A 55-year-old male smoker presents with hoarseness. Laryngoscopy reveals a lesion involving the anterior commissure and extending to both vocal cords. There is no cord fixation. According to standard management principles, what is the most significant implication of anterior commissure involvement in early glottic cancer?

• A It mandates total laryngectomy as the primary treatment
• B It increases the risk of spread to the prelaryngeal (Delphian) lymph node ✓
• C It contraindicates radiotherapy due to cartilage necrosis risk
• D It upstages the tumor to T3 regardless of cord mobility

Explanation

The anterior commissure is a site where the vocal cords meet anteriorly, and there is minimal barrier to spread. Tumors at this site can spread to the prelaryngeal (Delphian) lymph node at the thyroid cartilage notch, which is a recognized drainage pattern. Anterior commissure involvement does not automatically upstage to T3 (that requires cord fixation) and does not contraindicate radiotherapy, though it may make surgical resection more challenging.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.