A patient is diagnosed with carcinoma of the larynx involving the entire right true vocal cord, anterior commissure, and one-third of the left true vocal cord, with extension into the para-glottic space and inner thyroid cortex. The right vocal cord is completely immobile. What is the most likely tumor stage?

1. A

   T1

2. B

   T4

3. C

   T3

4. D

   T2

Appeared in: INI-CET EXAM -2025

Explanation

• The correct stage is T3, which is defined by a tumor limited to the larynx but causing vocal cord fixation (immobility).
• The patient's diagnosis explicitly states the right vocal cord is 'completely immobile,' which is synonymous with fixation.
• Additionally, extension into the para-glottic space and invasion of the inner thyroid cortex are specific criteria that also define a T3 tumor.
• The tumor has not invaded through the outer cortex of the thyroid cartilage or into extralaryngeal tissues, which would be required for a T4a classification.

Why Other Options Were Wrong

• Option A: T1 is incorrect because it is defined by normal vocal cord mobility. This patient has a fixed (immobile) vocal cord.
• Option B: T4 is incorrect because it requires invasion through the outer cortex of the thyroid cartilage or into tissues beyond the larynx (e.g., trachea, neck muscles). The description only mentions invasion of the inner cortex.
• Option D: T2 is incorrect because it is characterized by impaired (reduced) vocal cord mobility, not complete fixation (immobility). The patient's vocal cord is completely immobile.

Related Visual

• Visual 1: Diagram - An anatomical illustration comparing the T-stages of glottic cancer. This would show a T1 tumor on the cord, a T2 tumor extending to the supraglottis, a T3 tumor fixing the cord and invading the paraglottic space, and a T4 tumor breaking through the cartilage.

Clinical Relevance

• Nursing practice connection: Use the key finding related to TNM staging of laryngeal carcinoma (glottic cancer) to guide bedside assessment, documentation, and the next nursing action.
• Accurate staging is critical for determining the treatment plan and prognosis for laryngeal cancer.
• A T3 tumor is considered locally advanced. Treatment often involves either a total laryngectomy (removal of the voice box) followed by radiation, or a non-surgical, organ-preservation approach with intensive chemoradiation.
• Nurses play a vital role in managing the significant side effects of these treatments, including mucositis, dysphagia, and xerostomia, and in providing psychosocial support for patients dealing with changes in speech and swallowing.

How to Approach the Question

• First, identify the question type. This is an analytical question that requires applying a specific classification system (TNM staging) to a clinical scenario.
• Carefully read the clinical description and list all the key findings related to the tumor's location, extension, and effect on function (e.g., vocal cord immobility, paraglottic space invasion, inner thyroid cortex invasion).
• Recall the specific criteria for each T stage of glottic cancer (T1, T2, T3, T4). The most crucial distinction is often related to vocal cord mobility: normal (T1), impaired (T2), or fixed (T3).
• Systematically compare the patient's findings to the criteria for each stage.
• Note that vocal cord fixation, paraglottic space invasion, or inner cartilage invasion automatically places the tumor at least in the T3 category.
• Select the stage that perfectly matches the description. In this case, the findings are classic for T3.

Concept Tested & Keywords

• Concept Tested: TNM staging of laryngeal carcinoma (glottic cancer)
• Stem keywords: carcinoma of the larynx, true vocal cord, para-glottic space, inner thyroid cortex, vocal cord immobile
• Lead-in keywords: most likely tumor stage
• Clinical cues: Vocal cord immobility is a key finding that immediately points towards a more advanced stage (T3 or higher).

Question ID

QUA49LGcae_xW_7O70e0dj

Copy ID