Haemoptysis, dysphagia, and odynophagia
A 70 year old woman presented to the head and neck unit with a three month history of intermittent haemoptysis, progressive dysphagia, and odynophagia. On further questioning she reported no dysphonia or dyspnoea but complained of left sided otalgia. She had a 40 pack year history of smoking. Apart from controlled hypertension her medical history was unremarkable.
Physical examination showed a 3 cm lymph node in the anterior triangle of the neck but no other findings. Fibre optic laryngoscopy performed in the outpatient department showed a large epiglottic mass with normal vocal cords. She was admitted for examination under anaesthetic and imaging of the neck (fig 1).
The case presented here is an example of a T4 tumour because it has spread from the larynx to involve the lateral pharyngeal wall. As part of staging a chest computed tomogram should always be obtained because synchronous lung cancer occurs in about