Subglottic carcinoma (below the free edge of vocal cord to the lower border of cricoid cartilage) has the worst prognosis among laryngeal carcinomas primarily because:
- A The cricoid cartilage is particularly sensitive to radiation, limiting radiotherapy doses
- B Subglottis has a rich capillary network making haematogenous spread early
- C Subglottis has the most extensive lymphatic drainage, including bilateral paratracheal nodes ✓
- D Tumours are typically mucoepidermoid type with aggressive behaviour
Correct answer: C. Subglottis has the most extensive lymphatic drainage, including bilateral paratracheal nodes
Explanation
Subglottic cancers present late (no early voice change or hoarseness unlike glottic) and drain to bilateral paratracheal, pretracheal (Delphian) and inferior deep cervical nodes. This extensive bilateral lymphatic network causes early regional metastasis. The cricoid cartilage is also frequently invaded, requiring total laryngectomy and paratracheal dissection. In contrast, glottic cancer has the best prognosis due to sparse lymphatics at the level of the true cords and early symptomatic voice change.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.