Radiation Oncology/Head & Neck/Larynx/Staging

Laryngeal Cancer Staging

AJCC 8th Edition

AJCC 8th Edition (2017): To be used for staging beginning Jan 1, 2018.

T-Stage

N-Stage

Clinical (cN)

NX - Cannot be assessed
N0 - No regional lymph nodes metastasis
N1 - Single ipsilateral lymph node, <= 3 cm in greatest dimension, and ENE(-)
N2
- N2a - Single ipsilateral lymph node, 3-6 cm in greatest dimension, and ENE(-)
- N2b - Multiple ipsilateral lymph nodes, <= 6 cm in greatest dimension, and ENE(-)
- N2c - Bilateral or contralateral lymph nodes, <= 6cm in greatest dimension, and ENE(-)
N3
- N3a - Lymph node > 6 cm, and ENE(-)
- N3b - Clinically overt ENE(+) (ENE_c)
  (defined as invasion of skin, infiltration of muscle, dense tethering or fixation to adjacent structures, cranial nerve, brachial plexus, sympathetic trunk, or phrenic nerve invasion with dysfunction)

Pathological (pN)

NX - Cannot be assessed
N0 - No regional lymph nodes metastasis
N1 - Single ipsilateral lymph node, <= 3cm in greatest dimension, and ENE(-)
N2
- N2a - Single node (ipsi or contralateral), <= 3cm, and ENE(+); or single ipsilateral node, 3-6 cm, and ENE(-)
- N2b - Multiple ipsilateral nodes, <= 6 cm, and ENE(-)
- N2c - Bilateral or contralateral nodes, <= 6 cm, and ENE(-)
N3
- N3a - Lymph node > 6 cm, and ENE(-)
- N3b - Single ipsilateral node, > 3 cm, and ECE(+); or multiple LNs and any with ENE(+)

Overall stage

AJCC 7th Edition (2009)

Anatomy: the inferior boundary of the supraglottis is a horizontal plane passing through the lateral margin of the ventricle at its junction with the superior surface of the vocal cord.
- Subsites: False cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglotic folds
T1: Tumor limited to one subsite of supraglottis with normal vocal cord mobility
T2: Tumor 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, or medial wall of pyriform sinus) without fixation of the larynx
T3: Tumor limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space, and/or minor thyroid cartilage erosion (e.g., inner cortex)
T4a: Tumor invades through the thyroid cartilage, and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of the neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus
T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

Anatomy: The glottis is composed of the superior and inferior surfaces of the true vocal cords, including the anterior and posterior commissures. It occupies a horizontal plane 1 cm in thickness, extending inferiorly from the lateral margin of the ventricle.
T1: Tumor limited to the vocal cord(s), which may involve anterior or posterior commissure, with normal mobility
- T1a: Tumor limited to one vocal cord
- T1b: Tumor involves both vocal cords
T2: Tumor extends to supraglottis and/or subglottis and/or with impaired vocal cord mobility
T3: Tumor limited to the larynx with vocal cord fixation and/or invades paraglottic space, and/or minor thyroid cartilage erosion (e.g., inner cortex)
T4a: 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)
Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus
T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

Anatomy: The subglottis is the region extending from the lower boundary of the glottis to the lower margin of the cricoid cartilage.
T1: Tumor limited to the subglottis
T2: Tumor extends to vocal cord(s) with normal or impaired mobility
T3: Tumor limited to larynx with vocal cord fixation
T4a: 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)
Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus
T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

NX - Cannot be assessed
N0 - No regional lymph nodes metastasis
N1 - Single ipsilateral lymph node, <= 3cm in greatest dimension
N2
- N2a - Single ipsilateral lymph node, 3-6 cm in greatest dimension
- N2b - Multiple ipsilateral lymph nodes, <= 6cm in greatest dimension
- N2c - Bilateral or contralateral lymph nodes, <= 6cm in greatest dimension
N3 - Lymph node(s) >6 cm in greatest dimension

AJCC 6th edition (2002)

AJCC 5th edition (1997)

For all subsites, T4 is a single grouping, not divided into T4a and T4b
Supraglottis:
- Unchanged compared to current edition (7th), except for T4 as noted above
Glottis:
- Unchanged compared to current edition (7th), except for T4 as noted above
Subglottis:
- Unchanged compared to current edition (7th), except for T4 as noted above

AJCC 3rd edition (1988)

Supraglottis:
- no changes compared to 7th edition
Glottis:
- T1 - no changes compared to current edition (7th)
- T2 - no changes compared to current edition (7th)
- T3 - tumor limited to larynx with vocal cord fixation (does not mention paraglottic space invasion or minor thyroid cartilage erosion)
Subglottis:
- no changes compared to 7th edition

AJCC 2nd edition (1983)