.png){kind=small}
.png){kind=small}
BackTable / ENT / Article
Early Glottic Cancer: Symptoms & Staging
Iman Iqbal • Updated Mar 31, 2025 • 35 hits
Early glottic cancer, primarily affecting the vocal folds, is a localized malignancy that can often be treated with surgery or radiotherapy. While smoking remains the main risk factor, recent trends show an increasing number of cases among non-smokers, prompting new diagnostic considerations.
This article covers contemporary diagnostic approaches to glottic cancer, with hands-on experience described by expert laryngologist Dr. Bharat Panuganti. Learn about the role of voice analysis, flexible laryngoscopy, biopsy, and emerging imaging technologies like confocal laser endomicroscopy; and how these diagnostic modalities can work together to identify glottic cancer and assist with accurate staging.
This article features excerpts from the BackTable ENT Podcast. You can listen to the full podcast below.
The BackTable ENT Brief
• Early glottic cancer (T1-T2) has limited lymphatic spread, allowing for single-modality treatment with surgery or radiotherapy.
• While smoking remains the leading cause, a growing number of non-smokers are being diagnosed, particularly younger patients, suggesting unidentified risk factors.
• Diagnosis relies on perceptual voice analysis and endoscopic visualization, with flexible laryngoscopy playing a crucial role in evaluating tumor extent.
• Lesions can be exophytic (outward-growing) or endophytic (infiltrative), influencing treatment decisions and surgical complexity.
• Technologies like confocal laser endomicroscopy and EGFR-targeted fluorescence imaging provide high-resolution tumor mapping, improving detection and resection precision.
• A single-stage procedure combining biopsy and therapeutic ablation minimizes vocal fold trauma, ensures precise staging and oncologic control, reduces the risks of multiple interventions, preserves vocal function, and streamlines treatment by preventing unnecessary diagnostic delays.
• While CT scans have limited sensitivity for early vocal fold cancers, chest imaging and intraoperative tracheobronchoscopy help identify synchronous malignancies.
Table of Contents
(1) Early Glottic Cancer Symptoms & Risk Factors
(2) Glottic Cancer Staging: Assessing Tumor Extent
(3) Imaging & Biopsy Techniques in Early Glottic Cancer
Early Glottic Cancer Symptoms & Risk Factors
Early glottic cancer, classified as stage 1 or 2 (T1-T2), is a form of laryngeal cancer that is characterized by limited lymphatic drainage, allowing for single-modality treatment via surgery or radiotherapy. The most common symptom is dysphonia, with pain or hemoptysis indicating possible deeper tumor invasion. Histologically, squamous cell carcinoma is the predominant type, but rare variants also exist.
While smoking remains the leading risk factor for early glottic cancer, recent studies highlight a growing number of cases among non-smokers. Dr. Panguanti references a study discussing this trend, noting that between 2002 and 2022, 27% of patients diagnosed with early glottic cancer had no history of smoking, a notable shift in the traditional risk profile. Interestingly, non-smoking patients were slightly younger on average than their smoking counterparts, though no definitive alternative risk factors were identified. This evolving trend suggests that clinicians should maintain a high index of suspicion for early glottic cancer in all patients presenting with persistent voice changes, regardless of smoking history.
[Dr. Gopi Shah]
How do you define early glottic cancer? Is that just in situ or T1s?
[Dr. Bharat Panuganti]
That's a good question. Early glottic cancer, typically what that stipulates is stage 1 or stage 2 or T1 and T2 disease. That characterization is important. In general, early glottic cancers, if you look at the lymphatic supply or lymphatic drainage of the vocal folds, it's quite sparse, especially relative to the subglottis and supraglottis. Some of the basic features in early glottic cancer is it stipulates single modality treatment. That's either radiotherapy or surgery.
By virtue of what I just said, given that lymphatic drainage is sparse at the glottis, the next general way I would treat it. That is what defines an early glottic cancer. Mobility is at least partially preserved, which means that the underlying muscle of the vocal fold is at least partially preserved and you can get by with just using one treatment modality.
[Dr. Gopi Shah]
When these patients are presenting, the main symptom is going to be dysphonia, like you mentioned. Anything else that usually tips you off there that's more worrisome, like pain or trouble swallowing or anything else, or just some horses?
[Dr. Bharat Panuganti]
Generally for an early glottic cancer, dysphonia is the primary symptom. At the point where you start getting pain, what that generally implies is that there's deeper penetration of the tumor. That's a little bit more concerning. Someone's coming in and they have throat pain, it doesn't mean that it's more advanced than early glottic cancer, but it's strongly suggestive of the possibility.
Difficulty breathing, again, with an early glottic cancer, just by virtue of how early you're catching it, isn't usually something that you see. Other things like coughing up blood, sometimes you see that. Tumors in general, and certainly tumors that originate from the vocal folds are typically quite hypervascular. It's something that can occur.
[Dr. Gopi Shah]
This is typically squamous cell carcinoma?
[Dr. Bharat Panuganti]
Almost universally, and there are variants of squamous cell carcinoma that you see, papillary type squamous cell carcinoma, but for the sake of this discussion, I think for the sake of simplicity, it's almost universally a squamous cell carcinoma.
[Dr. Gopi Shah]
In terms of risk factors, I usually think of smokers. What other risk factors come into play and what demographics or who are the patients that you see that come in early with the early glottic cancer?
[Dr. Bharat Panuganti]
It's a really good question. I think head and neck cancer in general, and obviously the ZNTs were intimately familiar with the evolution in oropharynx cancer, the emergence, HPV being a primary etiology. I think there's been some evolution in early glottic cancer as well. This is unpublished data, but it's data that we submitted at the Academy Conference just last year. I, with my fellowship mentor, Steven Zeitels, we looked at all early glottic cancer patients that were either treated or diagnosed at the MGH Voice Center in Boston between 2002 and 2022.
Something like 27% of patients that came through the MGH Voice Center were non-smokers or never smokers. That is a very staunch departure from what we traditionally understand as the primary risk factor for laryngeal cancers, which is smoking. Overall, if you look at the population of people that develop voice box cancers, it's smoking. That's the major risk factor. If you look at some of the trends in laryngeal cancers in general, smoking incidence has gone down. By virtue of that, the incidence of larynx cancer has gone down. If you look at, I think in the last decade or so, the annual incidence has gone down on average by 3.5%.
[Dr. Gopi Shah]
You said almost 30% are non-smokers, would you say 27?
[Dr. Bharat Panuganti]
27, yes.
[Dr. Gopi Shah]
27. In that population, were there any trends or any risks that you could see? Were those people vaping or doing some other sort of tobacco or were they older or anything from that group? Because that's a pretty big chunk.
[Dr. Bharat Panuganti]
Oh yes. I should say that's probably not representative of the rest of the country. Boston, I would say just demographically and based on the population of people generally speaking that ended up at the MGH Voice Center, there's probably an over-representation of non-smokers relative to the rest of the population. That being said, amongst the rest of the factors that we looked at, there was nothing really outside of smoking. There's nothing we're meant to look for explicitly.
The only differentiating feature was that the average age among those non-smokers was a bit younger by about four years. Again, statistically speaking, it's significant, but objectively, it was a difference between 60 versus 64 years of age.
Listen to the Full Podcast
Stay Up To Date
Follow:
Subscribe:
Sign Up:
Glottic Cancer Staging: Assessing Tumor Extent
Initial assessment for early glottic cancer involves perceptual voice analysis and endoscopic visualization, both of which are crucial for detecting vocal fold pathology. Among endoscopic techniques, flexible laryngoscopy is preferred due to its ability to assess tumor extent beyond the vocal folds. Key clinical factors such as vocal fold mobility and contralateral vocal fold integrity play a critical role in staging and surgical decision-making. Additionally, in-office swallowing assessments are routinely performed to evaluate preoperative function and anticipate potential postoperative challenges.
Tumor morphology varies widely, influencing both diagnostic approach and treatment planning. Exophytic lesions, which grow outward, are typically easier to resect, whereas sessile or endophytic tumors infiltrate deeper and present greater surgical challenges. To further assess tumor characteristics, stroboscopy provides valuable insights into mucosal pliability, helping predict functional outcomes following intervention. While narrow-band imaging enhances visualization of vascular patterns, its utility remains limited to surface abnormalities, necessitating more advanced imaging techniques for comprehensive tumor assessment.
To address these limitations, emerging technologies such as confocal laser endomicroscopy and near-infrared fluorescence imaging allow for real-time, high-resolution tumor mapping, including subclinical and contralateral disease detection. Confocal laser endomicroscopy provides microscopic visualization of cellular morphology in vivo, revealing pre-malignant changes that might otherwise go undetected. Additionally, EGFR-targeted fluorescence imaging with Panitumumab Iodide 100 enables identification of deep tumor infiltration, improving precision in resection. Collectively, these advancements mark a promising shift toward more tailored, function-preserving interventions while enhancing oncologic control.
[Dr. Gopi Shah]
In terms of your exam, can you take us through start to finish? Are you, as soon as they walk into the office, listening to voice quality, or is it all in the scope?
[Dr. Bharat Panuganti]
That's a really good question. I think, obviously you hear the dysphonia and that's something that suggests at least that a vocal fold pathology might exist. The diagnosis of a vocal fold cancer requires that you see obviously, and get a biopsy. Typically for a clinic encounter, someone comes in, if they hadn't been diagnosed before, we look at the larynx. Generally speaking, if I'm suspicious for a larynx cancer, what I'll like to do is use a flexible camera as opposed to a rigid scope through the mouth, both of which are totally viable options, generally speaking, for laryngeal examinations.
The reason I like flexible examinations is that you can really advance the scope, not just to the level of the vocal folds, but beyond it. It is important to understand the potential geographic footprint of a tumor because it does advise you, at least tentatively, about what the treatment options might entail. If there's a tumor that extends far into the subglottis, obviously that should change your preoperative thinking about whether or not this person might be a surgical candidate.
We take a look with the scope, get a feel for how extensive the tumor is. Then there are a couple of really important things that we look at, the first of which is, is the vocal fold moving? Like I mentioned before, whether or not the vocal fold moves is important for us to determine the clinical stage. If the vocal fold doesn't move at all, that is not an early laryngeal cancer. That automatically upstages to a stage 3 and a T3.
If there is some mobility at least, that is at least a T2, but that also goes into our consideration of what would surgery entail for this person. If there's limited movement to the vocal fold, that suggests that in order to clear the disease, you're going to have to resect a portion of the muscle. When we think about functional outcomes after surgery, and I'm sure we'll get into this a little bit later, but if we have to remove a big portion of the muscle, then that conveys directly to whether or not a person can get the vocal folds closed, which by virtue of that, I've get a person's voices and swallow is going to be after the surgery.
The other thing that we look at is the good side of the larynx. It is not uncommon for cancer to involve both sides, but in situations where one side is preserved, that can be quite meaningful because if you survey laryngeal surgeons-- voice is, in general, just an amazingly fascinating thing. One of the things that I think a lot of laryngeal surgeons will notice is as long as you have one good side that's vibrating, even if the other side doesn't vibrate, as long as you have a wall for the good side to vibrate against, you can have pretty darn good voice.
If you have a completely preserved side of the vocal fold that doesn't have to be operated on in terms of what the voice outcomes and the swallow outcomes might be, again, that portends potentially good outcomes. Those are the biggest things that we look for almost universally in my practice unless someone has just a really small, well-confined T1 vocal fold cancer, where there's basically no expectation after the surgery that they'll have any voice or swallowing problems.
They're all getting in-office swallow exams with a speech-language pathologist, so a functional endoscopic evaluation of their swallow, one, to make sure that their swallowing is intact preoperatively, but also to give us an idea of what they're able to do from a laryngeal perspective to overcome potentially, at least in the short-term, some issues with vocal fold competency. That's the basic clinic exam. This goes for anybody that's undergoing a surgery, full head and neck exam.
Primarily, what you're looking for is things that might suggest that laryngeal exposure intraoperatively might be difficult. Small jaw, presence of mandibular tori, poor neck extension, big tongue, anything that might make it difficult for you to align the scope from the point of the lips to the entrance of the larynx. Those are really important considerations because if you don't have the confidence you'll be able to expose the larynx, then you should reconsider whether or not an endoscopic transoral surgical approach to a larynx cancer is the best option for the patient.
[Dr. Gopi Shah]
Going back to your exam, just thinking about what the tumors look like, is there a very typical appearance as far as exophytic or sessile, and is it more commonly anterior commissure or can it be anywhere all over the place?
[Dr. Bharat Panuganti]
Yes, totally. No, they have different flavors, so to speak. Sometimes you're lucky and it's a nice exophytic tumor that's confined to one vocal fold. Those are the nice ones, especially if the vocal fold is mobile, because what it implies is that the pattern of growth is outwards and those are really easy to cut out while preserving the underlying vocal fold architecture. Sometimes it's all over the place and there's more sessile disease that expands from the front to the back on both sides.
Sometimes it's endophytic and the pattern of growth is into the vocal fold and in those situations it's easy to underestimate what the functional outcome might be postoperatively. I guess the basic lesson is to never assume what a cancer will look like based on a clinic exam and it's critically important that you get a good intraoperative exam and certainly a radiographic imaging as well.
[Dr. Gopi Shah]
Is a strobe ever helpful to you? Does that provide more information or does that change your management ever?
[Dr. Bharat Panuganti]
A stroboscopy is really important and it goes to what we were talking about before. You don't need a strobe to assess for basic vocal fold mobility. What a strobe gives you is what is the pliability of the vocal fold that's ipsilateral to the tumor. Say, for example, you have a tumor sitting on the vocal fold, you ask the patient to phonate and you see vibration of the mucosa adjacent to the tumor. What that implies is even if you remove the tumor, there's enough pliable mucosa adjacent to it that perhaps the voice outcomes will be good enough.
That is very important. If you see no vibration of the vocal fold, what that implies is that the postoperative functional outcome may not be as good as it could be if the former scenario was present.
[Dr. Gopi Shah]
Then what about using, is it blue light or narrow-band when you're doing your flexible scope to look at hypervascularity or-- Am I saying this right? Is that helpful?
[Dr. Bharat Panuganti]
Totally. Narrow-band imaging, I don't typically use it in the clinic setting, mostly because if I'm taking someone to the operating room, they're getting the whole spectrum of introvertive imaging anyways. I think one of the most difficult things about treating early vocal fold cancers is understanding the footprint. There's a lot that you can tell from the clinic exam, but there's a lot that you can't. You're restricted by the resolution of the camera from the clinic.
When you go to the operating room, you get someone exposed. I use the universal modular glottoscope system. I'm a little biased because I trained with the person that invented it. In my humble opinion, a really, really great scope and in my practice, mission critical for full exposure of the inside of the voice box. Get the vocal folds exposed, 8.7X surgical microscopic magnification to look at the surface of the vocal folds, you still sometimes can't tell what the footprint of the tumor is.
That's where a couple of additional imaging modalities that are a big part of my ongoing research, I think come in. You mentioned narrow-band imaging. Narrow-band imaging, basically what it does is it leverages two maximum wavelengths, bands that highlights the microvasculature. There are a couple of different diagnostic schemas that surgeons can use to classify lesions based on the microvascular pattern. Narrow-band imaging gives you a better sense of what is otherwise grossly visible, the microvasculature.
Engaging narrow-band imaging, sometimes you can see, "Oh, I see stippling here," which would suggest that maybe there's perpendicular angiogenesis that's causing a vocal fold lesion or allowing a vocal fold lesion to grow on the surface. Narrow-band imaging does potentially give you a better sense of the footprint of the tumor. However, narrow-band imaging, all it really does is allow you to see better what is otherwise grossly visible, which is these vessels that are either in the epithelium or below the epithelium.
If you really want to get into seeing what you can't see to truly understand what the footprint of a tumor might be, you got to get microscopic. 8.7x surgical microscopy isn't microscopic. If you want to be able to see cells and the subcellular morphology, you've got to go even deeper than that. Two of the things that I've been using are a couple of different intraoperative optical imaging modalities. One is called confocal laser endomicroscopy. It's a really neat tool that gives you 1000x magnification.
The system that I use is something called the Cellvizio system. It's based on differential fluorescein uptake. A patient gets fluorescein injected in the operating room intravenously. You put the probe on the surface of the tissue and you see individual cells. The probe has a field of view of 240 micrometers. What I do in the operating room before I even start doing the resection is I will map the entire surface of the inside of the larynx.
That includes, for early glottic cancer, both of the vestibular folds, the false folds, and both of the true vocal folds. I scan the surface. This is data that I haven't yet published, but what I'm finding-- and there's a whole set of criteria that we're adapting and now modifying to use for the diagnosis based on the cellular morphology of cancer versus dysplasia. What I'm finding is that even in situations where there's a unilateral tumor, I go to the contralateral vocal fold and I'm seeing foci of cellular aberrancies, which suggests that it is not uncommon for there to be cancer on one side, but at least changes on the other side that are suggestive of pre-malignancy that are usually not accounted for.
Then the other thing that we've been using, which is also part of this phase I clinical trial we're running, is something called Panitumumab Iodide 100. Panitumumab is an EGFR monoclonal antibody, and that's paired with a near-infrared dye. It's injected intravenously about 24 to 48 hours before the surgery. We use a special camera that allows for excitation in the near-infrared wavelength. We can see tumor volumes as small as 450 cells. This is a different thing that we can use, not just for surface mapping, but for the identification of disease deep to the surface.
Between the two things, my hope is that we would have created a paradigm from an imaging perspective where we can see both deep and surface disease in a way that we haven't been able to before.
[Dr. Gopi Shah]
The fluorescein, when you inject the fluorescein for the confocal laser, is that through the IV or is it topical on the tumor?
[Dr. Bharat Panuganti]
It's intravenous and then obviously vascular. Within about seven seconds, I'll see the fluorescein light up in the larynx. It's pretty remarkable.
Imaging & Biopsy Techniques in Early Glottic Cancer
In Dr. Panuganti’s glottic cancer practice, biopsy and therapeutic intervention are often performed in a single staged procedure. Due to the delicate architecture of the vocal fold, large biopsies risk damaging the superficial lamina propria, which is essential for vibration. On the other hand, frozen sections are generally avoided preoperatively, as small biopsies often yield unreliable results due to cautery artifacts. Instead, definitive biopsy and treatment are performed in a single-stage procedure to minimize the risk of unnecessary vocal fold trauma while helping to ensure oncologic control.
Preoperative imaging plays a crucial role in staging and identifying concurrent pathology. Although early vocal fold cancers are often difficult to detect on CT, chest imaging remains essential to rule out synchronous malignancies rather than metastasis. Diagnostic tracheobronchoscopy is routinely performed intraoperatively to assess for occult endobronchial disease. While direct visualization remains the gold standard for identifying lesions, adjunctive imaging techniques, including confocal laser endomicroscopy and narrow-band imaging, enhance diagnostic accuracy.
Differential diagnoses for vocal fold lesions extend beyond malignancy, and can include dysplasia, hyperkeratosis, fungal infections, and changes from prior radiation or steroid inhaler use. In ambiguous cases, empirical antifungal treatment may help distinguish infection from malignancy.
[Dr. Gopi Shah]
Then if you have like a foci of aberrancy, do you send that for frozen? Do you get intrapathology frozen, "Hey, this could be something before I start doing anything on a side that I wasn't expecting, maybe?"
[Dr. Bharat Panuganti]
Yes, totally. The problem with early vocal fold cancers and the impetus for this entire avenue of research is that if you look at the vocal fold, in terms of what you see exposed generally when you do a flexible laryngoscopy, which I think most ENTs will do that are looking at larynges, in an adult, the visible portion of the vocal fold is about four millimeters in width. The full width of the vocal fold is longer, but just in terms of what upfront.
The superficial lamina propria, which is the critical layer of the vocal fold that's responsible for vibration, is between 50 to 150 micrometers. If what you're trying to do is maximize postoperative voice function, you can't take big honking biopsies. By the time you take a biopsy, you send it off for a frozen section and they go through the process of preparing the frozen section for analysis. The cautery artifact that's introduced makes it really difficult to accurately diagnose based on small-volume frozen section biopsies.
My practice has evolved to some degree. For the sake of preoperative diagnosis, I typically don't do frozens and that is in large part because of what we just talked about, that it's hard to rely on histopath explicitly when we're sending these tiny, tiny biopsies, but also because if it is truly just surface occult disease, with the way that I treat vocal fold cancers, you can treat it with basically no functional sequelae as a result of it. My practice is I'll take frozen sections for margins at the end of the case, but I won't take it upfront.
[Dr. Gopi Shah]
I think that's a really good point regarding biopsies. For your referring doctors who are sending you patients, are they typically not biopsying them and just saying, "This looks like it's something bad," just because it's small, and if they biopsy it might be gone and you may not be able to see it once they get to you? What's that process so we back up a little bit?
[Dr. Bharat Panuganti]
Absolutely. That's a really good point. I think that to get a diagnosis before referring someone, absolutely. Totally appropriate. I do think that there's some risk with exactly what you just said, that if it is a small lesion and you don't take a deliberate biopsy where you're respecting the micro-layered underlying architecture of the vocal fold, that there's some risk, one, that the biopsy cures the cancer, at least clinically, where it becomes really difficult for the person that's getting referred the patient to understand exactly what they're meant to clear.
Two, the other problem is the biopsy itself could destroy the voice. I think in a situation where there's any apprehension about what a biopsy would do, in my practice, especially, I don't stage the biopsy and treatment. It's all one stage anyhow. In my hands, I'll do the biopsy and treat everything up front. There's really no risk to holding off on the biopsy, simply saying that a lesion is concerning enough that you think it might be cancer and just shuffling off to referral if the intention, of course, is not to treat it eventually.
[Dr. Gopi Shah]
Bharat, just so I'm clear, you have a patient that comes to clinic, you're not immediately biopsying then. Maybe you'll get a CT neck or whatever for further workup and then plan for the path and if there is a treatment to be done all at the same time. Your case posting could be as quick as 45 minutes to a couple of hours.
[Dr. Bharat Panuganti]
Yes. I don't typically take in-office biopsies and there's nothing wrong with it since I'm biopsying and treating in one stage. To me, it doesn't actually save any time or the patient a trip to the operating room for the sake of a biopsy. My personal practice pattern is not to do that. In terms of a posting, typically what I'll call it is a suspension microlaryngoscopy with biopsy, possible laser-assisted resection of a tumor.
If it is apparent intraoperatively that surgery is not appropriate, then the case could last about 15 minutes. I will always, in the operating room, not just look at the larynx, but I'll look below as well. I'll do a diagnostic tracheobronchoscopy just to look for occult endobronchial disease. You mentioned this before, but CT imaging, I think there's a misconception about whether or not chest imaging is necessary for early vocal fold cancers. I always get chest imaging, not because I'm worried about metastasis, I get chest imaging because I'm worried about a second primary. All my patients, regardless of how small the vocal fold cancer is, will get CT neck and chest imaging.
[Dr. Gopi Shah]
Typically these early glottic cancers can be invisible or really hard to see on a CT. Right?
[Dr. Bharat Panuganti]
That's right. Yes. Even big ones can be hard to differentiate because it's hard to differentiate a tumor sitting on the surface of the vocal folds from the underlying mucosa, and you never know what the position of the vocal folds are going to be. Sometimes the patient is voicing or coughing at the time that that shot is taken and they're abducted, in which case it's impossible to differentiate a mass from just the structure of the vocal folds themselves.
Generally speaking, CT imaging is not terribly good for imaging, especially surface vocal fold cancers. It's really just a mechanism to make sure that there's nothing else worrisome in the larynx or the neck.
[Dr. Gopi Shah]
Also, if the read comes back that it's normal and negative, it's also not reassuring because you need to correlate it with direct visualization.
[Dr. Bharat Panuganti]
That's right. Exactly.
[Dr. Ashley Agan]
The standard line.
[Dr. Bharat Panuganti]
Exactly.
[Dr. Gopi Shah]
When you're taking a look in the office, it sounds like if it's obvious, maybe it's obvious, but what's on your differential? What other things are you thinking about and what else should we be considering?
[Dr. Bharat Panuganti]
If someone just has a lot of, I just call it schmutz, smoker, maybe a history of larynx cancer before, previously radiated, someone that is on a steroid inhaler, fungal infection, that's a big thing. Sometimes really bad fungal infections can masquerade as what appears to be a tumor in the clinic. If there's any doubt, I will put someone on an antifungal medication, an oral Diflucan typically just to see if there's interval resolution. Now those two things aren't mutually exclusive either.
You can have a fungal infection and cancer. Something to consider. If there's any doubt in my mind about whether or not there's a fungal infection, I'll treat them presumptively, and either say, "Why don't we just meet in the operating room for me to take a look after or just come to the clinic so we can get an interval exam." Sometimes something looks bad, but it's not cancer and it's dysplasia. There are different vocal fold lesions, again, besides cancer that can masquerade as a mass lesion.
You can have dysplasia, you can have parakeratosis, you can have hyperkeratosis. Obviously what they stipulate is that there is invasion beyond the basement membrane.
[Dr. Gopi Shah]
In just thinking of patients that are coming through your clinic and how that process is flowing, once you're concerned at all and you know, "Okay, we need to biopsy this," how do you talk to patients about that? It sounds like most of the time, whether it's cancer or not, it's going to be a diagnostic and therapeutic type of intervention.
[Dr. Bharat Panuganti]
That's exactly right. If it's something that's on the vocal fold that is impairing the voice that's not infectious, then it's got to go one way or the other. Typically what I'll tell a patient is in the operating room, my microscopic exam is good enough where generally speaking, I'll have a good sense of whether or not what we're dealing with is cancer. That's also where the other imaging modalities come in with a confocal laser and a microscopy.
Of course, if there's a mass lesion that isn't just a surface lesion, we can send it off for the frozen section. We can take a big chunk and get help from the pathologist and drop. The conversation generally is go to the operating room, take a biopsy. If there's concern for cancer, if there's concern for something that shouldn't be there, a mass, lesion, hyperkeratosis, perikeratosis, dysplasia, the approach is fundamentally the same, which is to use a laser to remove the lesion.
Podcast Contributors
Dr. Bharat Panuganti
Dr. Bharat Panuganit is an otolaryngologist and airway surgeon at Washington University in St. Louis, Missouri.
Dr. Gopi Shah
Dr. Gopi Shah is a pediatric otolaryngologist and the co-host of BackTable ENT.
Dr. Ashley Agan
Dr. Ashley Agan is an otolaryngologist in Dallas, TX.
Cite This Podcast
BackTable, LLC (Producer). (2024, November 12). Ep. 199 – Advances in Early Glottic Cancer Treatment Options [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
Podcasts
