Joseph smoked two packs of cigarettes a day for 25 years.He also consumed 2-3 packs of beer on weekends routinely since his early 20's.Now at age 50,he contacts his physician with complaints of a chronic cough,difficulty swallowing and hoarseness of voice.Two weeks later,Joseph has been scheduled for surgery to remove his larynx and has been referred to a speech-language pathologist for an evaluation and probable vocal rehabilitation because of a diagnosis of