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ENT · Head and neck oncology
Sample itemA 60-year-old smoker has hoarseness for six weeks. Laryngoscopy shows a small lesion on the mobile true vocal fold and no palpable neck nodes. Which anatomical feature best explains why such tumours rarely spread to nodes early?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
A. The glottis has very sparse lymphatic drainage
Glottic tumours present early because even a small lesion alters voice, and the true cords have very few lymphatics. Nodal spread is therefore uncommon in early disease, giving high cure rates with radiotherapy or limited surgery. Supraglottic tumours drain richly to the neck nodes and tend to present later.
Option by option
A. The glottis has very sparse lymphatic drainage (correct)
Correct. Few lymphatics and early hoarseness give early-stage, node-negative disease.
B. The glottis is separated from the supraglottis by a cartilage barrier
The glottis is not walled off by cartilage; spread depends on lymphatic density, not a cartilage barrier.
C. The glottis drains directly into the thoracic duct
The larynx drains to deep cervical nodes, not directly to the thoracic duct.
D. The vocal fold has a rich capillary plexus that traps tumour cells
Blood capillaries do not trap tumour cells and prevent lymphatic spread.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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