Squamous cell carcinoma of the larynx 73-year-old smoker (1 of 4)

This 73 year-old male patient with a history of heavy smoking. Over 95% of patients are smokers; 15 pack-years of smoking increase the risk 30-fold. Sixty percent of patients present with localized disease alone; 25% present with local disease and regional nodal metastatic disease; and 15% present with advanced disease, distant metastases, or both. Distant metastases occur most frequently in the lungs and liver. Common sites of origin are the true vocal cords (glottis) and the supraglottic larynx. The least common site is the subglottic larynx, where only 1% of primary laryngeal cancers originate. Verrucous carcinoma, a rare variant of squamous cell carcinoma, usually arises in the glottic area and has a better survival rate than standard squamous cell carcinoma. Symptoms and Signs Symptoms and signs differ based on the involved portion of the larynx. Hoarseness is common early in glottic cancers but is a late symptom for supraglottic and subglottic cancers. Supraglottic cancer is often asymptomatic until it manifests as a mass lesion (eg, with airway obstruction, dysphagia, otalgia, or a hot potato voice) or with weight loss. Such patients should be referred for indirect laryngoscopy without delay.