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Laryngeal cancer

Key sources
The following summarized guidelines for the evaluation and management of laryngeal cancer are prepared by our editorial team based on guidelines from the American Society of Clinical Oncology (ASCO 2022; 2018), the European Society for Radiotherapy and Oncology (ESTRO/EHNS/ESMO 2020), the American College of Radiology (ACR 2019), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2017), the American Cancer Society (ACS 2016), and the United Kingdom National Multidisciplinary Guidelines (UKNMG 2016).
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Guidelines

1.Classification and risk stratification

Staging: use the UICC TNM system for staging.
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2.Diagnostic investigations

History and physical examination: as per EHNS 2020 guidelines, obtain a clinical assessment in patients with suspected laryngeal cancer.
B

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  • Diagnostic imaging

3.Diagnostic procedures

Fine-needle aspiration
Perform FNA instead of open biopsy in patients with a neck mass of uncertain diagnosis deemed at increased risk for malignancy.
B
Continue evaluating patients with a cystic neck mass, as determined by FNA or imaging, until a diagnosis is obtained instead of assuming that the mass is benign.
B

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  • Tumor biopsy

  • Ancillary testing

4.Medical management

General principles: manage patients with oropharyngeal cancer at high-volume facilities.
B
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  • Management of locoregional disease (general principles)

  • Management of locoregional disease (induction chemotherapy)

  • Management of locoregional disease (primary surgery or radiotherapy)

  • Management of locoregional disease (postoperative chemoradiotherapy)

  • Management of locoregional disease (primary chemoradiotherapy)

  • Management of locoregional disease (elective neck dissection/irradiation)

  • Management of metastatic disease

  • Management of recurrent disease (locoregional disease)

  • Management of recurrent disease (advanced disease)

5.Nonpharmacologic interventions

Smoking cessation: encourage patients to abstain from smoking after the diagnosis and offer smoking cessation programs as necessary throughout and following treatment since continued cigarette smoking is associated with worse outcomes after therapy.
E

6.Therapeutic procedures

Technical considerations for radiotherapy
Use intensity-modulated radiotherapy or volumetric-modulated arc therapy for radiotherapy.
A
Use a hypoxic radiosensitizer agent to increase locoregional control and disease-free survival.
A

7.Perioperative care

Perioperative voice and swallow assessment
Obtain a baseline assessment of voice and swallowing function as part of a comprehensive pretreatment evaluation to establish the functional impact of tumor volume and extent and stage of disease on voice and swallowing outcomes. Counsel patients about the potential effect of treatment options on voice, swallowing, and QoL.
B
Use the following instrumental, performance status, and quality-of-life measures of voice and swallowing to evaluate the pre- and post-treatment function:
self-recorded and/or expert-rated voice-quality measures
voice-related quality-of-life tools
videostroboscopy
radiographic (videofluoroscopic) or fiber-optic laryngoscopic evaluation of swallowing
dietary assessment
B

8.Follow-up and surveillance

Serial clinical assessment: educate and counsel all head and neck cancer survivors about the signs and symptoms of local recurrence.
B
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  • Serial endoscopic assessment

  • Serial imaging assessment

  • Survivorship and rehabilitation (lifestyle modifications)

  • Survivorship and rehabilitation (neuromuscular complications)

  • Survivorship and rehabilitation (neurosensory complications)

  • Survivorship and rehabilitation (speech disturbance)

  • Survivorship and rehabilitation (oral and dental care)

  • Survivorship and rehabilitation (gastroesophageal complications)

  • Survivorship and rehabilitation (thyroid dysfunction)

  • Survivorship and rehabilitation (lymphedema)

  • Survivorship and rehabilitation (fatigue)

  • Survivorship and rehabilitation (sleep disorders)

  • Survivorship and rehabilitation (psychosocial distress)