A 62-year-old male presents with a 2-month history of a progressively hoarse voice. Initially, his voice was only slightly raspy, but over time, he has lost the ability to project it and can now only speak in a loud whisper. He endorses blood-tinged sputum with coughing, which has occurred approximately twice a week for the past month. His social history is remarkable for a 40-pack-year smoking history, and he continues to smoke 1 pack per day. On review of systems, he denies dyspnea, dysphagia, and odynophagia. On physical examination, his voice is breathy and raspy. His oral cavity and oropharynx are remarkable only for caries, and his neck is supple, without lymphadenopathy. Flexible laryngoscopy performed in the clinic reveals friable masses on both vocal cords, with a widely patent airway but with impaired mobility of the left vocal cord.