Advanced Metastatic Laryngeal Carcinoma: A Case Report on Palliative Management in Primary Care

This case describes a poorly differentiated laryngeal carcinoma diagnosed at an advanced stage. The disease was associated with extensive metastasis and severe functional impairment. The patient had multiple risk factors, including tobacco and alcohol abuse, low health literacy, and poor therapeutic adherence. The patient initially presented with dysphonia, followed by progressive cervical swelling. A biopsy confirmed undifferentiated laryngeal carcinoma. Due to clinical deterioration, an emergency tracheostomy was performed. Imaging revealed an extensive infiltrative tumor involving the larynx and hypopharynx, with necrotic lymphadenopathy and distant metastases, including bone and peritoneum. Treatment with cisplatin, 5-fluorouracil, and pembrolizumab was initiated. The clinical course was further complicated by subclavian vein thrombosis. The patient developed aphonia and severe cervical involvement, with progressive functional decline and increased dependence. Care was ultimately transitioned to the home setting, provided mainly by family members, including a frail primary caregiver. This case highlights the impact of delayed diagnosis and social vulnerability on disease progression and functional outcomes. It underscores the importance of early recognition, timely intervention, and the central role of primary care-led palliative management and caregiver support in advanced head and neck cancer.