A 58-year-old male presents to your clinic with a two-month history of a change in voice. He has had no stridor or respiratory difficulty, and denies hemoptysis, dysphagia, odynophagia, weight loss, or otalgia. His past medical history is significant for 38 pack years of cigarette smoking. His voice is slightly hoarse (raspy). He has no palpable lymphadenopathy in the neck. Fiberoptic laryngoscopy reveals a 4 mm diameter, exophytic, cauliflower-shaped and beige-colored mass on the mid free margin of the left true vocal cord. A neck CT scan is negative for lymph node enlargement. You refer the patient to an otolaryngologist, whose biopsy of the lesion reveals stage T1a (limited to one vocal cord) squamous cell carcinoma. A metastatic survey is negative. Regarding his treatment, you inform the patient that he will at least require which of the following?

Question

A 58-year-old male presents to your clinic with a two-month history of a change in voice.  He has had no stridor or respiratory difficulty, and denies hemoptysis, dysphagia, odynophagia, weight loss, or otalgia.  His past medical history is significant for 38 pack years of cigarette smoking.  His voice is slightly hoarse (raspy).  He has no palpable lymphadenopathy in the neck.  Fiberoptic laryngoscopy reveals a 4 mm diameter, exophytic, cauliflower-shaped and beige-colored mass on the mid free margin of the left true vocal cord.  A neck CT scan is negative for lymph node enlargement.  You refer the patient to an otolaryngologist, whose biopsy of the lesion reveals stage T1a (limited to one vocal cord) squamous cell carcinoma.  A metastatic survey is negative.  Regarding his treatment, you inform the patient that he will at least require which of the following?

Quizplus · Accepted Answer

Explanation: This patient has a T(1a)N(0)M(0) squamous cell carcinoma of the glottis. T1a designates a lesion confined to one vocal cord. Radiation is the primary nonsurgical treatment for early stage glottic tumors: T1 (confined to vocal cords) and some T2 (tumor extending to the supraglottis or subglottis with impaired vocal cord mobility) lesions. Radiotherapy may yield a more favorable voice outcome. Laser excision with a CO2 laser is also effective in curing early stage glottic cancer. (Choice B) Total laryngectomy is generally reserved as the initial treatment for more advanced glottic cancers, such as T4 lesions (tumor invading through the thyroid cartilage or with direct extralaryngeal spread). (Choice C) Since a major goal in the treatment of T1 glottic cancers is optimal voice preservation, cordectomy for such lesions is usually partial, employing endoscopy and microlaryngoscopic instruments. (Choice D) A partial or hemilaryngectomy is generally not indicated as a first-line treatment for T1 glottic cancer, unless the cancer involves the anterior comissure of the true vocal cords. It may become an option for patients with T1 lesions that failed to respond to radiotherapy or for patients with recurrent T1 lesions. (Choice E)In an attempt to preserve the larynx, induction chemotherapy followed by radiation is considered most often for T3 (tumor confined to the larynx with vocal cord fixation) lesions of the glottis. Patients whose T3 tumors respond to induction chemotherapy may be treated with further chemotherapy and radiation. Those whose T3 tumors have a limited response to chemotherapy are generally treated with partial or total laryngectomy. Educational Objective: The initial treatment of a squamous cell carcinoma of the glottis which is confined to one vocal cord and which has not metastasized [T(1a)N(0)M(0)] is radiation therapy, laser excision, or partial vocal cordectomy.

A 58-Year-Old Male Presents to Your Clinic with a Two-Month