016

Clinical Findings

Symptoms and Signs

  • Throat or ear pain

  • Weight loss

  • Hemoptysis

  • Change in speech/voice quality (including hoarseness or dysarthria)

  • Dysphagia

  • Airway compromise

  • Neck metastases are not common in early glottic (true vocal fold) cancer; however, one-third of patients with impaired vocal fold mobility will also have involved lymph nodes at neck dissection

  • Supraglottic carcinoma (false vocal folds, aryepiglottic folds, epiglottis) often metastasizes to both sides of the neck early in the disease

  • Visible mass (as seen on oral examination or indirect or fiberoptic pharyngoscopy)

  • Palpable mass in base of tongue or tonsil

  • Neck adenopathy (usually hard)

Differential Diagnosis

OROPHARYNX MASS

  • Occasionally a tumor can be misdiagnosed as a peritonsillar abscess

LARYNGEAL MASS

  • Vocal cord nodules

  • Papillomas or granulomas

  • Leukoplakia, as in the oral cavity, requires clarification clinically or by biopsy as judged by an experienced clinician

ORAL MASS

  • Aphthous ulcer (canker sore, ulcerative stomatitis)

  • See Leukoplakia & Erythroplakia and Lichen Planus for additional differential diagnosis

NASOPHARYNX MASS

  • Occasional benign cysts can mimic a tumor

Diagnosis

Laboratory Tests

  • Complete blood count, liver chemistry tests

Imaging Studies

  • CT or MRI is helpful in assessing tumor extent

  • Chest CT may be indicated if there is concern for a second primary mass in the lung or for lung metastases

  • PET or PET-CT may be helpful

Diagnostic Procedures

  • Laryngoscopy

  • Esophagoscopy and bronchoscopy are recommended at the same time to exclude synchronous primary cancers in these locations

  • Fine-needle aspiration biopsy may confirm the presence of the carcinoma and the histologic type, but caution and clinical judgment should be exercised in interpreting an apparently negative result

Treatment

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