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Laryngeal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - 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 TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define laryngeal cancer.[2]

Table 1. Primary Tumor (T)a

a Reprinted 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.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinomain situ.
Supraglottis
T1Tumor limited to one subsite of supraglottis with normal vocal cord mobility.
T2Tumor 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.
T3Tumor 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.
T4aModerately 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).
T4bVery advanced local disease.
Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures.
Glottis
T1Tumor limited to the vocal cord(s) (may involve anterior or posterior commissure) with normal mobility.
T1aTumor limited to one vocal cord.
T1bTumor involves both vocal cords.
T2Tumor extends to supraglottis and/or subglottis and/or with impaired vocal cord mobility.
T3Tumor limited to the larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of the thyroid cartilage.
T4aModerately 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).
T4bVery advanced local disease.
Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures.
Subglottis
T1Tumor limited to the subglottis.
T2Tumor extends to vocal cord(s) with normal or impaired mobility.
T3Tumor limited to larynx with vocal cord fixation.
T4aModerately 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).
T4bVery advanced local disease.
Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures.
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