PRESENTATION
The presentation of laryngeal cancer is determined by the size of the tumour and the location. It is divided into local, regional and systemic presentation symptoms. The systemic ones would be weight loss and weakness. The regional ones would be the detection of a neck mass, aspiration of liquids or food stuff, difficulty swallowing, and ear pain. The obvious local symptoms would be hoarseness, obstruction of the airway with stridor and shortness of breath, pain, halitosis and a bloody sputum.
HISTORY
The history is closely linked to the presentation and the duration of symptoms is important together with obviously a smoking history.
CLINICALLY
The doctor will do a full Head and Neck examination looking for second primaries, examining the teeth, the Neck for lymph nodes and of course the Larynx. This is done using a flexible nasopharyngolaryngoscope. If a tumour is seen, the size and position and extent is determined together with whether there is movement of the vocal cords or not.
INVESTIGATIONS
A Direct Laryngoscopy with biopsy is essential to confirm the diagnosis, to stage the tumour and to plan management. A CT scan is also done to confirm the extent of the tumour and to assess the glands in the neck. Other investigations that can be done is a PET scan looking for distant secondaries and an MRI scan which would further assist the staging.