## Distinguishing Features of Glottic vs Supraglottic Laryngeal Carcinoma ### Key Clinical Discriminator **Key Point:** Glottic carcinomas present with **early hoarseness** because the vocal cords are directly involved, leading to voice changes even with small tumours. This early symptom prompts earlier diagnosis and better prognosis (5-year survival ~70–80%). Supraglottic carcinomas remain silent until they are large, presenting late with dysphagia, neck nodes, or referred otalgia. ### Comparison Table | Feature | Glottic Carcinoma | Supraglottic Carcinoma | |---------|-------------------|------------------------| | **Presenting symptom** | Hoarseness (early) | Dysphagia, throat pain, referred otalgia | | **Stage at diagnosis** | Early (T1–T2 common) | Advanced (T3–T4 common) | | **Lymph node involvement** | Rare at presentation (~5%) | Common at presentation (~50%) | | **5-year survival** | 70–80% | 40–50% | | **Airway obstruction** | Late (if at all) | May occur with large tumours | | **Mechanism of early detection** | Voice change is noticeable to patient | Tumour grows away from vocal cords | ### Why Glottic Carcinomas Have Better Prognosis 1. **Anatomical advantage:** Glottic tumours involve the vocal cord, which is a mobile, sensitive structure. Even small lesions cause hoarseness. 2. **Patient awareness:** Hoarseness >2 weeks prompts medical consultation, leading to laryngoscopy and early biopsy. 3. **Limited lymphatic drainage:** Glottic region has sparse lymphatic drainage, reducing nodal metastasis risk. 4. **Radiation sensitivity:** Early-stage glottic cancers (T1–T2, N0) respond well to radiotherapy alone (cure rates >85%). **High-Yield:** Glottic carcinomas = **early hoarseness + early detection + better prognosis**. Supraglottic carcinomas = **late presentation + advanced stage + poor prognosis**. ### Clinical Pearl Any patient with hoarseness persisting >2–3 weeks, especially smokers or those with alcohol use, must undergo laryngoscopy. Early detection of glottic carcinoma is the single most important factor in achieving cure. **Mnemonic: GLOTTIC = Gets hoarse early** 
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