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Laryngeal SCC staging

Laryngeal squamous cell carcinoma is staged using the TNM staging system and actual staging is subsite (see laryngeal subsites) specific for T1-3. A rough approximation for all subsites is:

  • T1: limited to one subsite and normal cord mobility
  • T2: more than one subsite and impaired cord mobility (but no fixation)
  • T3: limited to larynx with cord fixation
  • T4: extension into tissues beyond larynx

Staging

Primary tumour (T)
Tx, T0 and Tis

Tx, T0 and Tis are the same for all three subsites:

  • Tx: primary tumour cannot be assessed
  • T0: no evidence of primary tumour
  • Tis: carcinoma in situ
Supraglottic
  • T1: limited to supraglottis with normal cord mobility
  • T2: invades mucosa of adjacent subsite or area (e.g. base of tongue) with normal cord mobility
  • T3
    • limited to larynx with cord fixation
      invades one or more of:
      • postcricoid area
      • pre-epiglottic area
      • paraglottic space
      • minor (inner surface only) cartilage erosion
Glottic
  • T1
    • T1a: limited to unilateral vocal cord with normal cord mobility
    • T1b: bilateral vocal cord involvement with normal cord mobility
  • T2
    • invades mucosa of adjacent subsite (supraglottis or subglottis) and/or impaired cord mobility
  • T3
    • limited to larynx with cord fixation
      invades one or more of:
      • postcricoid area
      • pre-epiglottic area
      • paraglottic space
      • minor (inner surface only) cartilage erosion
Subglottis
  • T1: limited to subglottis
  • T2: invasion of adjacent subsite (i.e. vocal cords) with no cord fixation (cords may demonstrate abnormal mobility)
  • T3: limited to larynx with cord fixation
T4 lesions

T4 is the same for all three subsites

  • T4: same for all three subsites
    • T4a: any of the following:
      • invasion thorough thyroid cartilage
      • invasion of the trachea
      • invasion of the deep extrinsic muscles of the tongue
      • invasions of the strap muscles
      • invasion of the thyroid gland
      • invasion of the oesophagus
    • T4b: any of the following:
      • invasion of the mediastinum
      • invasion of the prevertebral fascia
      • encases the carotid artery
Nodal status (N)

Nodal staging is the same for SCCs of the oral cavity, oropharynx, hypopharynx and larynx:

  • Nx: nodes cannot be assessed
  • N0: no regional nodal metastases
  • N1: single ipsilateral node, ≤ 3 cm
  • N2
    • N2a: single ipsilateral node, 3-6 cm
    • N2b: multiple ipsilateral nodes, < 6 cm
    • N2c
      • bilateral nodal metastases or contralateral nodal metastases < 6 cm
  • N3: any nodal metastasis > 6 cm
Metastases (M)
  • Mx: presence of metastases cannot be assessed
  • M0: no evidence of metastases
  • M1: distant metastases present

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