Treatment of Vocal Cord Metastasis
Vocal cord metastasis requires systemic therapy directed at the primary cancer, not local laryngeal treatment, because metastatic disease to the larynx represents disseminated malignancy with extremely poor prognosis. 1
Critical Diagnostic Distinction
The first priority is confirming whether the vocal cord lesion is truly metastatic disease versus a primary laryngeal squamous cell carcinoma, as these require fundamentally different treatment approaches. 2
- Biopsy with comprehensive immunohistochemistry is mandatory to distinguish metastatic disease from primary laryngeal cancer 3, 4
- Deep biopsies including lesion edges increase diagnostic yield 3
- Patients with prior malignancy (especially breast, renal, melanoma, or lung cancer) presenting with hoarseness must be evaluated for both primary laryngeal disease and metastases 1
Treatment Approach for Confirmed Metastatic Disease
Systemic Therapy as Primary Treatment
The treatment must target the primary cancer histology, not the laryngeal site. 1
- Systemic chemotherapy appropriate for the primary malignancy is the cornerstone of treatment 1
- Complete staging workup including PET-CT, bone marrow biopsy (if indicated by primary cancer type), and laboratory evaluation is required 3
- Multidisciplinary team should include medical oncology, radiation oncology, otolaryngology, and pathology 3
Role of Local Therapy
Local treatment to the larynx is palliative only, reserved for symptom control when systemic therapy fails to control local disease. 2
- Palliative radiotherapy to the larynx may be considered if airway obstruction or severe dysphagia develops 2
- Surgical intervention (including tracheostomy) is reserved for acute airway compromise 2
- Local treatment should only be initiated if symptoms occur and systemic therapy is insufficient 2
Prognosis and Quality of Life Considerations
Laryngeal metastases indicate advanced systemic disease with poor prognosis. 1
- Median survival is typically measured in months, not years 1
- Treatment goals should focus on maintaining airway patency, voice function, and swallowing ability rather than cure 1
- Early recognition and prompt systemic treatment are critical to improve quality of life 1
- Best supportive care including speech pathology, nutrition support, and palliative care consultation should be integrated early 2
Common Pitfall to Avoid
The critical error is treating vocal cord metastasis as if it were primary laryngeal cancer with surgery or definitive radiotherapy. This approach ignores the systemic nature of the disease and delays appropriate systemic therapy. 1 Laryngeal metastasis represents stage IV disease regardless of the size of the laryngeal lesion, and treatment algorithms for primary laryngeal cancer (T-staging, larynx-preservation strategies, etc.) do not apply. 2, 1