Persistent sore throat may be a warning sign for laryngeal cancer, study suggestsBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l435 (Published 29 January 2019) Cite this as: BMJ 2019;364:l435
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Re: Persistent sore throat may be a warning sign for laryngeal cancer, more likely to be a "Throat Cancer" - Oropharynx or Hypopharynx
The head and neck clinicians are grateful to Shephard E et al for their recent publication on “recognising laryngeal cancer in primary care”.  The incidence of laryngeal cancer in the UK has declined by nearly 20% but has levelled off since 2002. . This decline is considered to be linked with the reduction in smoking rather than alcohol. 
Shephard et al  it is unclear which symptoms from the “disparate range” reported in previous research are associated with laryngeal cancer in primary care. The larynx has three anatomical sub-sites : the glottis or vocal cords – involved in vocalisation resulting in constant hoarseness , the supraglottic – above the vocal cords – involved in laryngeal protect (solids and fluids) and maintaining an airway. The third - subglottis rarely involved in primary cancer.
Analysis of laryngeal cancer in England/Wales 2013 – 2014  allowed for 1051 to be studied; 844 early stage disease (T1/T2NO) – glottic 774 (>90%) and supraglottic 70 – the majority presented with hoarseness, and <10% had other symptoms. The advanced stage disease (T3/4 N0 – N+) was recorded in 607; glottic involvement was T3N0 167 and T40 99 = 266/378 – 70.2% would have hoarseness. The remaining advanced glottic had hoarseness and a neck mass (104/378) - 27.5% whereas (136/229) 59% advanced supraglottic had a palpable neck mass in (136/229) 59% and the remainder (31/229) 13.5% would have presented with non-specific throat symptoms.
A diagnosis of laryngeal cancer can only be made by inspection of the larynx and confirmed by tissue biopsy reported by a histopathologists confirming a malignant process most commonly squamous cell carcinoma. A patient who present with throat pain without any hoarseness should be referred to a head and neck clinic as a suspected “throat cancer” as pain alone or with a neck mass is more suggestive that the primary malignancy is located in the oropharynx/ hypopharynx or the supraglottic.
To conclude: patients who have persistent throat symptoms are best referred sooner than later, and more so men who are or have been smokers!
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Competing interests: No competing interests