A 58-year-old male smoker presents with progressive hoarseness and stridor. Laryngoscopy reveals a large mass involving the anterior commissure with fixation of the vocal cord. Which feature best distinguishes glottic carcinoma from supraglottic carcinoma in this patient?

## Distinguishing Features of Glottic vs Supraglottic Carcinoma **Key Point:** The location of the primary tumor determines the clinical presentation pattern and natural history of laryngeal carcinoma. ### Glottic Carcinoma (Anterior Commissure Origin) **High-Yield:** Glottic tumors involve the vocal cords early, causing voice changes (hoarseness) that prompt early medical attention. This results in earlier detection and generally better prognosis. - Presents with **early hoarseness** due to direct vocal cord involvement - Vocal cord fixation indicates advanced local disease (T3–T4) - **Lower rate of cervical lymph node metastasis** (5–15% at presentation) due to sparse lymphatic drainage from the true vocal cords - Better prognosis: 5-year survival ~70–80% for early-stage disease ### Supraglottic Carcinoma (Epiglottis, Aryepiglottic Fold, False Vocal Cords) - Presents **late** with dysphagia, throat pain, or neck mass (not hoarseness) - Rich lymphatic drainage → **frequent cervical node involvement (40–50% at presentation)** - Often T3–T4 at diagnosis due to silent early growth - Worse prognosis: 5-year survival ~50–60% ### Comparison Table | Feature | Glottic | Supraglottic | |---------|---------|---------------| | **Early symptom** | Hoarseness | Dysphagia, throat pain | | **Vocal cord fixation** | Common early sign | Late finding | | **Cervical nodes at Dx** | 5–15% | 40–50% | | **Stage at presentation** | Often early (T1–T2) | Often advanced (T3–T4) | | **Prognosis** | Better | Worse | | **Lymphatic drainage** | Sparse | Rich | **Clinical Pearl:** The anterior commissure location in this case (glottic) explains the early hoarseness and vocal cord fixation—hallmarks of glottic disease. Supraglottic tumors, by contrast, grow silently in a region with rich lymphatics, leading to late presentation with metastatic nodes. **Tip:** When comparing glottic vs supraglottic carcinoma, remember: **"Glottic = early voice change; Supraglottic = early nodes."** [cite:Harrison 21e Ch 183]