✅ MSRA Deep Dive: Laryngeal Cancer – Clinical Features, Referral Triggers, & Management
In this high-yield revision episode, we walk you through laryngeal cancer using clear insights from structured MSRA notes. From urgent referral red flags to staging, investigations, and treatment strategies, this is your shortcut to mastering this ENT malignancy before exam day.
🧠 Key Learning Points
📌 Definition
• Laryngeal cancer is a malignant tumour of the larynx (voice box)
• Most cases are squamous cell carcinomas affecting vocal cords, supraglottic or subglottic regions
📌 Urgent Referral Criteria (2WW)
🏥 Immediate ENT referral if:
• Aged ≥45 years with persistent unexplained hoarseness
• Or any unexplained neck lump
🔁 This criteria is repeated throughout the notes — must be memorised for exam questions
📌 Risk Factors & Pathophysiology
• Smoking = linked to 79% of UK cases
• Smoking + Alcohol = cause up to 93%
• Others: HPV-16, chronic GORD, male sex, age >60, chemical exposure
• Tumours arise from squamous cells with DNA mutations leading to uncontrolled growth → local invasion & metastasis
📌 Differential Diagnoses
Don’t jump to cancer:
• Vocal cord nodules or polyps
• Vocal cord paralysis
• Laryngitis
• Benign tumours
• Non-laryngeal malignancies
📌 Epidemiology (UK)
• 2nd most common head & neck cancer
• ~2,400 new UK cases (2021)
• Incidence: 2.9 per 100,000
• Predominantly males over 60
📌 Clinical Features
🗣️ Common:
• Persistent hoarseness (especially glottic cancers)
• Chronic sore throat, dysphagia, odynophagia
• Neck lump, persistent cough, haemoptysis
• Late: weight loss, fatigue
📌 Examination & Investigations
🔎 Clinical Exam:
• Head & neck exam, cranial nerve assessment, lymph node palpation
🧪 Key Investigations:
• Flexible laryngoscopy
• Biopsy (definitive diagnosis)
• CT/MRI for staging
• FNA of neck lumps
• Chest X-ray if hoarseness >3 weeks in older smokers
• EUA (examination under anaesthetic) to aid biopsy
📌 Staging
• TNM system
• Prognosis worsens with increased depth of infiltration
📌 Management
🎯 Depends on stage and location
• Early-stage:
Laser microsurgery
Radiotherapy
• Advanced-stage:
Total laryngectomy
Chemoradiation
Neck dissection if nodal disease
• Multidisciplinary team essential
• Speech/swallowing rehab critical post-op
• Aim: larynx preservation where possible
📌 Prognosis
📊 Survival varies by stage and location:
• 5-year survival ~70% (general)
• Early glottic cancers: >90% survival
• Advanced disease: ~54–55% depending on treatment
• Better prognosis in younger patients (15–49 years)
• Prognosis is better with early hoarseness detection
📌 Complications
• Recurrence, metastasis
• Voice loss, swallowing and breathing difficulties
• Nutrition issues, altered taste
• Psychological distress, body image impact
• Fistulas (rare but serious)
• Treatment side effects from surgery, radiotherapy, chemotherapy
• Emphasis on long-term follow-up and rehab
📌 Prevention Tips
🚭 Quit smoking
🍷 Limit alcohol
🥬 Healthy diet
🛑 Reduce chemical exposure
🌡️ Manage reflux
🔗 Laryngeal Cancer MSRA Revision Resources
📄 Notes: https://www.passthemsra.com/topic/laryngeal-cancer-revision-notes/
💬 Flashcards: https://www.passthemsra.com/topic/laryngeal-cancer-flashcards/
🧠 Q&A Notes: https://www.passthemsra.com/topic/laryngeal-cancer-accordion-qa-notes/
📝 Quiz: https://www.passthemsra.com/topic/laryngeal-cancer-rapid-quiz/
🎯 Quiz Portal: https://www.passthemsra.com/quizzes/laryngeal-cancer/
📚 ENT Course: https://www.passthemsra.com/courses/ent-for-the-msra/
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