TNM stages

The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor decide which treatment you need.

There are different ways of staging cancer of the larynx. The TNM staging system is the most common way. TNM stands for Tumour, Node, Metastasis.

Doctors use the T part of the TNM system to describe the stage of your cancer. They call this the T stage. Your T stage refers to how far your cancer has grown within the larynx and surrounding tissue. 

Doctors sometimes divide cancer of the larynx into early stage disease, locally advanced disease and advanced stage disease.

They might also use a number staging system. But they are more likely to refer to the T stages. This is different to the number staging system. 

Tumour (T)

Tumour (T)  describes how far your cancer has grown within the larynx and surrounding tissue.

The exact T staging of cancer of the larynx varies. It depends on which part of the larynx your cancer started in.

Cancer can start:

  • above the vocal cords (supraglottis)
  • on the vocal cords (glottis)
  • below the vocal cords (subglottis) - this is rare

There are 5 main T stages for cancer of the larynx – Tis to T4.

Tis (tumour in situ) means the cancer is very early. It is contained in the top layer of the skin like covering of the larynx (mucosa). It has not spread into any surrounding tissue.

T1 means the tumour is only in one part of the larynx and the vocal cords are able to move normally.

T2 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. 

T3 means the tumour is more bulky and has caused one of the vocal cords to not move (your doctor may describe it as fixed). OR the tumour has grown into nearby areas such as the tissue in front of the epiglottis (pre-epiglottis tissues) or the inner part of the thyroid cartilage. 

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). 

Node (N)

Node (N) describes whether your cancer has spread to the lymph nodes.

There are 4 main N stages for cancer of the larynx - N0 to N3. N2 is split into N2a, N2b and N2c.

The important points here are:

  • whether any nodes contain cancer
  • the size of the node containing cancer
  • which side of the neck the node containing cancer is on

N0 means that the lymph nodes don't contain cancer cells.

N1 means that one lymph node contains cancer cells on the same side of the neck as the cancer. And the node is less than 3cm across. 

N2a means that one lymph node contains cancer cells on the same side of the neck as the cancer. And the node is between 3cm and 6cm across.

N2b means that more than one lymph node contain cancer cells on the same side of the neck as the cancer. But none of the nodes are more than 6cm across.

N2c means that there are cancer cells in lymph nodes on the other side of the neck from the cancer, or in nodes on both sides of the neck. But none of the nodes are more than 6cm across.

N3 means that at least one lymph node containing cancer cells is larger than 6cm across. 

Metastasis (M)

Metastasis (M) describes whether the cancer has spread to a different part of the body.

There are 2 stages of metastasis – M0 and M1.

M0 means there is no cancer spread.

M1 means the cancer has spread to other parts of the body, such as the lungs. 


The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is
  • other health conditions that you have

You might have one or more of the following treatments:

  • surgery
  • radiotherapy
  • chemotherapy
  • chemotherapy with radiotherapy (chemoradiotherapy)
  • targeted cancer drug
Last reviewed: 
18 Jun 2018
  • Head and neck cancer: Multidisciplinary Management Guidelines 
    ENT UK, 2011

  • Cancer: Principles and Practice of Oncology (10th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

  • AJCC Cancer Staging Manual (8th Edition)
    MB Amin and others
    Springer, 2017

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