A 70 years old heavy smoker presents with hoarseness. Which of the following cancers is the most likely cause… - UPUMS Nsg.Officer-2024

UPUMS Nsg.Officer-2024

Medical & Surgical Nursing

Medium

Appeared in: UPUMS Nsg.Officer-2024

Explanation

Hoarseness is the cardinal and often the earliest symptom of laryngeal cancer, particularly for tumors located on the glottis (vocal cords).
The tumor's growth directly interferes with the normal vibration of the vocal cords, leading to a change in voice quality, which may sound harsh or raspy.
Tobacco use is the most significant risk factor for developing squamous cell carcinoma of the larynx.
The patient's clinical picture—an elderly heavy smoker with hoarseness—presents a classic triad for laryngeal cancer.

Option B: Hoarseness is typically a late symptom of lung cancer, resulting from the compression of the recurrent laryngeal nerve by a tumor in the chest. The primary symptoms are usually respiratory, such as a persistent cough, chest pain, or hemoptysis.
Option C: Hoarseness is a sign of advanced oesophageal cancer, indicating the tumor has invaded the recurrent laryngeal nerve. The hallmark symptom is progressive dysphagia (difficulty swallowing).
Option D: While thyroid cancer can cause hoarseness by invading the recurrent laryngeal nerve, its most common presentation is a palpable, painless neck mass or nodule. Smoking is not a primary risk factor for most types of thyroid cancer.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differential diagnosis of hoarseness in a patient with risk factors for head and neck cancer as background academic context rather than a clinical decision trigger.
Nurses must recognize that hoarseness lasting more than two weeks, particularly in a patient with risk factors like smoking, is a red flag that requires urgent referral to an otolaryngologist (ENT specialist) for laryngoscopy.
This scenario highlights the importance of taking a thorough history, including social habits like smoking, as it is a key diagnostic clue in differentiating potential causes of a symptom.
Patient education on smoking cessation is a critical nursing intervention, as it is the most important modifiable risk factor for laryngeal and lung cancers.

How to Approach the Question

First, analyze the patient's profile: 70 years old and a heavy smoker. These are significant risk factors for several cancers.
Next, identify the chief complaint: hoarseness. This symptom is directly related to the function of the vocal cords within the larynx.
Consider the most direct cause. A tumor growing on the vocal cords (laryngeal cancer) will cause hoarseness as a primary and early symptom.
Evaluate the other options. Lung, oesophageal, and thyroid cancers cause hoarseness indirectly and usually at a later stage by affecting the recurrent laryngeal nerve, which controls the vocal cords.
Conclude that the most likely diagnosis, given the direct symptom and strong risk factors, is laryngeal cancer.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of hoarseness in a patient with risk factors for head and neck cancer.
Stem keywords: 70 years old, heavy smoker, hoarseness
Lead-in keywords: most likely cause
Clinical cues: Patient is a 70-year-old heavy smoker, which are major risk factors for laryngeal cancer.
Clinical cues: The presenting symptom is hoarseness, a classic early sign of tumors on the vocal cords.

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 45-47

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