MCQs on Carcinoma Larynx for NEET PG & University Exams
1. What is the most common histological type of laryngeal cancer?
2. A 65-year-old male smoker presents with hoarseness for 4 weeks. Which laryngeal subsite is most likely involved? (NEET PG 2019)
3. Which risk factor increases the risk of laryngeal cancer by approximately 15 times when combined with smoking?
4. A 70-year-old male presents with a neck mass and dysphagia. Flexible laryngoscopy reveals an exophytic lesion above the vocal cords. Which subsite is primarily affected? (NEET PG 2020)
5. Which anatomical barrier limits the early spread of glottic tumors?
6. A 60-year-old smoker presents with stridor and dyspnea. Imaging shows a circumferential lesion below the vocal cords. Which subsite is involved? (NEET PG 2018)
7. What is the earliest symptom of glottic laryngeal cancer?
8. A 68-year-old male with a history of smoking presents with referred otalgia and a hot potato voice. What is the most likely diagnosis? (NEET PG 2021)
9. Which imaging modality is the investigation of choice for assessing laryngeal cancer extent? (NEET PG 2017)
10. What is the gold standard for diagnosing laryngeal cancer?
11. A 62-year-old male with T1a glottic cancer is advised transoral laser microsurgery (TLM). What is the key advantage of TLM over radiotherapy? (NEET PG 2019)
12. Which treatment is preferred for T3 laryngeal cancer to preserve the larynx? (NEET PG 2020)
13. A 75-year-old male undergoes total laryngectomy for T4a laryngeal cancer. Post-surgery, he struggles with speech. Which voice rehabilitation method provides immediate speech? (NEET PG 2018)
14. Which lymph nodes are commonly involved in supraglottic laryngeal cancer?
15. A 55-year-old female with laryngeal cancer post-radiotherapy develops xerostomia and mucositis. What is the best supportive care? (NEET PG 2021)
16. What is the primary indication for total laryngectomy in laryngeal cancer? (NEET PG 2016)
17. A 67-year-old male with subglottic cancer presents with vocal cord paralysis. Which nerve is likely involved? (NEET PG 2019)
18. Which histological variant of laryngeal cancer has a favorable prognosis due to limited nodal spread?
19. A 64-year-old smoker with T2 glottic cancer undergoes radiotherapy but develops recurrence. What is the next step? (NEET PG 2020)
20. What is the purpose of the nasal airflow-inducing maneuver (NAIM) post-laryngectomy?
21. A 72-year-old male with supraglottic cancer has bilateral neck node involvement. What is the management for nodal disease? (NEET PG 2017)
22. Which diagnostic tool is best for distinguishing carcinoma in situ from invasive laryngeal cancer? (NEET PG 2018)
23. A 58-year-old female post-laryngectomy struggles with swallowing. What surgical technique aids swallowing rehabilitation?
24. What is the most common site for lymph node metastasis in subglottic laryngeal cancer? (NEET PG 2016)
25. A 66-year-old male with T1b glottic cancer prefers voice preservation. What is the best treatment option? (NEET PG 2021)
Answer Keys
1. b) Squamous cell carcinoma
2. b) Glottis
3. b) Alcohol consumption
4. c) Supraglottis
5. b) Reinke’s space
6. c) Subglottis
7. b) Hoarseness
8. b) Supraglottic cancer
9. b) Contrast-enhanced CT
10. c) Direct laryngoscopy with biopsy
11. b) Quicker recovery
12. b) Chemoradiotherapy
13. b) Electrolarynx
14. b) Upper and middle jugular nodes
15. b) Hydration and pain management
16. b) T4a tumours with cartilage invasion
17. b) Recurrent laryngeal nerve
18. b) Verrucous carcinoma
19. b) Total laryngectomy
20. c) Regain smell sensation
21. b) Bilateral elective neck dissection
22. b) Narrow-band imaging (NBI)
23. b) Pharyngeal mucosa preservation
24. b) Delphian nodes
25. b) Radiotherapy
Explanations
1. Most common histological type. Explanation: Squamous cell carcinoma (SCC) accounts for 85–95% of laryngeal cancers, characterised by epithelial nests and keratin pearls. Adenocarcinoma, fibrosarcoma, and oat cell carcinoma are rare. Key Point: SCC’s prevalence makes it a high-yield fact for exams. Answer: b
2. Subsite for hoarseness (NEET PG 2019). Explanation: Hoarseness for >3 weeks in a smoker suggests glottic cancer, as even small lesions disrupt vocal cord vibration. Supraglottic cancers cause hoarseness late, subglottic cancers present with stridor, and transglottic involves multiple subsites. Key Point: Glottic cancer’s early hoarseness aids detection. Answer: b
3. Risk factor with 15x risk. Explanation. Alcohol combined with smoking increases laryngeal cancer risk by ~15 times due to synergistic carcinogenic effects. HPV, GERD, and asbestos are risk factors but lack this magnitude. Key Point: Alcohol-tobacco synergy is a critical risk association. Answer: b
4. Exophytic lesion above vocal cords (NEET PG 2020). Explanation: An exophytic lesion above the vocal cords with dysphagia and neck mass indicates supraglottic cancer, which often presents late with nodal metastasis. Glottic cancers cause hoarseness early, subglottic cancers cause stridor, and the ventricle is not a subsite. Key Point: Supraglottic cancers are often silent until advanced. Answer: c
5. Anatomical barrier for glottic tumors. Explanation: Reinke’s space, a submucosal layer, and Broyle’s ligament limit early glottic tumor spread due to sparse lymphatics. Pre-epiglottic and paraglottic spaces are involved in supraglottic spread, and pyriform sinus is adjacent. Key Point: Reinke’s space explains slow glottic spread. Answer: b
6. Circumferential lesion below vocal cords (NEET PG 2018). Explanation: Stridor and dyspnea with a circumferential lesion below the vocal cords suggest subglottic cancer, which narrows the airway. Supraglottic cancers cause dysphagia, glottic cancers cause hoarseness, and transglottic involves multiple subsites. Key Point: Subglottic cancer presents with airway obstruction. Answer: c
7. Earliest symptom of glottic cancer. Explanation: Hoarseness is the earliest symptom of glottic cancer, as small lesions disrupt vocal cord vibration. Dysphagia, stridor, and neck mass occur in advanced stages or other subsites. Key Point: Early hoarseness is a diagnostic clue. Answer: b
8. Hot potato voice and otalgia (NEET PG 2021). Explanation: A hot potato voice and referred otalgia suggest supraglottic cancer, which impairs articulation and invades laterally, causing ear pain via the vagus nerve. Glottic cancer causes hoarseness, subglottic causes stridor, and pharyngeal cancer is less likely. Key Point: Supraglottic symptoms often present late. Answer: b
9. Imaging for laryngeal cancer (NEET PG 2017). Explanation: Contrast-enhanced CT is the investigation of choice for assessing tumor extent, cartilage erosion, and lymph node metastases. MRI is better for soft tissue, PET-CT for recurrence, and chest X-ray for metastases. Key Point: CT is preferred for initial staging. Answer: b
10. Gold standard for diagnosis. Explanation: Direct laryngoscopy with biopsy under anesthesia is the gold standard, allowing visualization and histopathological confirmation. Indirect and flexible laryngoscopy are preliminary, and contact endoscopy is adjunctive. Key Point: Biopsy confirms diagnosis. Answer: c
11. Advantage of TLM (NEET PG 2019). Explanation: TLM for T1a glottic cancer offers quicker recovery as a daycare procedure compared to RT’s weeks-long schedule. Both preserve voice, and recurrence rates are similar. Follow-up is required for both. Key Point: TLM’s speed suits active patients. Answer: b
12. T3 treatment (NEET PG 2020). Explanation: Chemoradiotherapy is preferred for T3 lesions to preserve the larynx while controlling cancer. Total laryngectomy is for T4a, and OPL or TORS are alternatives if chemoradiotherapy is unavailable. Key Point: Organ preservation is key for T3. Answer: b
13. Immediate speech post-laryngectomy (NEET PG 2018). Explanation: Electrolarynx provides immediate speech post-laryngectomy, though robotic-sounding. Oesophageal speech requires training, TEP needs surgical placement, and NAIM is for smell. Key Point: Electrolarynx is quick but less natural. Answer: b
14. Lymph nodes in supraglottic cancer. Explanation: Supraglottic cancers cause early lymph node metastasis to upper and middle jugular nodes, often bilaterally. Delphian, paratracheal, and mediastinal nodes are typical for subglottic cancers. Key Point: Supraglottic cancers have high nodal risk. Answer: b
15. Supportive care for RT complications (NEET PG 2021). Explanation: Xerostomia and mucositis from radiotherapy are managed with hydration and pain relief. Antibiotics are for infections, debridement for necrosis, and chemotherapy is not supportive care. Key Point: Supportive care eases RT side effects. Answer: b
16. Indication for total laryngectomy (NEET PG 2016). Explanation: Total laryngectomy is indicated for T4a tumors with cartilage or bone invasion. T1a and T2 lesions use TLM/RT, and premalignant lesions use laser stripping. Key Point: T4a requires aggressive surgery. Answer: b
17. Nerve in subglottic cancer (NEET PG 2019). Explanation: Vocal cord paralysis in subglottic cancer suggests recurrent laryngeal nerve involvement, which controls vocal cord movement. Hypoglossal affects tongue, glossopharyngeal sensation, and vagus is broader. Key Point: Recurrent laryngeal nerve is key in ENT. Answer: b
18. Favorable histological variant. Explanation: Verrucous carcinoma, a well-differentiated SCC, has limited nodal spread and better prognosis. Spindle cell, oat cell, and adenocarcinoma are aggressive. Key Point: Verrucous carcinoma is less metastatic. Answer: b
19. Recurrence after RT (NEET PG 2020). Explanation: T2 glottic cancer recurrence after RT often requires total laryngectomy due to tumor factors. Repeat RT is rarely effective, chemotherapy alone is insufficient, and palliative care is for end-stage. Key Point: Laryngectomy salvages RT failure. Answer: b
20. Purpose of NAIM. Explanation: NAIM (polite yawning) restores smell post-laryngectomy by drawing air into the nasal cavity. It doesn’t aid swallowing, voice, or pulmonary function. Key Point: NAIM targets olfactory rehabilitation. Answer: c
21. Nodal management in supraglottic cancer (NEET PG 2017). Explanation: Bilateral elective neck dissection (levels II–IV) manages nodal disease in supraglottic cancer due to early bilateral metastasis. Chemotherapy alone, RT to primary, or observation are inadequate. Key Point: Nodal dissection is critical for supraglottic cancers. Answer: b
22. Tool for carcinoma in situ (NEET PG 2018). Explanation: Narrow-band imaging (NBI) distinguishes carcinoma in situ from invasive cancer by enhancing mucosal visualization. Chest X-ray, ultrasound, and indirect laryngoscopy are less specific. Key Point: NBI improves diagnostic precision. Answer: b
23. Swallowing rehabilitation post-laryngectomy. Explanation: Preserving pharyngeal mucosa during laryngectomy creates a wide neopharynx, reducing dysphagia. Cricopharyngeal myotomy aids TEP speech, tracheal stenting is for airway, and vocal cord augmentation is irrelevant. Key Point: Mucosa preservation eases swallowing. Answer: b
24. Lymph nodes in subglottic cancer (NEET PG 2016). Explanation: Subglottic cancers commonly metastasize to Delphian (precricoid), paratracheal, and mediastinal nodes. Upper jugular nodes are for supraglottic, submandibular for oral, and supraclavicular for distant spread. Key Point: Delphian nodes are subglottic-specific. Answer: b
25. T1b glottic cancer treatment (NEET PG 2021). Explanation: Radiotherapy is preferred for T1b glottic cancer involving the anterior commissure due to better voice outcomes. Total laryngectomy is for T4a, chemotherapy is adjunctive, and OPL is less common. Key Point: RT preserves voice in T1b. Answer: b
———— End of the chapter ————
Reference Textbooks.
- Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
- Cummings, Otolaryngology-Head and Neck Surgery.
- Stell and Maran’s, Textbook of Head and Neck Surgery and Oncology.
- Ballenger’s, Otorhinolaryngology Head And Neck Surgery
- Susan Standring, Gray’s Anatomy.
- Frank H. Netter, Atlas of Human Anatomy.
- B.D. Chaurasiya, Human Anatomy.
- P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
- Hazarika P, Textbook of Ear Nose Throat And Head Neck Surgery Clinical Practical.
- Mohan Bansal, Textbook of Diseases of Ear, Nose and Throat Head and Neck Surgery.
- Hans Behrbohm, Textbook of Ear, Nose, and Throat Diseases With Head and Neck Surgery.
- Logan Turner, Textbook of Diseases of The Nose, Throat and Ear Head And Neck Surgery.
- Arnold, U. Ganzer, Textbook of Otorhinolaryngology, Head and Neck Surgery.
- Ganong’s Review of Medical Physiology.
- Guyton & Hall Textbook of Medical Physiology.
Author:
Dr. Rahul Bagla
MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
Fellow Rhinoplasty & Facial Plastic Surgery.
Renowned Teaching Faculty
Mail: msrahulbagla@gmail.com
India
———– Follow us on social media ————
- Follow our Facebook page: https://www.facebook.com/Dr.Rahul.Bagla.UCMS
- Follow our Instagram page:https://www.instagram.com/dr.rahulbagla/
- Subscribe to our Youtube channel: https://www.youtube.com/@Drrahulbagla
- Please read. Juvenile Angiofibroma. https://www.entlecture.com/juvenile-angiofibroma/
- Please read. Tumours of Hypopharynx . https://www.entlecture.com/tumours-of-the-hypopharynx/
- Please read. Anatomy of Oesophagus. https://www.entlecture.com/anatomy-of-oesophagus/
Keywords:Discover the causes, symptoms, histological types, and spread of larynx (throat) cancer. Learn how early signs help improve survival and treatment options. Laryngeal cancer, Vocal cord cancer, Throat cancer symptoms, Glottic carcinoma, Subglottic tumour, Supraglottic tumour, Early signs of throat cancer, Risk factors for laryngeal cancer, Vocal cord tumour symptoms