Laryngeal cancer staging: Difference between revisions

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==Staging==
==Staging==
The following stages are used for Laryngeal cancer cancer:<ref>Staging of Laryngeal cancer.<ref name="pmid28094848">{{cite journal |vauthors=Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP |title=The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging |journal=CA Cancer J Clin |volume=67 |issue=2 |pages=93–99 |date=March 2017 |pmid=28094848 |doi=10.3322/caac.21388 |url=}}</ref>
The following stages are used for Laryngeal cancer cancer: <ref name="pmid27841116">{{cite journal |vauthors=Jones TM, De M, Foran B, Harrington K, Mortimore S |title=Laryngeal cancer: United Kingdom National Multidisciplinary guidelines |journal=J Laryngol Otol |volume=130 |issue=S2 |pages=S75–S82 |date=May 2016 |pmid=27841116 |pmc=4873912 |doi=10.1017/S0022215116000487 |url=}}</ref>
http://www.cancer.gov/types/head-and-neck/patient/laryngeal-treatment-pdq#section/_26</ref>
{| class="wikitable"
{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px"
| colspan="1" rowspan="1" |Supraglottis
|valign=top|
| colspan="1" rowspan="1" |
|+
|-
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Stage  }}
| colspan="1" rowspan="1" |T1
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Features}}
| colspan="1" rowspan="1" |Tumour limited to one subsite of supraglottis with normal vocal fold mobility
|-
| colspan="1" rowspan="1" |T2
| colspan="1" rowspan="1" |Tumour 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, medial wall of piriform sinus) without fixation of the larynx
|-
| colspan="1" rowspan="1" |T3
| colspan="1" rowspan="1" |Tumour limited to larynx with vocal fold fixation and/or invades any of the following: post-cricoid area, pre-epiglottic tissues, paraglottic space, and/or with minor thyroid cartilage erosion (e.g. inner cortex)
|-
| colspan="1" rowspan="1" |T4a
| colspan="1" rowspan="1" |Tumour invades through the thyroid cartilage and/or invades tissues beyond the larynx, e.g. trachea, soft tissues of neck, including deep/extrinsic muscle of tongue (e.g. genioglossus, hyoglossus, palatoglossus and styloglossus), strap muscles, thyroid and oesophagus
|-
| colspan="1" rowspan="1" |T4b
| colspan="1" rowspan="1" |Tumour invades pre-vertebral space, mediastinal structures or encases carotid artery
|-
| colspan="1" rowspan="1" |Glottis
| colspan="1" rowspan="1" |
|-
| colspan="1" rowspan="1" |T1
| colspan="1" rowspan="1" |Tumour limited to vocal fold(s) (may involve anterior or posterior commissure) with normal mobility
T1a. Tumour limited to one vocal fold
T1b. Tumour involves both vocal folds
|-
| colspan="1" rowspan="1" |T2
| colspan="1" rowspan="1" |T2a. Tumour extends to supraglottis and/or subglottis with normal vocal fold mobility
T2b. Tumour extends to supraglottis and/or subglottis with impaired vocal fold mobility
|-
| colspan="1" rowspan="1" |T3
| colspan="1" rowspan="1" |Tumour limited to larynx with vocal fold fixation and/or invades paraglottic space, and/or with minor thyroid cartilage erosion (e.g. inner cortex)
|-
| colspan="1" rowspan="1" |T4a
| colspan="1" rowspan="1" |Tumour invades through the thyroid cartilage or invades tissues beyond the larynx, e.g. trachea, soft tissues of neck, including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus and styloglossus), strap muscles, thyroid and oesophagus
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T4b
:Stage 0
| colspan="1" rowspan="1" |Tumour invades prevertebral space, mediastinal structures or encases carotid artery
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Carcinoma in situ]]
*Abnormal tumor cells are found in the lining of the [[larynx]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| colspan="1" rowspan="1" |Subglottis
:Stage 1
| colspan="1" rowspan="1" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Stage I laryngeal cancer depends on where cancer began in the larynx:
:*'''Supraglottis''': Cancer is in one area of the supraglottis only and the vocal cords can move normally
:*'''Glottis''': Cancer is in one or both [[vocal cord]]s and the vocal cords can move normally
:*'''Subglottis''': Cancer is in the subglottis only
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T1
:Stage 2
| colspan="1" rowspan="1" |Tumour limited to subglottis
| style="padding: 5px 5px; background: #F5F5F5;" |
*Stage II laryngeal cancer depends on location of cancer in the larynx:
:*'''Supraglottis''': Cancer is in more than one area of the supraglottis or surrounding tissues
:*'''Glottis''': Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally
:*'''Subglottis''': Cancer has spread to one or both vocal cords, which may not move normally
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T2
:Stage 3
| colspan="1" rowspan="1" |Tumour extends to vocal fold(s) with normal or impaired mobility
| style="padding: 5px 5px; background: #F5F5F5;" |
*Stage III laryngeal cancer depends on whether cancer has spread from the supraglottis, [[glottis]], or subglottis
 
:*Stage III cancer of the '''supraglottis''':
::*Cancer is in the larynx only and the vocal cords cannot move
::*Cancer may have spread to one [[lymph node]] on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller
:::::'''or'''
::*Cancer is in one area of the supraglottis and in one lymph node on the same side of the neck as the original tumor
::*The lymph node is 3 centimeters or smaller and the vocal cords can move normally
:::::'''or'''
::*Cancer is in more than one area of the supraglottis or surrounding tissues and in one lymph node on the same side of the neck as the original tumor
::*The lymph node is 3 centimeters or smaller
 
:*Stage III cancer of the '''glottis''':
::*Cancer is in the larynx only and the vocal cords cannot move
::*Cancer is in tissues next to the larynx
::*Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller
:::::'''or'''
::*Cancer is in one or both vocal cords and in one lymph node on the same side of the neck as the original tumor
::*The lymph node is 3 centimeters or smaller and the vocal cords can move normally
:::::'''or'''
::*Cancer has spread to the supraglottis or the subglottis or the vocal cords cannot move normally
::*Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller
 
:*Stage III cancer of the '''subglottis''':
::*Cancer is in the larynx and the vocal cords cannot move
::*Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller
:::::'''or'''
::*Cancer is in the subglottis and in one lymph node on the same side of the neck as the original tumor
::*The lymph node is 3 centimeters or smaller
:::::'''or'''
::*Cancer has spread to one or both vocal cords, which may not move normally
::*Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T3
:Stage 4A
| colspan="1" rowspan="1" |Tumour limited to larynx with vocal fold fixation
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cancer has spread through the thyroid cartilage and has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus
*Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller
:::::'''or'''
*Cancer has spread to one lymph node on the same side of the neck as the original tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters or has spread to more than one lymph node anywhere in the neck with none larger than 6 centimeters
*Cancer may have spread to tissues beyond the larynx, such as the [[neck]], [[trachea]], [[thyroid]], or [[esophagus]]
*The vocal cords may not move normally
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T4a
:Stage 4B
| colspan="1" rowspan="1" |Tumour invades through cricoid or thyroid cartilage and/or invades tissues beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus and styloglossus), strap muscles, thyroid and oesophagus
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cancer has spread to the space in front of the spinal column, surrounds the [[carotid artery]], or has spread to parts of the chest
*Cancer may have spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size
:::::'''or'''
*Cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest
*The vocal cords may not move normally
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T4b
:Stage 4C
| colspan="1" rowspan="1" |Tumour invades prevertebral space, mediastinal structures or encases carotid artery
| style="padding: 5px 5px; background: #F5F5F5;" |
*Cancer has spread to other parts of the body, such as the [[lung]]s, [[liver]], or [[bone]]
|}
|}
TNM Staging


===TNM Staging===
The staging of hypopharyngeal cancer is based on the TNM staging system.<ref>Staging of Laryngeal cancer. Radiopaedia 2015.http://radiopaedia.org/articles/laryngeal-scc-staging. Accessed on October 27, 2015 </ref>
The staging of hypopharyngeal cancer is based on the TNM staging system.<ref>Staging of Laryngeal cancer. Radiopaedia 2015.http://radiopaedia.org/articles/laryngeal-scc-staging. Accessed on October 27, 2015 </ref>
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! style="background: #4479BA; width: 100x;" | {{fontcolor|#FFF|Primary Tumor}}
! style="background: #4479BA; width: 100x;" | {{fontcolor|#FFF|Primary Tumor}}
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! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Nodal Involvement}}
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! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Distant Metastasis}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Distant Metastasis}}

Revision as of 19:00, 10 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]

Overview

According to the TNM staging system, there are 5 stages of laryngeal cancer based on the tumor size, lymph node involvement, and distant metastasis.

Staging

The following stages are used for Laryngeal cancer cancer: [1]

Supraglottis
T1 Tumour limited to one subsite of supraglottis with normal vocal fold mobility
T2 Tumour 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, medial wall of piriform sinus) without fixation of the larynx
T3 Tumour limited to larynx with vocal fold fixation and/or invades any of the following: post-cricoid area, pre-epiglottic tissues, paraglottic space, and/or with minor thyroid cartilage erosion (e.g. inner cortex)
T4a Tumour invades through the thyroid cartilage and/or invades tissues beyond the larynx, e.g. trachea, soft tissues of neck, including deep/extrinsic muscle of tongue (e.g. genioglossus, hyoglossus, palatoglossus and styloglossus), strap muscles, thyroid and oesophagus
T4b Tumour invades pre-vertebral space, mediastinal structures or encases carotid artery
Glottis
T1 Tumour limited to vocal fold(s) (may involve anterior or posterior commissure) with normal mobility

T1a. Tumour limited to one vocal fold T1b. Tumour involves both vocal folds

T2 T2a. Tumour extends to supraglottis and/or subglottis with normal vocal fold mobility

T2b. Tumour extends to supraglottis and/or subglottis with impaired vocal fold mobility

T3 Tumour limited to larynx with vocal fold fixation and/or invades paraglottic space, and/or with minor thyroid cartilage erosion (e.g. inner cortex)
T4a Tumour invades through the thyroid cartilage or invades tissues beyond the larynx, e.g. trachea, soft tissues of neck, including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus and styloglossus), strap muscles, thyroid and oesophagus
T4b Tumour invades prevertebral space, mediastinal structures or encases carotid artery
Subglottis
T1 Tumour limited to subglottis
T2 Tumour extends to vocal fold(s) with normal or impaired mobility
T3 Tumour limited to larynx with vocal fold fixation
T4a Tumour invades through cricoid or thyroid cartilage and/or invades tissues beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus and styloglossus), strap muscles, thyroid and oesophagus
T4b Tumour invades prevertebral space, mediastinal structures or encases carotid artery

TNM Staging

The staging of hypopharyngeal cancer is based on the TNM staging system.[2]

Primary Tumor Description
TX
  • Primary tumor cannot be assessed
T0
  • No evidence of primary tumor
Tis
  • Carcinoma in situ/dysplasia (tumor size <0.5 mm), confined to mucosa
T1
  • Limited to 1 subsite
  • Tumor size ≤ 2 cm in greatest dimension
T2
  • Extends into adjacent subsite or area (larynx, oropharynx)
  • Tumor size between 2-4 cm in greatest dimension
  • Clinically there must not be fixation of the hemilarynx
T3
  • Tumor size > 4cm
  • Fixation to hemilarynx
T4
  • Direct invasion of one or more of the following:


Nodal Involvement Description
NX
  • Regional lymph nodes cannot be assessed
N0
  • No regional lymph node metastasis
N1
  • Regional lymph node metastasis
Distant Metastasis Description
M0
  • No distant metastasis
M1
  • Distant metastasis

References

  1. ↑ Jones TM, De M, Foran B, Harrington K, Mortimore S (May 2016). "Laryngeal cancer: United Kingdom National Multidisciplinary guidelines". J Laryngol Otol. 130 (S2): S75–S82. doi:10.1017/S0022215116000487. PMC 4873912. PMID 27841116.
  2. ↑ Staging of Laryngeal cancer. Radiopaedia 2015.http://radiopaedia.org/articles/laryngeal-scc-staging. Accessed on October 27, 2015
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