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Cancer Staging Systems

Staging of laryngeal cancer

TNM definition

Primary tumor (T)

• 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 tissues
• T4: Tumor invades through the thyroid cartilage, and/or extends into soft tissues of the neck, thyroid, and/or esophagus

  Subsites include the following:

  • ventricular bands (false cords)
  • arytenoids
  • suprahyoid epiglottis
  • infrahyoid epiglottis
  • aryepiglottic folds (laryngeal aspect)

Glottis

• T1: Tumor limited to 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
• T4: Tumor invades through the thyroid cartilage and/or to other tissues beyond the larynx (e.g., trachea, soft tissues of neck, including thyroid, pharynx)

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
• T4: Tumor invades through cricoid or thyroid cartilage and/or extends to other tissues beyond the larynx (e.g., trachea, soft tissues of neck, including thyroid, esophagus)

Regional lymph nodes (N)

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
• N2: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
  • N2a: Metastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension
  • N2b: Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
  • N2c: Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
• N3: Metastasis in a lymph node more than 6 cm in greatest dimension

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

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Stage grouping

Stage 0

• Tis, N0, M0

Stage I

• T1, N0, M0

Stage II

• T2, N0, M0

Stage III

• T3, N0, M0
• T1, N1, M0
• T2, N1, M0
• T3, N1, M0

Stage IVA

• T4, N0, M0
• T4, N1, M0
• Any T, N2, M0

Stage IVB

• Any T, N3, M0

Stage IVC

• Any T, any N, M1

References

1. Larynx. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 5th ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1997, pp 41-46. 

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