Symptoms, Signs and Work Up

"I would take a history and do a physical exam, and order a CBC, metabolic panel and CXR with the goal of determining:

The size of the primary tumor and if it invades adjacent structures
If there is any regional adenopathy
If there are any distant metastases
and if there is a condition that would increase the risk of surgery or radiotherapy such as neurologic, cardiac, pulmonary disease active collagen vascular disease or history of prior RT"

Imaging: CT scan with contrast, PET/CT at some institutions
Direct laryngoscopy to assess the extent of primary, obtain biopsy and look for second primaries

Dental eval: to advise on extractions and optimize dental care

Odynophagia
Dysphagia
Painless neck mass

Hoarseness
Advanced cancers:
Airway obstruction
Pain
Dysphagia
Referred otalgia
Painless neck mass

Hoarseness - false vocal cord
Voice changes, "hot potato voice"
Local Pain
Referred ear pain
Advanced:
Dysphagia
Airway obstruction

History of recurrent nasal obstruction
Recently worsened sinusitis
Intermittent epistaxis
Mass protruding from nose
Epiphora - if mass obstructs nasolacrimal duct
Diplopia
Proptosis
Frontal Headache
Aberration or loss of smell

Post-menopausal bleeding
Profuse watery discharge
Menorrhagia for perimenopausal or premenopausal women
Advanced:
Abdominal pain
Back pain
Lymphedema

Vaginal bleeding: post-coital spotting, metrorrhagia, menorrhagia
Fatigue secondary to anemia
Vaginal discharge
Pelvic pain
Lumbosacral pain- due to hydropnephrosis or lymphadeopathy
Hematuria - due to invasion of the bladder
rectal bleeding- due to invasion of the rectum
Rectal bleeding