Clinical manifestations of laryngeal cancer 1. Supraglottic type includes laryngeal cancer occurring in the epiglottis, aryepiglottic fold (laryngeal side), aryepiglottic cartilage, ventricular zone, etc., mostly originating from the root of the laryngeal surface of the epiglottis. In the early stage, there are often no obvious symptoms, and when the tumor develops to a considerable extent, there are often only mild or non-specific symptoms, such as itching, foreign body sensation, swallowing discomfort, etc., which are not easy to alert the patients. The lymphatic vessels in the supraglottis area are rich, and the tumor is easy to metastasize to the cervical lymph nodes in the deep upper cervical group located at the bifurcation of common carotid artery. Because of poor differentiation and rapid development of supraglottic cancer, the tumor often draws attention only when cervical lymph node metastasis occurs. Throat pain often appears when the tumor infiltrates deeper or develops deeper ulcers. Hoarseness is caused by the tumor invading the arytenoid cartilage, the paraventricular space or involving the recurrent laryngeal nerve. Difficulty in breathing, difficulty in swallowing, coughing, blood in sputum and often foul smell are usually the advanced symptoms of supraglottic carcinoma. Due to the hidden location of tumors originating from the laryngeal surface of epiglottis or laryngeal chambers, it is often difficult to be detected by indirect laryngoscopy, and the lesions can be detected at an early stage by careful examination with fiberoptic laryngoscope. 2.Vocal fold cancer is a laryngeal cancer that occurs in the vocal folds, and the early symptom is hoarseness. As the tumor increases, the hoarseness gradually increases. When the tumor increases further, dyspnea will appear, which is often caused by the restricted or fixed movement of vocal folds and the blockage of vocal folds by tumor tissues. Blood in sputum may occur when the tumor surface is eroded. In the late stage, the tumor develops to the supra- or infra-vocal area, and in addition to severe hoarseness or loss of voice, symptoms such as radioactive ear pain, dyspnea, dysphagia, frequent cough, difficulty in coughing up sputum and bad breath may occur. Since there are fewer lymphatic vessels in the vocal fold area, it is not easy to metastasize to the lymph nodes in the neck. Subglottic type is laryngeal cancer that occurs below the plane of vocal cords and above the lower edge of cricoid cartilage. Subglottic laryngeal cancer is rare, because of its concealed location and inconspicuous early symptoms, it is not easy to be detected during routine laryngoscopy. When the tumor develops to a considerable extent, symptoms such as irritating cough, hoarseness, hemoptysis and dyspnea may appear. This type of laryngeal cancer can penetrate the cricothyroid membrane and invade the anterior cervical muscles and thyroid gland, and also invade the anterior wall of esophagus. The subglottic laryngeal cancer often has metastasis to the pre-tracheal or paratracheal lymph nodes. In addition, some scholars believe that there is another type of laryngeal carcinoma called transglottic carcinoma, which is a carcinoma originating from the laryngeal ventricle and spanning two anatomical regions (supraglottic region and glottic region), with cancerous tissue infiltrating and expanding under the mucosa, characterized by extensive infiltration of the paraglottic space. This type of carcinoma is controversial and has not been confirmed by the UICC organization. The early symptoms of this type of laryngeal cancer are not obvious, and the vocal cords are often fixed by the time hoarseness appears, and laryngoscopy still fails to visualize the tumor. This type of laryngeal cancer extends into the paravocal space and invades the thyroid cartilage. Examination: All parts of the larynx should be carefully examined by laryngoscopy. Particular attention should be paid to the laryngeal surface of the epiglottis, anterior commissure, laryngeal chambers and subglottic area, which are relatively hidden. Cauliflower-like, nodular or ulcerative swellings in the larynx may be seen (Figure). Care should be taken to observe whether the vocal fold movement is restricted or fixed. It is also important to carefully touch whether the anterior epiglottis space is full, whether there are enlarged lymph nodes in the neck, whether the laryngeal body is enlarged, and whether there are masses in the soft tissues of the anterior neck and the thyroid gland. Diagnosis】Diagnosis is mainly based on symptoms, examination and biopsy. Anyone older than 40 years old with hoarseness or throat discomfort or foreign body sensation should be carefully examined by laryngoscopy to avoid missing the diagnosis. For suspicious lesions, biopsy should be performed under indirect laryngoscopy, fiberoptic laryngoscopy or direct laryngoscopy to determine the diagnosis. Lateral laryngeal X-ray, laryngeal CT and MRI can help to understand the extent of tumor infiltration. Differential diagnosis】 Laryngeal cancer should be differentiated from the following diseases: 1. Laryngeal nodule The main symptoms are laryngeal pain and hoarseness. The laryngeal pain is more intense; the occurrence of hypoacusis and even loss of voice. Laryngoscopy shows pale edema of laryngeal mucosa with multiple superficial ulcers, and the lesions are mostly located in the posterior part of the larynx. It may also show extensive edema and superficial ulcers in the epiglottis and aryepiglottic folds. On chest x-ray, some patients have progressive tuberculosis, but many patients with laryngeal tuberculosis have a negative lung examination. Sputum examination for Mycobacterium tuberculosis is helpful in the differential diagnosis. The differentiation of laryngeal nodules depends on biopsy. 2.Papillary laryngeal tumor mainly presents with hoarseness and has a long course. The tumor can be single or multiple, papillary, light red or gray-white, and is often difficult to distinguish from laryngeal cancer with the naked eye. Adult laryngeal papilloma is prone to malignant transformation and must be identified by biopsy. 3.Laryngeal syphilis has hoarseness and mild laryngeal pain. The laryngoscopic lesions are mostly found in the anterior part of the larynx, with red and swollen mucosa, often with elevated syphilitic nodules and deep ulcers, and contracted scar adhesions after healing, resulting in laryngeal malformation. Serological examination and laryngeal biopsy can make the distinction.