A large case-control study used electronic records to identify and quantify the symptoms associated with larynx cancer to help primary care physicians refer the right patients for further tests.
The larynx is the voice box located just below the pharynx or the throat in the neck. The larynx contains the vocal cords that make a sound when air passes through them. This sound echoes through the pharynx, mouth and nose to make the voice of a person. Larynx cancer is the disease in which cancer cells form in the thin, flat cells lining the inside of the larynx.
Larynx cancer is one of the more common types of head and neck cancer. It affects about 13,000 people in the US and about 2,400 people in the United Kingdom each year. It is more common in men than in women and as with most other cancer, larynx cancer is more common in older people. The use of tobacco and the misuse of alcohol increase the risk of larynx cancer.
Early detection is the key to successful treatment of larynx cancer
A delay in the diagnosis of larynx cancer is the main cause of poor prognosis in a patient. It is important for the primary care physicians to select appropriate patients for the referral if the symptoms point to larynx cancer. However, the lack of specific and notable symptoms associated with this cancer may lead to diagnostic delays that could worsen survival rate for larynx cancer.
Recognizing early symptoms and symptom combinations associated with larynx cancer
Larynx cancer grows slowly. Early referral of the appropriate high-risk patients by the primary care physician will help prompt diagnosis and treatment of larynx cancer. Based on the current guidelines from the National Institute for Health and Care Excellence (NICE), patients with persistent hoarseness and neck lump must be referred for further screening for suspected cancer. However, there are several other symptoms that may be associated with larynx cancer such as ear pain, difficulty in swallowing, wheezing, sore throat, and weight loss. Given the wide range of relatively low-level symptoms linked with larynx cancer, it is important to identify and quantify the association of these symptoms with the occurrence of this cancer.
A new study aimed to facilitate early detection of larynx cancer
A new research recently published in the British Journal of General Practice, used electronic patients records from the UK’s Clinical Practice Research Datalink (CPRD) to identify and quantify the individual and combined symptoms associated with the risk of larynx cancer in primary care patients. The researchers from the University of Exeter, UK, included 806 cases of patients and 3559 controls in the study. The clinical features of the patients included a total of 34 symptoms and 14 investigations such as inflammatory markers and liver function tests. Only 10 clinical features that were statistically significant were included in the final study analysis.
The researchers referred to a clinical feature as significantly associated with larynx cancer if it was reported twice on two subsequent consultation dates. The symptoms were monitored and counted for 12 months before the diagnosis of larynx cancer.
Hoarseness has the highest association with larynx cancer
The results of the statistical analysis revealed that hoarseness has the highest individual risk of larynx cancer. When hoarseness was combined with other symptoms such as difficulty while swallowing, mouth symptoms, earache, or shortness of breath, the risk of larynx cancer increased further. The highest risk was found for hoarseness combined with a sore throat or raised inflammatory markers.
The findings also showed that a persistent sore throat presented with shortness of breath, difficulty swallowing, or earache has a higher association with larynx cancer than the presence of hoarseness alone.
Interestingly, this study found no association between neck lumps and larynx cancer. However, the authors point out that neck lumps could be symptoms of lymphoma and should be further examined.
The findings may be helpful in improving survival rates of larynx cancer
The researchers of this study are optimistic that these findings will help reduce the diagnostic delays of larynx cancer. The study results provide a better understanding of symptom combinations that, previously thought to be low-key, may, in fact, be warning signs of larynx cancer. For instance, persistent sore throat in combination with shortness of breath should alert the primary care physician prompting patient referral for further investigation. This will help earlier diagnosis and better health outcome for patients.
The study used one of the largest medical records databases
The use of over 800 patient records from one of the world’s largest medical records database is the main strength of this study. The results are generalizable and the study included all pertinent symptoms that could be linked with larynx cancer.
The current recommendations may need improvement
The authors suggest that the current guidelines for patient referrals based on symptom presentation in primary care may need to be revised based on these results. Although the results support the current guidelines relating to hoarseness, they highlight a need to add other symptom combinations such as sore throat combined with an earache, difficulty in swallowing, or shortness of breath.
In conclusion, this study helps in the identification of symptom combinations that are associated with larynx cancer. The findings showed that a combination of persistent sore throat with hoarseness had the highest association with larynx cancer. Some other symptom combinations to look out for include hoarseness combined with an earache, shortness of breath, or difficulty in swallowing. The presentation of these symptoms in the primary care setting should be taken as a warning sign for selecting the appropriate patients for referral.
Written by Preeti Paul, MS Biochemistry
Reference: Elizabeth A Shephard et al., Recognising laryngeal cancer in primary care: a large case-control study using electronic records. Br J Gen Pract2019. DOI: https://doi.org/10.3399/bjgp19X700997
