Which investigations are recommended for confirming a diagnosis of laryngeal cancer in primary care?

Investigations recommended in primary care to confirm a diagnosis of laryngeal cancer include:

• Consider urgent referral via a suspected cancer pathway for people aged 45 and over presenting with persistent unexplained hoarseness or an unexplained lump in the neck, as these symptoms raise suspicion of laryngeal cancer. This referral is the key step in primary care to facilitate further diagnostic workup by specialists NICE NG12.
• Primary care itself does not perform definitive diagnostic investigations such as biopsy or imaging to confirm laryngeal cancer; these are conducted after referral to secondary care. However, initial assessment should include clinical examination and history to identify red-flag symptoms warranting urgent referral NICE NG12.

Subsequent investigations after referral (in secondary care) include:

• Endoscopic examination with narrow-band imaging to identify the primary tumour site NICE NG36.
• Biopsy of the suspected lesion to confirm diagnosis histologically NICE NG36.
• Imaging such as CT or MRI to assess tumour extent and staging NICE NG36.
• Ultrasound-guided fine-needle aspiration cytology or core biopsy of neck lumps if present NICE NG36.

In summary, in primary care, the recommended investigation is prompt recognition of symptoms and urgent referral for suspected cancer; definitive diagnostic investigations are performed in secondary care NICE NG36,NICE NG12.