For the purposes of staging, the larynx is divided into three anatomical regions: the glottis (true vocal cords, anterior and posterior commissures); the supraglottis (epiglottis, arytenoids and aryepiglottic folds, and false cords); and the subglottis.

Laryngeal cancer may spread by: direct extension to adjacent structures, metastasis to regional cervical lymph nodes, or via the blood stream.

Using alcohol and tobacco together is an especially high risk factor and causes 89% of laryngeal cancer cases.

[citation needed] Diagnosis is made by the doctor on the basis of a medical history, physical examination, and special investigations which may include a chest x-ray, CT or MRI scans, and tissue biopsy.

[citation needed] The physical exam includes a systematic examination of the whole patient to assess general health and to look for signs of associated conditions and metastatic disease.

The neck and supraclavicular fossa are palpated to feel for cervical adenopathy, other masses, and laryngeal crepitus.

Indirect laryngoscopy can be highly effective, but requires skill and practice for consistent results.

For this reason, many specialist clinics now use fibre-optic nasal endoscopy where a thin and flexible endoscope, inserted through the nostril, is used to clearly visualise the entire pharynx and larynx.

A full endoscopic examination of the larynx, trachea, and esophagus is often performed at the time of biopsy.

The final management plan will depend on the site, stage (tumour size, nodal spread, distant metastasis), and histological type.

A prognostic multigene classifier has been shown to be potentially useful for the distinction of laryngeal cancer of low or high risk of recurrence and might influence the treatment choice in future.

[12] Laryngeal tumours are classified according to the guidelines set by academic organisations such as the National Comprehensive Cancer Network (NCCN) .

[14] The specific “staging” criteria for laryngeal cancer, as utilised in the NCCN’s 2019 Guidelines for Head and Neck Cancers,[15] are: TX: Unable to assess Tis: Carcinoma in situ T1: Tumour present in only one subsite of the supraglottis.

Clinical decision-making can be difficult in circumstances where the patient is unable to access necessary adjunct treatment.