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ENT · Larynx and airway: T4a glottic cancer
Sample itemCT of a glottic carcinoma shows erosion through the thyroid cartilage with extension into the soft tissues of the neck. What is the standard treatment?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Total laryngectomy with adjuvant therapy as indicated
Invasion through the thyroid cartilage into neck soft tissue is T4a disease. Primary total laryngectomy, usually with thyroidectomy and neck dissection plus adjuvant therapy, is the standard because function after non-surgical treatment is poor and cure rates are higher with surgery.
Option by option
A. Supracricoid partial laryngectomy
Partial laryngectomy cannot encompass disease through the thyroid cartilage.
B. Transoral laser cordectomy
Laser cordectomy is for very early, small cancers.
C. Definitive radiotherapy alone
Radiotherapy alone has poor control rates when cartilage is destroyed.
D. Total laryngectomy with adjuvant therapy as indicated (correct)
Correct. Cartilage destruction with extralaryngeal spread needs total laryngectomy.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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