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

The actual staging is as follows:

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