In English | En español
Questions About Cancer? 1-800-4-CANCER

Laryngeal Cancer Treatment (PDQ®)

  • Last Modified: 07/31/2014

Page Options

  • Print This Page
  • Print This Document
  • View Entire Document
  • Email This Document

Stage Information for Laryngeal Cancer

Definitions of TNM

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
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.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinoma in 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.

Table 2. Regional Lymph Nodesab
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension.
N2Metastasis 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.
N2aMetastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension.
N2bMetastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension.
N2cMetastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension.
N3Metastasis 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.
M0No distant metastasis.
M1Distant 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.
0TisN0M0
IT1N0M0
IIT2N0M0
IIIT3N0M0
T1N1M0
T2N1M0
T3N1M0
IVAT4aN0M0
T4aN1M0
T1N2M0
T2N2M0
T3N2M0
T4aN2M0
IVBT4bAny NM0
Any TN3M0
IVCAny TAny NM1

References
  1. 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]

  2. 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.