Laryngeal Cancer Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Laryngeal Cancer. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Laryngeal Cancer Indian Medical PG Question 1: A 50-year-old male with a long smoking history presents with a 2-month history of hoarseness, ear pain, and hemoptysis. Laryngoscopy reveals a mass on the vocal cords, and a chest X-ray shows a suspicious nodule. What is the most likely diagnosis?
- A. Tuberculosis
- B. Laryngeal carcinoma (Correct Answer)
- C. Pneumonia
- D. Chronic bronchitis
Laryngeal Cancer Explanation: ***Laryngeal carcinoma***
- The combination of **hoarseness, ear pain, and hemoptysis** in a patient with a **long smoking history** is highly suggestive of **laryngeal carcinoma**.
- **Hoarseness** is the cardinal symptom of glottic laryngeal cancer, while **ear pain** (referred otalgia via Arnold's nerve) suggests advanced disease.
- **Laryngoscopy identifying a vocal cord mass** provides direct visualization of the tumor.
- The **suspicious nodule on chest X-ray** may represent a **synchronous primary lung cancer** (both share smoking as a major risk factor), **distant metastasis**, or requires further evaluation. Smokers are at high risk for multiple aerodigestive tract malignancies.
*Tuberculosis*
- While **hemoptysis** and a **suspicious nodule on chest X-ray** can be seen in tuberculosis, **hoarseness** and **ear pain** are not typical primary symptoms.
- Laryngeal tuberculosis is rare and usually secondary to pulmonary TB with **constitutional symptoms** like fever, night sweats, and weight loss, which are not mentioned.
- A **vocal cord mass** would be unusual for TB without systemic features.
*Pneumonia*
- **Pneumonia** typically presents with acute symptoms such as **cough, fever, dyspnea, and chills**.
- **Hoarseness** and **ear pain** are not characteristic features of uncomplicated pneumonia.
- A **mass on the vocal cords** is not associated with pneumonia, and the **2-month duration** is too prolonged for typical bacterial pneumonia.
*Chronic bronchitis*
- **Chronic bronchitis** is defined by a **chronic productive cough** for at least three months a year for two consecutive years.
- While common in smokers, it typically does not cause **ear pain, hemoptysis**, or a **vocal cord mass**.
- Chronic bronchitis does not produce discrete masses on laryngoscopy, differentiating it from a malignant process.
Laryngeal Cancer Indian Medical PG Question 2: Treatment of choice for carcinoma larynx T1N0M0 stage -
- A. External beam radiotherapy (Correct Answer)
- B. Surgery
- C. Radioactive implants
- D. Surgery & radiotherapy
Laryngeal Cancer Explanation: ***External beam radiotherapy***
- For **early-stage laryngeal cancer (T1N0M0)**, both **radiotherapy and surgery are considered equally effective first-line treatments** with excellent local control rates (>90%).
- EBRT offers the advantage of being **completely non-invasive** while preserving vocal function and avoiding surgical risks.
- Treatment duration is typically **6-7 weeks**, requiring patient compliance with daily fractions.
- Preferred when patient prefers non-invasive approach or has comorbidities making surgery high-risk.
*Surgery*
- **Transoral laser microsurgery (TLS)** or endoscopic **cordectomy** are equally effective surgical options for T1 glottic cancer with cure rates comparable to radiotherapy.
- Modern laser techniques provide excellent **voice preservation** with minimal morbidity.
- Advantages include **shorter treatment time** (single procedure), obtaining tissue for histopathology, and preserving radiotherapy as salvage option.
- Both **surgery and radiotherapy are Category 1 recommendations** for T1N0M0 disease; choice depends on institutional expertise, patient preference, and individual factors.
*Radioactive implants*
- **Brachytherapy (radioactive implants)** can be used for early-stage glottic cancer at specialized centers.
- However, **external beam radiotherapy** is more commonly employed due to greater accessibility and extensive outcome data.
*Surgery & radiotherapy*
- **Combined modality treatment** is indicated for **locally advanced disease** (T3-T4) or **node-positive disease** (N+).
- For **T1N0M0 disease**, single modality (either surgery OR radiotherapy) is sufficient and preferred to minimize treatment-related morbidity.
Laryngeal Cancer Indian Medical PG Question 3: Trotter's syndrome involves:
- A. Nasopharynx (Correct Answer)
- B. Oropharynx
- C. Pharynx
- D. Larynx
Laryngeal Cancer Explanation: ***Nasopharynx***
- **Trotter's syndrome** is a classic triad of symptoms (unilateral conductive hearing loss, trigeminal neuralgia, and soft palate paralysis) associated with malignant tumors of the **nasopharynx** [1].
- The syndrome arises from the tumor's invasion of critical structures surrounding the **nasopharynx**, including the Eustachian tube, trigeminal nerve, and cranial nerves IX, X, XI [1].
*Oropharynx*
- Malignancies of the **oropharynx** typically present with symptoms such as dysphagia, odynophagia, globus sensation, and referred otalgia to the ear, rather than the specific triad of Trotter's syndrome.
- While oropharyngeal tumors can metastasize, they do not directly cause the unique combination of symptoms seen in Trotter's syndrome due to their anatomical location.
*Pharynx*
- The **pharynx** is a broader anatomical region encompassing the nasopharynx, oropharynx, and hypopharynx. While Trotter's syndrome involves a part of the pharynx (the nasopharynx), simply stating "Pharynx" is too general and lacks the specificity required for this syndrome.
- The specific symptoms of Trotter's syndrome are linked to tumor involvement in a very particular area of the pharynx, not the entire structure.
*Larynx*
- Tumors of the **larynx** primarily cause symptoms related to voice changes (hoarseness), stridor, and difficulty breathing or swallowing.
- The anatomical position of the larynx is distinct from the nasopharynx, and therefore, laryngeal pathologies do not lead to the specific neurological and auditory symptoms characterizing Trotter's syndrome.
Laryngeal Cancer Indian Medical PG Question 4: All the following statements about laryngeal carcinoma are true except:
- A. Laryngeal carcinoma is more common in males.
- B. Laryngeal carcinoma is associated with smoking.
- C. Laryngeal carcinoma is more common in individuals over 40 years of age.
- D. Laryngeal carcinoma has a poor prognosis. (Correct Answer)
Laryngeal Cancer Explanation: ***Laryngeal carcinoma has a poor prognosis.***
- While prognosis depends on stage and treatment, laryngeal carcinoma, especially when detected early, often has a **relatively good prognosis** compared to other head and neck cancers, with overall survival rates exceeding 50-60%.
- Many patients, particularly those with early-stage disease, can be cured with **surgery or radiation therapy** while preserving laryngeal function.
*Laryngeal carcinoma is more common in males.*
- **Laryngeal carcinoma** demonstrates a significant **male predominance**, with incidence rates typically 4 to 5 times higher in men than in women.
- This disparity is largely attributable to historically higher rates of **smoking and alcohol consumption** among men.
*Laryngeal carcinoma is associated with smoking.*
- **Smoking** is the most significant and well-established **risk factor** for laryngeal carcinoma, with the risk directly correlated to the intensity and duration of tobacco use.
- Exposure to **carcinogens in tobacco smoke** directly damages laryngeal epithelial cells, leading to dysplasia and eventual malignant transformation.
*Laryngeal carcinoma is more common in individuals over 40 years of age.*
- The incidence of **laryngeal carcinoma** significantly increases with age, with the majority of cases diagnosed in individuals **over the age of 50 or 60 years**.
- This age distribution reflects the cumulative exposure to **environmental carcinogens** like tobacco and alcohol over a longer lifespan.
Laryngeal Cancer Indian Medical PG Question 5: Stage IVa with thyroid cartilage invasion in laryngeal carcinoma is treated with:
- A. Total laryngectomy
- B. Radiotherapy
- C. Total laryngectomy with radiotherapy (Correct Answer)
- D. Hemilaryngectomy
Laryngeal Cancer Explanation: ***Total laryngectomy with radiotherapy***
- **Stage IVa laryngeal carcinoma** with **thyroid cartilage invasion** is considered advanced disease requiring aggressive treatment.
- **Multimodal therapy** combining surgical resection (total laryngectomy) to remove the tumor and adjuvant radiotherapy to address microscopic disease and reduce recurrence is the standard of care.
*Total laryngectomy*
- While a **total laryngectomy** is necessary to remove the primary tumor with cartilage invasion, it often requires additional (adjuvant) therapy like radiation to improve local control and survival rates.
- Relying solely on surgery for **Stage IVa disease** may not adequately address potential microscopic spread, leading to higher recurrence rates.
*Radiotherapy*
- **Radiotherapy alone** is typically reserved for early-stage laryngeal cancers or as a palliative measure for advanced, unresectable disease.
- In Stage IVa with **thyroid cartilage invasion**, radiation alone is insufficient due to the bulk of the disease and high risk of local recurrence.
*Hemilaryngectomy*
- A **hemilaryngectomy** is a partial removal of the larynx, suitable for much smaller, early-stage tumors that are confined to one side of the larynx, without cartilage invasion.
- It is inadequate for **Stage IVa disease** with cartilage invasion due to the extensive nature of the tumor.
Laryngeal Cancer Indian Medical PG Question 6: What is the name of the nerve block technique shown in the image?
- A. Intra-arterial anesthesia (Correct Answer)
- B. Bier's block
- C. Regional anesthesia
- D. Axillary block
Laryngeal Cancer Explanation: ***Intra-arterial anesthesia***
- The image shows a **cannula inserted directly into an artery**, indicated by the blood reflux and the context of anesthesia, suggesting direct drug delivery into the arterial system.
- This method is used for specific types of regional pain management or diagnostic procedures where direct arterial access is required for **localized drug distribution**.
*Bier's block*
- A Bier's block, or **intravenous regional anesthesia**, involves injecting local anesthetic into a **vein** in an extremity after it has been exsanguinated and isolated by a tourniquet.
- The image clearly shows a **bright red blood flash**, characteristic of arterial cannulation, not venous.
*Regional anesthesia*
- This is a broad term referring to the **anesthesia of a specific region** of the body and encompasses various techniques.
- While intra-arterial anesthesia is a type of regional anesthesia, "regional anesthesia" itself is too general to specifically describe the technique shown.
*Axillary block*
- An **axillary block** is a type of peripheral nerve block targeting the brachial plexus in the axilla to anesthetize the arm.
- The image does not depict the axillary region or the characteristic needle placement for an axillary block; instead, it shows direct vascular access.
Laryngeal Cancer Indian Medical PG Question 7: A 45-year-old patient presents with persistent hoarseness for 3 months. Which finding on indirect laryngoscopy is most concerning for malignancy?
- A. Reinke's edema
- B. Unilateral cord paralysis (Correct Answer)
- C. Bilateral polyps
- D. Vocal cord nodules
Laryngeal Cancer Explanation: ***Unilateral cord paralysis***
- **Unilateral cord paralysis** can be an indicator of an underlying malignancy impinging on the **recurrent laryngeal nerve**, which innervates the vocal cords.
- The **persistent hoarseness** for 3 months, combined with paralysis, raises significant concern for a malignant process in the head, neck, or chest.
*Reinke's edema*
- **Reinke's edema** is typically associated with **chronic irritation** like smoking and presents as a swollen, gelatinous fluid collection in the superficial lamina propria.
- While it causes hoarseness, it is a **benign condition** and not directly indicative of malignancy.
*Bilateral polyps*
- **Vocal cord polyps** are typically **benign lesions** often caused by vocal trauma or abuse, and while they can cause hoarseness, they are not usually a direct sign of malignancy, especially when bilateral.
- While requiring management, polyps themselves do **not raise immediate concern for cancer** compared to paralysis.
*Vocal cord nodules*
- **Vocal cord nodules** (singer's nodules) are benign, bilateral lesions caused by **vocal abuse** and are a common cause of hoarseness.
- They are a benign condition and do not suggest an underlying malignancy at their core.
Laryngeal Cancer Indian Medical PG Question 8: Chimney Sweeper cancer is the other name for
- A. Carcinoma testis
- B. Carcinoma lung
- C. Carcinoma scrotum (Correct Answer)
- D. Carcinoma skin
Laryngeal Cancer Explanation: ***Carcinoma scrotum***
- **Chimney sweepers' cancer** is a historical term for **squamous cell carcinoma of the scrotum**, first described by Percivall Pott in 1775.
- It was linked to prolonged exposure to **soot**, a known carcinogen, in young chimney sweeps.
*Carcinoma testis*
- This is a cancer of the **testicles**, not typically associated with occupational exposure to soot or referred to as "chimney sweeper cancer."
- It commonly presents as a **painless lump** in the testis.
*Carcinoma lung*
- While lung cancer can be linked to occupational exposures (e.g., asbestos, smoking), it is not called "chimney sweeper cancer."
- It primarily affects the **respiratory system**.
*Carcinoma skin*
- Skin cancer can be caused by various factors, including **UV radiation**, but the term "chimney sweeper cancer" specifically refers to scrotal carcinoma due to soot exposure.
- It can occur on any skin surface, unlike the specific scrotal location.
Laryngeal Cancer Indian Medical PG Question 9: Lymph node metastasis in neck is almost never seen with:
- A. Carcinoma vocal cords (Correct Answer)
- B. Supraglottic carcinoma
- C. Carcinoma of tonsil
- D. Papillary carcinoma thyroid
Laryngeal Cancer Explanation: ***Carcinoma vocal cords***
- The **vocal cords** are relatively poor in lymphatic drainage, which significantly reduces the likelihood of regional lymph node metastasis.
- Due to this sparse lymphatic network, spread to cervical lymph nodes is rare, especially in early-stage disease.
*Supraglottic carcinoma*
- **Supraglottic** regions have a rich lymphatic network, leading to a high incidence of cervical lymph node metastasis, even in early stages.
- Bilateral lymphatic drainage further increases the risk of nodal involvement.
*Carcinoma of tonsil*
- The **tonsils** are richly supplied with lymphatic vessels, making them prone to early and frequent metastasis to cervical lymph nodes.
- Metastasis is often seen in levels II, III, and IV of the neck.
*Papillary carcinoma thyroid*
- **Papillary thyroid carcinoma** commonly metastasizes to regional lymph nodes, with documented rates as high as 30-80%.
- Nodal metastasis can occur in the central compartment (level VI) and lateral neck (levels II-V).
Laryngeal Cancer Indian Medical PG Question 10: High tracheostomy is done in which one of the following conditions?
- A. Laryngeal cancer
- B. Tracheal stenosis (Correct Answer)
- C. Severe asthma exacerbation
- D. Vocal cord dysfunction
Laryngeal Cancer Explanation: ***Tracheal stenosis***
- A **high tracheostomy** is performed when there is **lower tracheal stenosis** or obstruction, requiring placement of the tracheostomy stoma **above the stenotic segment**.
- This approach ensures that the **tracheostomy tube** bypasses the narrowed portion of the trachea and provides a patent airway.
- The level of tracheostomy is chosen based on the location of the pathology - high tracheostomy for lower pathology, and vice versa.
*Laryngeal cancer*
- In **laryngeal cancer**, a **low tracheostomy** is typically preferred, not a high one.
- A high tracheostomy in laryngeal malignancy is generally **contraindicated** due to the risk of tumor seeding and interference with surgical planning.
- The tracheostomy should be placed **away from the tumor site** and below the pathology, especially if laryngectomy is planned.
*Severe asthma exacerbation*
- **Severe asthma exacerbation** rarely requires a tracheostomy; endotracheal intubation and mechanical ventilation are the standard initial management.
- If prolonged ventilatory support is needed, a **standard tracheostomy** (not high) would be performed.
- There is no specific indication for high tracheostomy placement in asthma.
*Vocal cord dysfunction*
- **Vocal cord dysfunction (VCD)** involves paradoxical vocal cord movement and is typically managed with **conservative measures** including speech therapy and breathing exercises.
- VCD does not cause structural obstruction requiring surgical airway intervention.
- Tracheostomy, especially high tracheostomy, has no role in the management of VCD.
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