Author: Isobel Sims
GPs should suspect laryngeal cancer and consider urgent referral in patients who present with a persistent sore throat and hoarseness, according to a new study.
A recurrent sore throat in combination with symptoms such as hoarseness, difficulty swallowing or ear pain increases the likelihood that a patient has laryngeal cancer and may warrant urgent referral, the authors said.
The study, published in the British Journal of General Practice, was carried out by researchers at the University of Exeter and looked at primary care data for just over 800 patients diagnosed with laryngeal cancer, as well as just over 3,500 controls.
The researchers found hoarseness carried the greatest individual risk, with those presenting with the symptom having a 2.7% likelihood of having laryngeal cancer – just under the NICE (National Institue for Health & Care Excellene) threshold of 3% for urgent referral.
Patients presenting with a recurrent sore throat in combination with hoarseness had a 12% likelihood of having laryngeal cancer.
The likelihood of cancer was also increased above the NICE threshold when recurrent sore throat presented with dysphagia, recurrent dyspnoea, ear pain and raised inflammatory markers, the researchers said.
They found that, ‘unexpectedly’, neck lumps were not associated with laryngeal cancer.
The authors said the findings back up the NICE recommendation to consider referring patients with persistent unexplained hoarseness, but that GPs should also be vigilant about symptoms not currently listed in the NICE guidance.
The paper said: ‘This evidence supports some of the recommendations in current NICE guidance, particularly relating to hoarseness.It refutes the recommendation for neck lumps, though the clinician must still consider lymphoma.
‘It adds some new symptom combinations: sore throat supplemented by otalgia, dyspnoea, or dysphagia.
‘However, selection of patients for investigation is not simply a matter of totting up symptoms and positive predictive values. Clinical experience — although almost impossible to measure — adds to skilful decision making.’