# A nurse is assessing a 58-year-old male client who has been diagnosed with laryngeal cancer. Which assessment finding would be most indicative of disease progression? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540741 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a 58-year-old male client who has been diagnosed with laryngeal cancer. Which assessment finding would be most indicative of disease progression? ## 보기 1. Progressive hoarseness with complete voice loss **✔ 정답** 2. Mild throat discomfort when swallowing 3. Occasional dry cough in the morning 4. Slight difficulty with solid foods **정답: 1** ## 해설 Progressive hoarseness leading to complete voice loss is the most significant indicator of laryngeal cancer progression, as it suggests tumor growth affecting vocal cord function. Other options represent mild or non-specific symptoms that are less indicative of progression. ## 심화 해설 Understanding the Clinical Progression of Laryngeal Cancer Laryngeal cancer directly affects the structures responsible for voice production (phonation) and airway protection. As a tumor grows, it disrupts the normal vibratory mechanics of the vocal folds. The earliest and most consistent sign of advancing disease is a change in voice quality, which reflects the tumor's direct invasion into the glottic tissues. This is not merely a symptom of irritation but a mechanical disruption of the mucosal wave essential for sound production. Why Progressive Hoarseness is the Most Indicative Finding Progressive hoarseness that advances to complete voice loss (aphonia) signals extensive tumor infiltration into the vocal folds or involvement of the recurrent laryngeal nerve. Research using high-speed videoendoscopy has demonstrated that malignant glottic lesions cause significant and quantifiable deterioration in vocal fold vibratory parameters, including amplitude and mucosal wave patterns, compared to benign lesions or normal tissue [3]. When a lesion obliterates the layered structure of the vocal fold or fixes it in place, the glottic gap cannot close, and vibration ceases entirely, leading to aphonia. This progression from dysphonia to aphonia is a hallmark of local tumor advancement and is a critical finding for nurses to recognize and report promptly. Differentiating Early from Late Symptoms The other options presented represent earlier or less specific symptoms. Mild throat discomfort when swallowing (option 2) and occasional dry cough (option 3) are often associated with local irritation or early-stage disease and can be caused by many benign conditions. Slight difficulty with solid foods (option 4) suggests a mass effect in the hypopharynx or upper esophagus, which can occur, but hoarseness is the sentinel symptom for glottic and supraglottic tumors. In the context of a known laryngeal cancer diagnosis, the trajectory from hoarseness to complete voice loss directly mirrors the pathological process of tumor growth and tissue destruction, making it the most specific indicator of disease progression among the choices. This aligns with the clinical understanding that treatment strategies for advanced laryngeal cancer, including larynx preservation protocols, are often initiated when significant local symptoms like severe dysphonia are present . References (research sources) - [3]High-Speed Videoendoscopy Enhances the Objective Assessment of Glottic Organic Lesions: A Case-Control Study with Multivariable Data-Mining Model Development.Research articleMalinowski J, Pietruszewska W, Stawiski K, Kowalczyk M, Barańska M, Rycerz A, Niebudek-Bogusz E. (2023) · DOI: 10.3390/cancers15143716 ## 임상 시나리오 Recognizing Laryngeal Cancer ProgressionVoice Changes as the Sentinel Sign The hallmark of advancing glottic laryngeal cancer is a change in voice quality. Progressive hoarseness (dysphonia) advancing to complete voice loss (aphonia) indicates direct tumor infiltration into the vocal folds or involvement of the recurrent laryngeal nerve. This occurs because the tumor mechanically disrupts the mucosal wave and normal vibratory mechanics. When the lesion fixes the vocal fold, the glottic gap cannot close, and vibration ceases entirely, resulting in aphonia. CautionAny adult with persistent hoarseness lasting longer than 2 weeks requires prompt evaluation by an otolaryngologist. Do not dismiss voice changes as simple laryngitis without a thorough assessment. ## 핵심 개념 - **Aphonia** — Complete loss of voice resulting from disease, injury, or structural changes to the vocal folds or their nerve supply. - **Dysphonia** — Difficulty producing vocal sounds or hoarseness, often an early sign of laryngeal pathology. - **Glottic Cancer** — Laryngeal cancer originating on the true vocal cords, typically presenting early with voice changes. - **Recurrent Laryngeal Nerve** — The nerve that innervates the intrinsic muscles of the larynx responsible for vocal fold movement; its invasion by tumor can cause paralysis and voice loss. - **Mucosal Wave** — The vibratory pattern of the vocal fold cover essential for normal phonation, which is disrupted by malignant lesions. ## 같은 주제 문제 - [A nurse is assessing a 58-year-old male client who has been diagnosed with laryngeal cance…](https://mymerci.kr/pages/nclex_q.php?qn_id=540740) - [A nurse is caring for a client who underwent a total laryngectomy 3 days ago for laryngeal…](https://mymerci.kr/pages/nclex_q.php?qn_id=540742) - [A nurse is caring for a client who underwent a total laryngectomy 48 hours ago for larynge…](https://mymerci.kr/pages/nclex_q.php?qn_id=540743) - [A nurse is caring for a client who underwent a total laryngectomy 3 days ago for laryngeal…](https://mymerci.kr/pages/nclex_q.php?qn_id=540744) - [A nurse is caring for a client who underwent a total laryngectomy 1 week ago for laryngeal…](https://mymerci.kr/pages/nclex_q.php?qn_id=540745) - [A nurse is caring for a client who underwent a total laryngectomy 2 days ago. 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