The stages of cancer of the larynx
This page tells you about the stages of laryngeal cancer. There is information about
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 doctors take the stage into account when deciding on treatment. The TNM system is used to stage cancer of the larynx.
TNM stands for Tumour, Node, and Metastasis. The system describes the size of a primary tumour (T), whether the nearby lymph nodes have cancer cells in them (N), and whether the cancer has spread to a different part of the body (M).
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 is called low grade
- Grade 2 is called intermediate grade
- Grade 3 is called high grade
Generally, low grade cancers are usually slower to grow and less likely to spread than high grade cancers.
You can view and print the quick guides for all the pages in the treating laryngeal cancer section.
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. Laryngeal cancers are staged using the TNM system. Your doctor may also refer to the number system, but this is rarely used now. Doctors often divide cancer of the larynx into early stage disease and locally advanced disease. T stages 1 and 2 are called early disease. T stages 3 and 4 are called locally advanced disease.
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. The cancer may start on the vocal cords (glottis), above the vocal cords (supraglottis), or below the vocal cords (subglottis). Tumours of the subglottis are rare. They only make up 2% of laryngeal cancers.
In very early cancer of the larynx, doctors may use the term T stage 0. This means there are abnormal cells that may be precancerous. Tis (tumour in situ) means an early cancer that has not broken through the basement membrane of the tissue it is growing in.
T stage 1 means the tumour is in only one part of the larynx and the vocal cords are able to move normally.
T stage 2 means the tumour which may have started on the vocal cords (glottis), above the vocal cords (supraglottis), or below the vocal cords (subglottis) has grown into another part of the larynx’ In cancer of the vocal cords (glottic cancer) stage T2a means that the vocal cords move normally.
In T stage 2b in cancer that starts in the vocal cords (glottis) the vocal cord movement is limited.
T stage 3 means the tumour is throughout the larynx but has not spread further than the covering of the larynx. One of the vocal cords can't move. Your doctor may describe it as fixed.
T stage 4 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.
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.
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