This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Larynx, Subject name: ENT
All are true of supraglottic cancer except: 
Select and explain. 
A. Earliest symptom is hoarseness, B. Most aggressive of laryngeal cancers, C. High incidence of nodal metastases, D. Commonest site in supraglottic region is epiglottis
A: Earliest symptom is hoarseness
Answer: A: Earliest symptom is hoarseness 
Explanation: Supraglottic growth remains asymptomatic or present with cough and something sticking in throat. Hoarseness is the earliest symptom in glottic carcinoma.Commonest site involved in supraglottic region with cancer is epiglottis. From here it spreads to aryepiglottic folds, false cords and ventricles.Supraglottis has rich lymphatic network and therefore incidence of lymphatic metastasis is high. Some of them present with nodal metastases at the initial visit.Even in patients with no clinically positive nodes. 30% have shown micrometastases on pathology.