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Suspect laryngeal cancer in patients with sore throat and hoarseness, GPs urged

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 BJGP, 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 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.’

Readers' comments (8)

  • Moor groundbreaking 'research' from the BJGP/RCGP isn't this just basic medicine, this is what we all do already.Is this just 'Top' GPs regurgitating basic medicine in the form of research to become a more important 'Top"GP .pathetic.

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  • Teaching granny to suck eggs come to mind....

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  • 1/2 my clinic this am are persistent sore throats and hoarseness. Send the, all in?

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  • Well I never thought that. I was sure persistent hoarseness and sore throat meant suspect a rectal prolapse.
    Thanks for the groundbreaking research

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  • AlanAlmond

    GPs should consider the possibility of infection in the under fives with a raised tympanic membrane temperature.

    Respiratory tract infection should be considered in those presenting with cough of recent onset where another explanation is unlikely.

    Anyone need any more advice please get in touch.

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  • Bob Hodges

    This as been in the 2 week wait referral criteria for over a decade!

    Talk about old news.

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  • Another revelation from Department of the Blindingly Obvious.

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  • 2016 - 1771 cases in uk - hoarseness 4 weeks, more likely in smokers, excess alcohol, 80% male. this study looked at 813 cases, hoarseness alone in 52% of cases only, raised inflammatory markers in only 9%, average age 67 years, mostly male. Having seen a case of tonsillar cancer recently, speaking to an ent surgeon, this is becoming more common, seen in non smokers, will increase as tonsils not being removed anymore, older person, non smoker, unilateral ear pain, check their throat was the advice.

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