Laryngeal carcinoma (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 fixationinvades 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 impaired cord mobility
• T3
  • limited to larynx with cord fixationinvades 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 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