A 55-year-old male smoker undergoes laryngoscopy and is found to have a vocal cord lesion. Biopsy shows carcinoma in situ (CIS) of the glottis. The most appropriate management is:

• A Immediate total laryngectomy
• B Watchful waiting for 6 months before treating
• C Microlaryngoscopic stripping / laser cordectomy with close follow-up ✓
• D Definitive radiotherapy to 60 Gy

Explanation

Glottic carcinoma in situ (Tis) is managed by microlaryngoscopic laser cordectomy (or cold-instrument mucosal stripping) with close endoscopic surveillance, which allows tissue diagnosis, treatment, and voice preservation simultaneously. Radiotherapy is an alternative for Tis but is generally reserved for invasive disease given the cumulative dose constraints. Total laryngectomy is vastly over-treatment for CIS. Watchful waiting for malignancy is inappropriate.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.