The stages of cancer of the larynx

The stage of a cancer explains how far it has grown and whether it has spread. It is important because your doctor takes the stage into account when deciding which treatment is best for you. The tests and scans you have to diagnose your cancer will help to stage it. But your doctor may not be able to tell you the exact stage until you have surgery.

There are different ways of staging cancers. The two main ways are the TNM system and number systems. There is more about staging cancers in the about cancer section of CancerHelp UK.

TNM stands for Tumour, Node, and Metastasis. The system describes

• The size of a primary tumour (T)
• Whether the lymph nodes have cancer cells in them (N)
• Whether the cancer has spread to a different part of the body (M)

The exact T staging of laryngeal cancer varies depending on which part of the larynx is involved. This is very complicated, so below is a simplified version that applies to all laryngeal cancers.

There are 4 main T stages of cancer of the larynx

• T1 means the tumour is in only one part of the larynx and the vocal cords are able to move normally
• T2 means the tumour has grown into another part of the larynx. The vocal cords may or may not be affected
• T3 means the tumour is throughout the larynx but has not spread further than the covering of the larynx. The vocal cords do not move normally
• T4 means the tumour has grown into body tissues outside the larynx. It may have spread to the thyroid gland, windpipe (trachea) or food pipe (oesophagus)

There are 4 main lymph node stages in cancer of the larynx. N2 is divided into N2a, N2b and N2c. The important points here are whether there is cancer in any of the nodes and if so, the size of the node and which side of the neck it is on.

• N0 means there are no lymph nodes containing cancer cells
• N1 means there are cancer cells in one lymph node on the same side of the neck as the cancer, but the node is less than 3cm across
• N2a means there is cancer in one lymph node on the same side of the neck and it is between 3cm and 6cm across
• N2b means there is cancer in more than one lymph node, but none are more than 6cm across. All the nodes must be on the same side of the neck as the cancer
• N2c means there is cancer in lymph nodes on the other side of the neck from the tumour, or in nodes on both sides of the neck, but none is more than 6cm across
• N3 means that at least one lymph node containing cancer is larger than 6cm across

There are two stages to describe whether cancer of the larynx has spread

• M0 means there is no cancer spread
• M1 means the cancer has spread to other parts of the body, such as the lungs

Together, the T, N and M stages give a complete description of the stage of your cancer. For example, if you have a T2, N0, M0 cancer, you have a tumour affecting more than one area of your larynx, but there is no sign of cancer cells in the lymph nodes and there is no spread of your cancer to other parts of the body.

There are four main stages in this system – stages 1 to 4. Some doctors also refer to stage 0.

Stage 0 or Carcinoma in situ (CIS)

If you have CIS or stage 0 cancer of the larynx, you have a very early stage cancer. Some doctors call this pre cancer because there are cancer cells only in the skin like tissue that covers and lines your larynx. This lining tissue is called the mucosa. The cancer cells are only in the mucosa, so there is very little risk of the cancer having spread. It is unusual to have a larynx cancer diagnosed this early, as there are unlikely to be any symptoms at this stage.

Stage 1

This is the earliest stage of invasive cancer. It means that the cancer has begun to grow into the tissues underneath the inner lining of the larynx (mucosa). The cancer is only in a small part of the larynx and the vocal cords are still able to move. The cancer has not spread to nearby tissues, lymph nodes or other organs.

Stage 2

The cancer has grown into another part of the larynx from where it started. In some types of laryngeal cancer, stage 2 means it has grown into the vocal cords. The vocal cords may not be able to move easily, causing a hoarse voice or noisy breathing. In stage 2, the cancer has not spread to lymph nodes or any other organs.

Stage 3

The cancer has grown throughout the larynx, but there is no spread to other parts of the body. Stage 3 larynx cancer means that at least one vocal cord is fixed in position by the tumour and cannot move normally. This may cause a loss of voice or noisy breathing. In stage 3, the cancer may also have spread to a nearby lymph node, but that node is no more than 3cm across.

Stage 4

This means the cancer is advanced. But unlike many other types of cancer, stage 4 laryngeal cancer does not necessarily mean the cancer has spread to another part of the body. There are 3 different subgroups to stage 4 – 4a, 4b and 4c.

4a means either that

• The cancer has grown through the wall of the larynx into body tissues nearby and there may be cancer cells in one lymph node that is smaller than 3cm across OR
• The cancer has spread to one lymph node that is bigger than 3cm across but smaller than 6cm across OR
• The cancer has spread to more than one lymph node but none of the lymph nodes are more than 6cm across

4b means that the cancer has spread to at least one lymph node that is more than 6cm across.

4c means that the cancer has spread to another part of the body, for example the lungs.

The grade of a cancer tells you how much the cancer cells look like normal cells under a microscope. There are 3 grades of laryngeal cancer:

• Grade 1 (low grade) – the cancer cells look very much like normal larynx cells (they are well differentiated)
• Grade 2 (intermediate grade) – the cancer cells look slightly like normal larynx cells (they are moderately differentiated)
• Grade 3 (high grade) – the cancer cells look very abnormal and very little like normal larynx cells (they are poorly differentiated)

Differentiation is how developed or mature a cell is. The grade of the cancer gives your specialist an idea about how the cancer is likely to behave. Low grade cancers are usually slower to grow and less likely to spread. High grade cancers are likely to be faster growing and are more likely to spread. This is only a guide. Your specialist will consider all your test results when deciding which treatment is best for you.