Laryngeal Cancer: Stages

What does stage of cancer mean?

After your diagnosis, your healthcare provider will want to find out the stage of the cancer. The stage of cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses imaging scans and tests to find out the size of the cancer and where it is. Scans can also show if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer.

The TNM staging system

The most commonly used system to stage laryngeal cancer is the TNM system from the American Joint Committee on Cancer. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

  • T tells how large the main  tumor is and whether it has grown into nearby structures.

  • N tells whether the cancer has spread into nearby lymph  nodes.

  • M tells whether the cancer has spread ( metastasized) to other organs in the body, like the bones, liver, or other organs.

Numbers or letters after T, N, and M provide more details about each of these factors.

There's also another value that can be assigned:  X. It means the provider does not have enough information to assess the extent of the main tumor (TX) or if the lymph nodes have cancer cells in them (NX).

Stage groupings are made by combining the T, N, and M values from the TNM system. These groupings give an overall description of the cancer. A stage grouping can have a value of 0 to 4 and they're written as Roman numerals 0, I, II, II, and IV. The higher the number, the more advanced the cancer is. Letters and numbers can be used after the Roman numeral to give more details.

What are the stages of laryngeal cancer?

Laryngeal cancer is staged based on the exact location of the tumor relative to the vocal cords:

  • Supraglottis. The cancer is above the vocal cords.

  • Glottis. The cancer is in the area of the vocal cords and includes the cords.

  • Subglottis. The cancer is below the vocal cords.

Stage 0

The cancer is only in the layer of tissue lining the inside of the larynx. It has not spread to nearby lymph nodes or other parts of the body. Stage 0 is also called carcinoma in situ.

Stage I

At this stage, the cancer has not spread to the lymph nodes or other parts of the body. The exact definition of stage I depends on where the cancer started.

  • Supraglottis. The cancer has grown deeper than the lining layer, but it is only in 1 part of the supraglottis. The vocal cords move normally.

  • Glottis. The cancer has grown deeper than the lining layer, but it is only in the vocal cords. The vocal cords move normally.

  • Subglottis. The cancer has grown deeper than the lining layer, but it is only in the subglottis.

Stage II

At this stage, the cancer is only in the larynx. It hasn’t spread to the lymph nodes or other parts of the body. The exact definition of stage II depends on where the cancer started and its effects on that area:

  • Supraglottis. The cancer has grown deeper and has spread to more than one part of the supraglottis. The vocal cords move normally.

  • Glottis. The cancer has spread into the supraglottis, the subglottis, or both. The vocal cords may not move normally.

  • Subglottis. The cancer has spread to the vocal cords, which may or may not be able to move normally.

Stage III

At this stage, the cancer has not spread to other parts of the body, and one or more of these things has happened:

  • The cancer has not spread outside the larynx, but it has caused a vocal cord to stop moving.

  • The cancer has spread near or through the inner part of the thyroid cartilage.

  • The cancer is in one part of the supraglottis and the vocal cords work normally.

  • The cancer is in more than one area in the supraglottis.

  • The cancer has spread to the base of the tongue or to tissues near the vocal cords.

  • The cancer has spread to one lymph node on the same side of the neck as the main tumor. The lymph node is 3 cm (centimeters) or less across.

  • The cancer is in one or both vocal cords and the vocal cords work normally.

Stage IV

This stage is divided into these subgroups:

  • Stage IVA. The cancer has not spread to organs in other parts of the body and is any of these:

    • The cancer has spread to tissues around the larynx, like the thyroid gland, esophagus (the tube that connects the mouth to the stomach), the trachea (the main breathing tube), or tongue or neck muscles. It also may have grown through the thyroid cartilage. The lymph nodes do not contain cancer. Or there's cancer in only one node, which is no more than 3 cm across and on the same side of the neck as the cancer. 

    • The cancer may or may not have spread to tissues around the larynx and may or may not be affecting a vocal cord. It has spread to lymph nodes in one of these ways:

      • The cancer has spread to one lymph node on the same side of the neck as the cancer and the node is between 3 and 6 cm across.

      • The cancer has spread to two or more lymph nodes on the same side of the neck as the cancer, and the nodes are less than 6 cm across.

      • The cancer has spread to at least one lymph node on the other side of the neck, and none of the nodes are more than 6 cm across.

  • Stage IVB. The cancer has not spread to organs in other parts of the body and is any of these:

    • The cancer is growing into the area in the neck, in the front of the spine, or it's wrapped around a carotid artery, or it's growing into the space between the lungs. It may or may not have spread to nearby lymph nodes.

    • The cancer may or may not have spread to tissues around the larynx and may or may not be affecting a vocal cord. It has spread to lymph nodes in one of these ways:

      • The cancer has spread to at least one lymph node that's more than 6 cm across.

      • The cancer has spread to a lymph node and then grown outside the node.

  • Stage IVC. The cancer may or may not have spread to nearby organs and lymph nodes. It may or may not be affecting a vocal cord. It has spread to other parts of the body far from the larynx, like the liver, lungs, or bones.

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Make sure to ask any questions or talk about your concerns.