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

• unchanged from 7th edition

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

• unchanged from 7th edition

AJCC 7th Edition

AJCC 7th Edition (2009)

Tumor Stage

Supraglottis

• 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

Glottis

• 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

Subglottis

• 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

Lymph Node Stage

• 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

Metastasis Stage

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

AJCC Overall Stage

• I - T1 N0
• II - T2 N0
• III - T3 N0, T1-3 N1
• IVA - T4a N0-2, T1-4a N2
• IVB - T4b any N, any T N3
• IVC - M1

Older staging systems

AJCC 6th edition (2002)

• no changes compared to 7th edition
• new since 5th edition: subdivided T4 into T4a and T4b

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)

• Glottis:
  • T2a - normal mobility
  • T2b - decreased mobility