Differential diagnosis of laryngeal cancer

When diagnosing laryngeal cancer, it is necessary to differentiate it from the following diseases:

(1) Laryngeal tuberculosis: Early laryngeal cancer must be differentiated from laryngeal tuberculosis. Laryngeal cancer often occurs in the anterior 2/3 of the vocal cords, and almost no laryngeal cancer occurs in the interarytenoid notch. Laryngeal tuberculosis lesions are mostly located in the posterior part of the larynx, manifested as pale and edematous laryngeal mucosa, accompanied by multiple superficial ulcers, such as worm-eaten; congestion and thickening of the vocal cord on one side may also occur, but the epiglottis and aryepiglottic folds have more extensive edema and superficial ulcers. The main symptoms of laryngeal tuberculosis are hoarseness and sore throat. Pulmonary X-rays and sputum tuberculosis examinations are helpful for differential diagnosis, but ultimately it still depends on biopsy.

(2) Laryngeal papilloma: Laryngeal papilloma can be single or multiple. It has a rough, light red appearance and no vocal cord movement disorder. Laryngeal cancer is mostly single and extremely difficult to identify with the naked eye. Laryngeal papilloma in adults is especially prone to malignant transformation and requires biopsy for identification.

(3) Laryngeal amyloid tumor: It is not a true tumor, but may be caused by amyloidosis of laryngeal tissue due to chronic inflammation, blood and lymphatic circulation disorders, and metabolic disorders. It manifests as a dark red mass in the vocal cords, laryngeal ventricle or subglottic area with a smooth surface. During biopsy, it feels hard and difficult to remove with forceps. It is easy to identify by pathological examination.

(4) Laryngeal syphilis: The lesions are mostly located in the front part of the larynx, the mucosa is red and swollen, and there are often syphilitic tumors, followed by deeper ulcers, which destroy more tissues. After healing, there are scar contraction and adhesion, causing laryngeal deformity. The patient has a hoarse but powerful voice and mild throat pain. There is a history of sexually transmitted diseases, and the Kang-Hua reaction is positive, which can be confirmed by biopsy. Recurrent laryngeal nerve paralysis and cricoarytenoid arthritis can also be misdiagnosed as laryngeal cancer. Conversely, laryngeal cancer is often mistaken for recurrent laryngeal nerve paralysis or cricoarytenoid arthritis, and should be carefully differentiated. Laryngeal cancer should also be differentiated from laryngeal keratosis, laryngeal mucosal leukoplakia, respiratory sclerosis, ectopic thyroid gland in the trachea or larynx, laryngeal edema, and laryngeal chondroma.