GPAtlas🧭 When to suspect
Laryngeal cancer is uncommon but eminently curable when caught early.
• Over 1,700 people are diagnosed each year in England.
• The great majority are squamous cell carcinomas (SCC) arising in lifelong smokers.
• The cardinal primary-care symptom is persistent, unexplained hoarseness, which carries the highest individual cancer risk of any presenting feature.
The one decision that matters in general practice is whether the larynx needs to be looked at.
• The larynx cannot be examined directly in primary care, so recognise who needs a flexible nasendoscopy and refer them.
• Refer promptly on the suspected cancer pathway, or immediately if the airway is threatened.
| Presentation | Suspect | Action |
|---|---|---|
| Stridor, stertor or respiratory distress | Impending airway obstruction | 999 or immediate ENT – not a routine pathway |
| Persistent unexplained hoarseness ≥ 3 weeks, age ≥ 45 | Laryngeal cancer | Suspected cancer pathway referral |
| Unexplained lump in the neck, age ≥ 45 | Nodal or head & neck malignancy | Suspected cancer pathway referral |
| Persistent sore throat with dysphagia, otalgia or dyspnoea | Higher-risk symptom combination | Low threshold to refer or discuss |
| Hoarseness < 3 weeks, explained, or age < 45 | Usually benign (URTI, voice overuse, reflux) | • Treat cause, voice advice, review • Refer if it persists ≥ 3 weeks |
Suspect laryngeal cancer particularly in those aged 45 and over with any of:
• A smoking history (the strongest risk factor).
• Heavy alcohol use (synergistic with tobacco).
• Smokeless tobacco or betel quid (paan) use.
• Previous head and neck cancer, dysplasia or radiotherapy.
The National Institute for Health and Care Excellence (NICE) sets clear age and symptom thresholds for urgent referral.
|
🧠 Clinical pearl • Fewer than 1 in 30 suspected head and neck cancer referrals turn out to be cancer. • The commonest finding by far is laryngopharyngeal reflux. • Reassuringly, intermittent hoarseness and an isolated globus (sensation of a lump in the throat) are associated with benign disease. • What should worry you is the persistent, progressive or unilateral picture in an older smoker. |
Source: NICE NG12 · British Journal of General Practice
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