Compared with glottic carcinoma, supraglottic squamous cell carcinoma carries a much higher rate of clinically apparent cervical node metastasis at presentation. The principal reason is:

• A Supraglottic tumours are invariably larger than glottic tumours at diagnosis
• B Supraglottic cancers have a higher grade of differentiation histologically
• C The rich bilateral lymphatic network of the supraglottis drains to levels II and III ✓
• D The supraglottis is directly contiguous with the thyroid gland

Explanation

The supraglottis has abundant, freely communicating lymphatics that drain through the thyrohyoid membrane to upper deep cervical nodes, chiefly levels II and III, and cross the midline so bilateral and contralateral spread is common. In contrast, the true cords are almost devoid of lymphatics, explaining the low nodal rate in glottic cancer. Early symptoms like sore throat and odynophagia actually mean many supraglottic tumours present smaller than assumed, and histological grade does not differ systematically.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.