Photo Rounds

Difficulty swallowing

A 52-year-old man with a 40-pack-year history of smoking presented with worsening hoarseness that had begun about 6 weeks earlier. He complained of globus sensation and difficulty swallowing solid foods. He denied odynophagia, otalgia, hemoptysis, and hematemesis. There was no associated cough and he did not have any fevers, chills, or recent weight loss. The family physician (FP) performed a flexible fiberoptic laryngoscopy.

What's your diagnosis?


The FP suspected that the patient had squamous cell carcinoma (SCC) and referred him to Otolaryngology for a biopsy and workup. SCC accounts for 95% of laryngeal cancer cases. Approximately 11,000 new cases of laryngeal cancer are diagnosed in the United States each year. Peak incidence of laryngeal cancer is in the sixth and seventh decades of life with a strong male predominance.

SCC has a multifactorial etiology, but 90% of patients have a history of heavy tobacco and/or alcohol use. These risk factors have a synergistic effect. Other independent risk factors include employment as a painter or metalworker, exposure to diesel or gasoline fumes, and exposure to therapeutic doses of radiation.

The patient’s biopsy confirmed SCC of the larynx. Fortunately, the metastatic workup was negative and the patient underwent a laryngectomy.

Photo courtesy of Blake Simpson, MD. Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Matrka L, Simpson CB, King JM. The larynx (hoarseness). In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:220-226.

To learn more about the Color Atlas of Family Medicine, see:

You can now get the second edition of the Color Atlas of Family Medicine as an app by clicking this link:

Next Article: