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- Page navigation anchor for Recognising laryngeal cancer - hoarseness and neck lump 90% accurateRecognising laryngeal cancer - hoarseness and neck lump 90% accurate
We thank Bradley for his interest and perspective on our paper.1 We concur with most of his points, but wish to raise one point of caution. While the National Audit is a very useful resource,2 it focusses on patients after a cancer diagnosis, has no primary care data, or information on patients without cancer. Thus we have to be careful in extrapolating to the selection of patients by primary care for specialist investigation. The Audit is an example of spectrum bias, whereby patients in the referred population have different cancer symptoms to those in the community due to the selection process.3 It is not surprising the patients in that audit had predominately hoarseness and neck lumps – as they were the only features recommended for referral at that time. These may be late symptoms of laryngeal cancer, especially the neck masses. We wish to emphasise the possibility of laryngeal cancer in the over 60s when certain symptom combinations are present. So, we wholly agree with the last line of his letter welcoming early referral.
References
1. Shephard EA, Parkinson MA, Hamilton WT. Recognising laryngeal cancer in primary care: a large case-control study using electronic records. Br J Gen Pract 2019;69(679):e127-e33.
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2. Health and Socia...Competing Interests: None declared. - Page navigation anchor for Recognising laryngeal cancer - hoarseness and neck lump 90% accurateRecognising laryngeal cancer - hoarseness and neck lump 90% accurateThe head and neck clinicans are grateful to Shephard E et al for their recent publication on “recognising laryngeal cancer in primary care”.1 The incidence of laryngeal cancer in the UK has declined by nearly 20% but has levelled off since 2002.2 This decline is considered to be linked with the reduction in smoking rather than alcohol.3Shephard et al1 it is unclear which symptoms from the “disparate range” reported in previous research are associated with laryngeal cancer in primary care. The larynx has three anatomical sub-sites : the glottis or vocal cords – involved in vocalisation resulting in constant hoarseness,4 the supraglottic – above the vocal cords – involved in laryngeal protect (solids and fluids) and maintaining an airway. The third - subglottis rarely involved in primary cancer.5Analysis of laryngeal cancer in England/Wales 2013 – 20146 allowed for 1051 to be studied; 844 early stage disease (T1/T2NO) – glottic 774 (>90%) and supraglottic 70 – the majority presented with hoarseness, and <10% had other symptoms. The advanced stage disease (T3/4 N0 – N+) was recorded in 607; glottic involvement was T3N0 167 and T40 99 = 266/378 – 70.2% would have hoarseness. The remaining advanced gl...Show MoreCompeting Interests: None declared.