Among the three subsites of the larynx, carcinoma of the glottis has the best overall prognosis. The single most important anatomical reason for this is:
- A The glottic mucosa is keratinised and therefore resistant to malignant transformation
- B The glottis is richly supplied by blood vessels allowing effective chemotherapy delivery
- C The true vocal cords are almost devoid of lymphatic vessels, so nodal spread occurs late ✓
- D The glottis drains lymphatics exclusively to level I nodes, which are easily palpable
Correct answer: C. The true vocal cords are almost devoid of lymphatic vessels, so nodal spread occurs late
Explanation
The true vocal cords have sparse or absent subepithelial lymphatics, so even T1 and T2 glottic cancers rarely produce cervical node metastases, keeping them curable with radiotherapy or cordectomy. Hoarse voice also leads to early diagnosis. The cords are not keratinised throughout, the glottis drains mainly to level II and III nodes when drainage exists at all, and vascularity plays no role in prognosis.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.