Case 2: Your patient is a 36 year old female who works as a…

Case 2: Your patient is a 36 year old female who works as a banker and has 3 school-aged children.  She smokes about three packs of cigarettes per week, occasionally drinks alcohol, and has a mild (managed) history of heart burn (reflux).  About 2 weeks ago she began to notice a change in her vocal quality and more recently has developed pain in her ear when she swallows.  The patient presents to an ENT and finds out that she has T3N1M1 laryngeal cancer. a). Has this cancer metastasized at this point? (Yes/No) .