Mr. Linh, 68, sought medical attention for hoarseness lasting about 10 days, initially attributing it to a sore throat. However, doctors at Tam Anh General Clinic District 7 diagnosed metastatic lung cancer. Master of Science, Doctor, Level one specialist Truong Tan Phat, Head of the Ear, Nose, and Throat Department, reported that a laryngeal endoscopy revealed a paralyzed left vocal cord, swollen vocal cords, and hyperemic arytenoid cartilage. Vocal cord paralysis often follows thyroid or goiter surgery, neck or chest trauma, vocal cord injury, or intubation after anesthesia, none of which Mr. Linh had experienced.

A CT scan of Mr. Linh’s neck and chest revealed a large tumor in the left lung. This tumor extended into the central region, causing bronchial obstruction and nearly complete collapse of the left lung. It had also metastasized to the left adrenal gland and abdominal lymph nodes. Biopsy results confirmed the patient had large cell carcinoma of the lung.

Doctor Phat explained, "The invasive, metastatic tumor compressed the recurrent laryngeal nerve, causing vocal cord paralysis. This led to hoarseness that did not respond to sore throat medication." Vocal cord paralysis, resulting in hoarseness, shortness of breath, and difficulty breathing, is a severe complication of advanced or metastatic lung cancer. Mr. Linh's only symptom was hoarseness, which caused him to mistake his condition for common ailments like a sore throat, laryngitis, or reflux.

Doctor Phat examining and advising Mr. Linh on treatment. *Photo: Tam Anh General Clinic District 7*

Immunohistochemistry testing on Mr. Linh revealed an E298* mutation on the TP53 gene. Master of Science, Doctor Tran Nhu Tung, from the Department of Pathology and Cell Biology at Tam Anh General Hospital TP HCM, explained that TP53 is a tumor suppressor gene on chromosome 17. It encodes the p53 protein, which acts as a "controller" in the cell cycle. This protein detects and repairs DNA damage, also eliminating abnormal cells. When a TP53 gene mutation occurs, the p53 protein's structure and function are impaired or completely lost. Damaged cells, no longer controlled, continue to divide, accumulating and forming tumors.

Based on these findings, doctors developed a treatment plan combining chemotherapy and immunotherapy. The goal is to reduce symptoms, improve the patient's comfort, and extend their prognosis.

Doctor Phat emphasized that hoarseness can stem from either benign or malignant causes. He advises patients to visit an Ear, Nose, and Throat specialist for a laryngeal endoscopy if unusual signs appear, such as hoarseness lasting longer than one to two weeks and not responding to conventional treatment. This allows for assessment of the cause, diagnosis, and timely, effective management.

Uyen Trinh

*Patient's name has been changed