Stage Information for Laryngeal Cancer
The staging system for laryngeal cancer is clinical and based on the best possible estimate of the extent of disease before treatment. The assessment of the primary tumor is based on inspection and palpation when possible and by both indirect mirror examination and direct endoscopy when necessary. The tumor must be confirmed histologically, and any other pathological data obtained on biopsy may be included. Head and neck magnetic resonance imaging or computed tomography should be done prior to therapy to supplement inspection and palpation.[1] Additional radiographic studies may be included. The appropriate nodal drainage areas in the neck should be examined by careful palpation.
Definitions of TNMThe American Joint Committee on Cancer has designated staging by TNM classification to define laryngeal cancer.[2]
Table 1. Primary Tumor (T)a| aReprinted with permission from AJCC: Laryngeal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 57-67. | |
| TX | Primary tumor cannot be assessed. |
| T0 | No evidence of primary tumor. |
| Tis | Carcinoma in situ. |
| Supraglottis | |
| T1 | Tumor limited to one subsite of supraglottis with normal vocal cord mobility. |
| T2 | Tumor invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis (e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynx. |
| T3 | Tumor limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic space, paraglottic space, and/or inner cortex of thyroid cartilage. |
| T4a | Moderately advanced local disease. |
| Tumor invades through the thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus). | |
| T4b | Very advanced local disease. |
| Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures. | |
| Glottis | |
| T1 | Tumor limited to the vocal cord(s) (may involve anterior or posterior commissure) with normal mobility. |
| T1a | Tumor limited to one vocal cord. |
| T1b | Tumor involves both vocal cords. |
| T2 | Tumor extends to supraglottis and/or subglottis and/or with impaired vocal cord mobility. |
| T3 | Tumor limited to the larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of the thyroid cartilage. |
| T4a | Moderately advanced local disease. |
| Tumor invades through the outer cortex of the thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus). | |
| T4b | Very advanced local disease. |
| Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures. | |
| Subglottis | |
| T1 | Tumor limited to the subglottis. |
| T2 | Tumor extends to vocal cord(s) with normal or impaired mobility. |
| T3 | Tumor limited to larynx with vocal cord fixation. |
| T4a | Moderately advanced local disease. |
| Tumor invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus). | |
| T4b | Very advanced local disease. |
| Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures. | |
Table 2. Regional Lymph Nodesab
| NX | Regional lymph nodes cannot be assessed. |
| N0 | No regional lymph node metastasis. |
| N1 | Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension. |
| N2 | Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension. |
| Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension. | |
| Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension. | |
| N2a | Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension. |
| N2b | Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension. |
| N2c | Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension. |
| N3 | Metastasis in a lymph node, >6 cm in greatest dimension. |
| aReprinted with permission from AJCC: Laryngeal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 57-67. | |
| bMetastases at level VII are considered regional lymph node metastases. |
Table 3. Distant Metastasis (M)a
| aReprinted with permission from AJCC: Laryngeal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 57-67. | |
| M0 | No distant metastasis. |
| M1 | Distant metastasis. |
Table 4. Anatomic Stage/Prognostic Groups
| Stage | T | N | M |
| aReprinted with permission from AJCC: Laryngeal. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 57-67. | |||
| 0 | Tis | N0 | M0 |
| I | T1 | N0 | M0 |
| II | T2 | N0 | M0 |
| III | T3 | N0 | M0 |
| T1 | N1 | M0 | |
| T2 | N1 | M0 | |
| T3 | N1 | M0 | |
| IVA | T4a | N0 | M0 |
| T4a | N1 | M0 | |
| T1 | N2 | M0 | |
| T2 | N2 | M0 | |
| T3 | N2 | M0 | |
| T4a | N2 | M0 | |
| IVB | T4b | Any N | M0 |
| Any T | N3 | M0 | |
| IVC | Any T | Any N | M1 |
References
- Thabet HM, Sessions DG, Gado MH, et al.: Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope 106 (5 Pt 1): 589-94, 1996. [PUBMED Abstract]
- Larynx. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 57-62.
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