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Laryngeal Cancer

Stages and Grades of Laryngeal Cancer

After laryngeal cancer is diagnosed, tests are done to determine the extent or stage of the cancer. The stage of cancer describes how much cancer is in the body. It helps you and your doctor understand the severity of cancer, how best to treat it, and the chance of survival.

Doctors mainly depend on the TNM system created by the American Joint Committee on Cancer (AJCC) for hypopharyngeal cancer. The TNM system is based on three key pieces of information:

  • How big the main tumor (T) is

  • If the cancer has spread to nearby lymph nodes (N)

  • The spread (metastasis) to distant parts of the body (M)

The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer and communicating it, so doctors can work together to plan the best treatments. Numbers or letters after T, N, and M provide more details about each of these factors. Lower numbers mean that the cancer is in an early stage. Higher numbers mean the cancer is more advanced.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm).

When describing T1 to T4 tumors, doctors divide the larynx into 3 regions: the glottis, the supraglottis, and the subglottis.

Glottis tumor of the larynx

T1: The tumor is limited to the vocal cords, but it does not affect the movement of the cords.

  • T1a: The tumor is only in the right or left vocal cord.

  • T1b: The tumor is in both vocal folds.

T2: The tumor has spread to the supraglottis and/or the subglottis. The tumor may also affect the movement of the vocal cord.

T3: The tumor is limited to the larynx and paralyzes at least 1 of the vocal cords. The tumor may also invade the space inside the larynx and/or the cartilage around the thyroid gland.

T4: The tumor has spread beyond the larynx.

  • T4a: The tumor has spread to the thyroid cartilage and/or the tissue beyond the larynx.

  • T4b: The tumor has spread to the area in front of the spine (prevertebral space) or the chest area, or it encases the arteries.

Supraglottis tumor of the larynx

T1: The tumor is located in a single area above the vocal cords that do not affect the movement of the vocal cords.

T2: The tumor started in the supraglottis, but it has spread to the mucous membranes that line other nearby areas, such as the base of the tongue. The vocal cords are not affected.

T3: The tumor is limited to the larynx and affects the vocal cords. The tumor may have spread to surrounding tissue.

T4: The tumor has spread beyond the larynx.

  • T4a: The tumor has spread through the thyroid cartilage and/or the tissue beyond the larynx.

  • T4b: The tumor has spread to the area in front of the spine (prevertebral space) or the chest area, or it encases the arteries.

Subglottis tumor of the larynx

T1: The tumor is only in the subglottis.

T2: The tumor has spread to the vocal cords. The movement of the vocal cords may be affected.

T3: The tumor is limited to the larynx and affects the vocal folds. It may also invade the space inside the larynx and/or the cartilage of the thyroid.

T4: The tumor has spread beyond the larynx.

  • T4a: The tumor has spread to the cricoids, the ring-shaped cartilage near the bottom of the larynx, or thyroid cartilage and/or the tissue beyond the larynx.

  • T4b: The tumor has spread to the area in front of the spine or the chest area or encases the arteries.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Regional lymph nodes are located near the head and neck, while distant lymph nodes are located in other parts of the body.

When cancer has spread through a lymph node and into the tissues directly surrounding it, this is called extranodal extension (ENE). Knowing whether ENE is present plays an important role in the evaluation of lymph nodes in laryngeal cancer.

The evaluation of nodes can be clinical or pathological. Clinical evaluation is based on the results of tests done before surgery. Pathological evaluation is based on what is found during surgery plus other testing results.

Clinical N

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller. There is no ENE.

N2a: Cancer has spread to a single lymph node on the same side as the primary tumor and is larger than 3 cm but not larger than 6 cm. There is no ENE.

N2b: Cancer has spread to more than 1 lymph node on the same side as the primary tumor, and none measures larger than 6 cm. There is no ENE.

N2c: Cancer has spread to more than 1 lymph node on either side of the body, and none measures larger than 6 cm. There is no ENE.

N3a: The cancer is found in a lymph node and is larger than 6 cm. There is no ENE.

N3b: There is ENE in any lymph node.

Pathological N

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller. There is no ENE.

N2a: Cancer has spread to 1 lymph node and is 3 cm or smaller, but there is ENE. Or, cancer has spread to a single lymph node on the same side as the primary tumor and is larger than 3 cm but not larger than 6 cm, and there is no ENE.

N2b: Cancer has spread to more than 1 lymph node on the same side as the primary tumor, and none measures larger than 6 cm. There is no ENE.

N2c: Cancer has spread to more than 1 lymph node on either side of the body, and none measures larger than 6 cm. There is no ENE.

N3a: The cancer is found in a lymph node and is larger than 6 cm. There is no ENE.

N3b: There is ENE in a single lymph node on the same side as the primary tumor, and it is larger than 3 cm. Or, cancer has spread to many lymph nodes, and at least 1 has ENE. Or, there is ENE in a single lymph node on the opposite side of the primary tumor that is 3 cm or smaller.

Metastasis (M)

The "M" in the TNM system describes whether the cancer has spread to other parts of the body, called metastasis.

M0: The cancer has not spread to other parts of the body.

M1: The cancer has spread to other parts of the body.

Cancer Stage Grouping for Laryngeal Cancer

Stage 0: This stage describes a carcinoma in situ with no spread to lymph nodes or distant metastasis (Tis, N0, M0).

Stage I: This stage describes a small tumor with no spread to lymph nodes or distant metastasis (T1, N0, M0).

Stage II: This stage describes a tumor that has spread to some nearby areas but has not spread to lymph nodes or to distant parts of the body (T2, N0, M0).

Stage III: Either of the following applies:

  • A larger tumor with no spread to regional lymph nodes or metastasis (T3, N0, M0).

  • A tumor that has spread to regional lymph nodes but has no sign of distant metastasis (T1 to T3, N1, M0).

Stage IVA: Either of the following applies:

  • There is an invasive tumor. If it has spread to the lymph nodes, it is only to a single lymph node on the same side of the primary tumor. There is no distant metastasis (T4a, N0 or N1, M0).

  • There is significant spread to the lymph nodes but no distant metastasis (T1 to T4a, N2, M0).

Stage IVB: Either of the following applies:

  • There is extensive spread to the lymph nodes but no distant metastasis (any T, N3, M0).

  • The tumor is locally advanced and may involve the lymph nodes, but there is no distant metastasis (T4b, any N, M0).

Stage IVC: There is evidence of distant spread (any T, any N, M1).

Head and Neck Cancer Care Available in Brevard County

If you have been diagnosed with laryngeal cancer or a different type of head and neck cancer, the Cancer Care Centers of Brevard are ready to help. We provide second opinions on diagnosis and create personalized treatment plans based on each patient. Our cancer centers are available throughout Brevard County, including Melbourne, Rockledge, Merritt Island, Palm Bay, and Sebastian, FL.