Radiation Oncology/Head & Neck/Larynx/Staging

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Laryngeal Cancer Staging

AJCC 8th Edition[edit]

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(+) (ENEc)
      (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[edit]

AJCC 7th Edition (2009)


Tumor Stage[edit]

Supraglottis[edit]

  • 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[edit]

  • 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[edit]

  • 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[edit]

  • 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[edit]

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


AJCC Overall Stage[edit]

  • 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[edit]

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