A 58-year-old male smoker noticed throat discomfort and a lump in the right neck for six months before developing any voice change. Endoscopy reveals a 3 cm ulcerative lesion of the epiglottis with normal vocal cord mobility. Compared with glottic carcinoma, supraglottic carcinoma typically presents at a more advanced stage primarily because:

• A The supraglottis has dense sensory innervation producing early pain that patients ignore
• B The supraglottis is inaccessible to office endoscopy
• C Supraglottic tumors grow more rapidly than glottic tumors
• D Hoarseness appears only late, and symptoms such as foreign body sensation or dysphagia are nonspecific and ignored ✓

Explanation

Glottic tumors alter vocal cord vibration almost immediately, so hoarseness brings patients to the doctor early. The supraglottis produces only vague globus sensation, odynophagia, or referred ear pain until the tumor is large, and its rich bilateral lymphatic drainage means neck nodes are often the first sign. Office laryngoscopy readily visualizes the supraglottis, ruling out option B.

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

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Written and medically reviewed by the StethoPrep medical team.