Which of the following signs and symptoms would Nurse Maureen include in her teaching plan as an early manifestation of laryngeal cancer?
A. Stomatitis
B. Airway obstruction
C. Hoarseness
D. Dysphagia
Correct Answer: C. Hoarseness
Early warning signs of laryngeal cancer can vary depending on tumor location. Hoarseness lasting 2 weeks should be evaluated because it is one of the most common warning signs. Patients are typically male with a history of current or past tobacco smoking. Hoarseness is often an early presenting symptom of glottic cancers due to vocal cord immobility or fixation, with pain with swallowing and referred ear pain indicating advanced disease.
Option A: Stomatitis is one of the early signs of oral cancer. Oral mucosal cancer presents clinically in various ways depending on its location. Early disease may manifest as irregular white, red, or mixed patches on the mucosa. More established cancers appear as an indurated raised nodule, often with an ulcerated surface that may cause little pain.
Option B: Airway obstruction occurs in the late stage, when the swelling or lump in the neck increases in size, enough to obstruct the larynx. Nodal metastases present as fixed, firm, painless masses in the neck. Late symptoms across all subsites include weight loss, dysphagia, aspiration, and its sequelae, and airway compromise. The most crucial component of a physical examination is an invasive assessment of the primary lesion, including indirect laryngoscopy, mirror exam, and often fiberoptic endoscopy.
Option D: Dysphagia is one of the symptoms of laryngeal cancer, but it does not occur in the early stages. The majority of patients first present with hoarseness, otalgia, dysphagia and weight loss to the nurse practitioner or primary care provider. Patients are typically male with a history of current or past tobacco smoking. A referral to an ENT surgeon should be made if the hoarseness is prolonged and associated with other features indicating a malignancy.