Step 1 of 14
Clinical Presentation
Voice · swallowing · pain · airway · neck · constitutional symptoms
Glottic and subglottic carcinoma announces itself early through the voice and late through the airway. Voice symptoms — persistent hoarseness beyond 2–3 weeks, voice fatigue, and a change in voice quality — are the earliest and commonest, because even a small glottic tumour disturbs cord vibration. Swallowing symptoms (dysphagia, odynophagia) and pain (referred otalgia via the vagus, throat pain) suggest more advanced or supraglottic/hypopharyngeal extension.
Airway symptoms — dyspnoea, stridor, frank obstruction — signal a bulky or subglottic tumour and demand urgent assessment. A neck mass reflects nodal metastasis (uncommon in early glottic disease, more frequent with subglottic or advanced tumours). Constitutional features (weight loss) and the risk exposures of tobacco and alcohol complete the picture. The key clinical reflex is simple: hoarseness that persists must be scoped, never simply treated as reflux or laryngitis.
- Voice — persistent hoarseness >2–3 weeks, voice fatigue, quality change (earliest, commonest)
- Swallowing — dysphagia, odynophagia; Pain — referred otalgia, throat pain
- Airway — dyspnoea, stridor, obstruction (bulky/subglottic tumour)
- Neck — mass (nodal metastasis); General — weight loss
- Exposures — tobacco, alcohol
Key statistics
Earliest sign of glottic cancer
hoarseness
Hoarseness is the earliest and most common presenting symptom of glottic cancer; persisting beyond 2–3 weeks it mandates laryngoscopy. US national data document its epidemiology and the much-debated decline in survival over recent decades.
★ High-yield pearls (chapter-wide)
- Hoarseness persisting beyond 2–3 weeks is laryngeal cancer until the larynx is visualised — every such patient needs laryngoscopy, not another course of reflux therapy.
- Vocal-cord mobility is the cornerstone of glottic T staging — impaired mobility is T2, fixation is T3; assess it carefully before anything else changes management.
- Early glottic cancer rarely spreads to cervical nodes because the true cords have almost no lymphatics — the N0 neck usually needs no treatment.
- Subglottic cancer is rare, presents late, and carries a high paratracheal (level VI) nodal risk — include the paratracheal and lower-neck nodes in the treatment volume.
- Larynx preservation is not the same as functional-larynx preservation — a severely dysfunctional, aspirating larynx after chemoradiotherapy can be worse than a well-rehabilitated total laryngectomy.
- Stridor, cord fixation, a large transglottic tumour, or subglottic obstruction is an airway emergency — secure the airway (awake fibreoptic or tracheostomy) before completing the work-up.
- T1–T2 glottic cancer is cured in roughly 90% by either transoral laser microsurgery or radiotherapy — the choice turns on voice outcome, anterior-commissure involvement, and patient factors.
- Salvage total laryngectomy is the most reliable treatment for disease persisting or recurring after chemoradiotherapy — and flap reinforcement reduces the pharyngocutaneous fistula rate.
- Positive margins or extracapsular nodal extension after surgery are the two features that mandate concurrent cisplatin chemoradiotherapy, not radiotherapy alone.
- Anterior-commissure involvement and impaired cord mobility predict radiotherapy and laser failure — flag them at staging and counsel accordingly.
Evidence base
3 sources- HIGH
Steuer CE, El-Deiry M, Parks JR · CA Cancer J Clin · 2017ReviewPMID 27898173
Comprehensive review anchoring epidemiology, staging, and stage-directed management of laryngeal cancer.
- MOD
Hoffman HT, Porter K, Karnell LH · Laryngoscope · 2006National database studyPMID 16946667
Landmark US database study of laryngeal-cancer demographics, treatment patterns, and the much-debated survival decline.
- MOD
Obid R, Redlich M, Tomeh C · Oral Maxillofac Surg Clin North Am · 2019ReviewPMID 30449522
Practical treatment review across early and advanced glottic and subglottic disease.
Decision tree
The triage screen is the first gate. Classification routes the stable patient to one of the aetiology-keyed pathways below. Cross-cut cards capture the chapter's must-not-miss rules.