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Cancer Staging Systems

Staging of laryngeal cancer

Last Update: Sunday January 4th, 2004 7:15 PM GMT

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

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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