Charles M. Norris

Part III—symptomatology and diagnosis: Cancer of the larynx

cally rather small in cross-section diameter, a tumor of only moderate size will encroach on the lumen and produce a significant degree of obstruction. Symptoms of dyspnea and “¿ wheezing― (actually stridor) have been errone ously interpreted on occasion as indi cating obstructive disease in the tra cheobronchial tree, and initial treat ment for “¿ asthma― based on an er roneous inferential diagnosis, has been observed in the case records of many laryngologists. The problem is further compounded by the fact that the sub glottic region is less well seen on in direct laryngoscopy than the glottic and supraglottic regions; if the impor tance of endoscopy in such cases is not fully appreciated, a considerable delay in diagnosis may occur. Impairment of cordal motion, as seen on mirror exami nation, may indicate the presence of a subglottic carcinoma, otherwise hidden from view. In tumors of the supraglottic region (vestibule, epiglottis, aryepiglottic folds and arytenoids) the first symp tom is likely to be a sensation of vague discomfort resembling a “¿ lump in the throat―; somewhat later, pain on swal lowing or dysphagia for solid foods may be noted. In the more advanced lesion, pain referred to the ear may be a conspicuous symptom. Hoarseness will not occur in cases confined to the supraglottic region, although ulti mately they may involve the vocal cord, with resultant voice impairment. Enlargement of one or more cervical lymph nodes may be the first manifes Symptomatology

Part I—introduction and historical notes: Cancer of the Larynx

adequate air and food passage. Increasing recognition by the laity, as well as the medical profession, that hoarseness is one of the “¿ danger sig nals― has increased the frequency of early diagnosis. Correspondingly, the greater role of irradiation and limited surgical resection in treatment is re flected both in relatively high cure rates (over 80% for lesions limited to the vocal cords) and relatively minor de grees of disability following treatment. The ease with which the larynx may be examined by indirect and direct methods, and the accuracy with which diagnosis may be confirmed or dis proven by biopsy add to the hopeful overall outlook. To the laryngologist, problems in differential diagnosis should be infrequent. However, the physician first consulted must accept the responsibility for avoiding un necessary delay. The laryngologist still sees with distressing frequency l)a tients whose recovery has been com promised by prolonged empirical treat ment under an inferential diagnosis of laryngitis; in some of these, even the most skillful and radical surgery may offer small prospect of cure. The preparation of this series of articles, tragically interrupted by the untimely death of the senior author, is based on the premise that a more corn