Staging
Staging is a process that characterizes the current extent of the cancer. Staging for laryngeal cancer depends on the location and extent of the tumor (T-stage), and whether it has spread to any lymph nodes, (N-stage), and whether it has spread to areas outside the neck and throat (M-stage). Staging is an important step in understanding the chances of cancer cure and the optimal treatment options.
Staging of Glottic Cancer
Stage 0
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Description
- "Carcinoma in-situ." Abnormal, but non-invasive cells found in the top layer of tissue. This growth is technically "pre-cancer" but must undergo treatment to ensure it does not develop into an invasive cancer.
Stage I
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Description
- Tumor is confined to the vocal cords (glottis), and the vocal cords can move normally. This stage is not defined by the absolute dimensions of the tumor, but by the fact that no other portions of the larynx are involved and that vocal cord motion is not impacted. Additionally, there can be no spread to the lymph nodes. Stage 1 glottic cancer is further divided into 2 subcategories:
Stage Ia
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Description
- Tumor involves only one of the vocal cords.
Stage Ib
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Description
- Tumor has spread across the front of the voice box to involve both vocal cords.
Stage II
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Description
- The tumor arises within the area of the vocal cords and has spread either above to involve the supraglottic structures or spread below to involve the subglottis. Alternatively, tumors arising on the vocal folds and are limited to the area of the glottis but have caused an impairment of the movement of the vocal cords. Additionally, there can be no spread to the lymph nodes.
Stage III
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Description
Tumor arises from the area of the vocal folds and has begun to invade the cartilage or ligament which forms the structure of the larynx. Alternatively, tumors arising within the glottis have now caused a complete absence of any motion of the vocal cords.
OR
The tumor is of any of the above stages but the cancer has spread to a single lymph node on the same side of the neck that is 3 cm or less in diameter.
Stage IVa
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Description
Tumor has grown through the thyroid cartilage and/or spread to tissues beyond the outer structure of the larynx. The tumor may be involving one of the following non-critical structures such as the thyroid gland, esophagus, trachea, neck muscles, or tongue muscles.
OR
Cancer has spread to:
- a single lymph node on same side of the neck that is between 3 cm and 6 cm in diameter, or
- multiple lymph nodes on same side of the neck that are less than 6 cm in diameter, or
- multiple lymph nodes on opposite or both sides of the neck that are less than 6 cm in diameter.
Stage IVb
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Description
- Tumor has grown beyond the area of the larynx to invade critical structures such as the spine or the carotid artery.
- OR
- Cancer has spread to a single lymph node that is more than 6 cm in diameter.
Stage IVc
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Description
- Cancer has spread to distant organs or parts of the body (distant metastasis), most often the lungs, liver, or bones.
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Staging of Supraglottic Cancer
- Stage 0: "Carcinoma in-situ." Abnormal, but non-invasive cells found in the top layer of tissue. This growth is technically a "pre-cancer" but must undergo treatment to ensure it does not develop into an invasive cancer.
- Stage I: Tumor is confined to one section of the supraglottis, for instance the epiglottis or the false vocal folds. Additionally, there can be no spread to the lymph nodes.
- Stage II: Tumor has spread to involve a neighbor of the supraglottis such as the vocal cord, but they are still able to move (but movement may be impaired). Additionally, there can be no spread to the lymph nodes.
- Stage III:
Tumor has invaded downward into the glottis and at least one of the vocal cords can no longer move. Alternatively, the tumor has spread to invade the structure of the larynx, such as the surrounding cartilage.
OR
The tumor is of any of the above stages, but the cancer has spread to a single lymph node on the same side of the neck that is 3 cm or less in size.
- Stage IVa: Moderately advanced local disease
Tumor has grown through the thyroid cartilage and/or has spread to tissues beyond the outer structures of the larynx. The tumor may be involving one of the following non-critical structures such as the thyroid gland, esophagus, trachea, neck muscles, or tongue muscles.
OR
Cancer has spread to:
-
- 1 lymph node on the same side of the neck that is between 3 cm and 6 cm in diameter, or
- multiple lymph nodes on the same side of the neck, none of which are greater than 6 cm, or
- lymph nodes on opposite or both sides of the neck, none of which are greater than 6 cm.
-
- Stage IVb: Very advanced local disease
Tumor has grown beyond the area of the larynx to invade critical structures such as the spine or the carotid artery.
OR
Cancer has spread to a lymph node that is greater than 6 cm in diameter.
- Stage IVc: Cancer has spread to distant organs of the body (distant metastasis), most often the lungs, liver, or bones.
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Staging of Subglottic Cancer
- Stage 0: "Carcinoma in-situ." Abnormal, but non-invasive cells found in the top layer of tissue. This growth is technically a "pre-cancer" but must undergo treatment to ensure it does not develop into an invasive cancer.
- Stage I: Tumor is confined to the borders of the subglottis.
- Stage II: Tumor grows upward and invades into the vocal cords. Vocal cords may be able to move normally, or movement may be impaired.
- Stage III:
Tumor has extended to any portion of the larynx but is still confined within its boundaries, and vocal cord motion is absent.
OR
Cancer has spread to a single lymph node on the same side of the neck that is 3 cm or less in diameter.
- Stage IVa: Moderately advanced local disease
Tumor has spread to the cricoid or thyroid cartilage and/or has spread outside of the larynx to structures such as the trachea, the soft tissues of the neck, the thyroid gland, and the esophagus.
OR
Cancer has spread to:
-
- 1 lymph node on the same side of the neck that is between 3 cm and 6 cm in diameter, or
- multiple lymph nodes on the same side of the neck, none of which are greater than 6 cm, or
- lymph nodes on opposite or both sides of the neck, none of which are greater than 6 cm.
-
- Stage IVb: Very advanced local disease
Tumor has grown beyond the area of the larynx to invade critical structures auch as the spine or carotid artery
OR
Cancer has spread to a lymph node that is greater than 6 cm in diameter.
- Stage IVc: Cancer has spread to distant organs or parts of the body (distant metastasis), most often the lungs, liver, or bones.
