How should I manage a patient with laryngeal cancer who presents with pain and difficulty swallowing?

Management of a patient with laryngeal cancer presenting with pain and difficulty swallowing should include:

• Assessment: Confirm diagnosis with biopsy and imaging (MRI or CT) to stage the tumour and plan treatment appropriately. Consider FDG PET-CT for systemic staging if advanced disease is suspected (beyond T2N0) ¹.
• Symptom management: Assess and support nutritional status early, including consideration of enteral nutrition or prophylactic feeding tube placement due to dysphagia ¹.
• Treatment options: For early-stage (T1-T2) laryngeal squamous cell carcinoma, offer transoral laser microsurgery or radiotherapy ¹.
• For advanced disease (T3), discuss with the patient the choice between radiotherapy with concomitant chemotherapy or surgery with adjuvant radiotherapy, considering swallowing function and airway status ¹.
• For T4a disease, surgery with adjuvant radiotherapy, with or without chemotherapy, is recommended ¹.
• Supportive care: Involve speech and language therapy for swallowing exercises and voice therapy as needed ¹.
• Palliative care: If airway obstruction or severe symptoms occur, consider endoluminal debulking rather than tracheostomy and involve palliative care teams ¹.