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{{Laryngeal cancer}}
{{Laryngeal cancer}}
{{CMG}} {{AE}}{{Faizan}}
{{CMG}} {{AE}} {{OK}}
==Overview==
==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]].
According to the [[TNM staging system]], the stages of [[laryngeal cancer]] are based on the [[tumor]] size, [[lymph node]] involvement, and distant [[metastasis]]


==Staging==
==Staging==
The following stages are used for Laryngeal cancer cancer:<ref>Staging of Laryngeal cancer. http://www.cancer.gov/types/head-and-neck/patient/laryngeal-treatment-pdq#section/_26</ref>
The following [[TNM staging system|TNM staging]] is used for laryngeal 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>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
{| class="wikitable"
|valign=top|
| colspan="1" rowspan="1" |'''Supraglottis'''
|+
| colspan="1" rowspan="1" |
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Stage  }}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Features}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T1
:Stage 0
| colspan="1" rowspan="1" |[[Tumour|Tumor]] limited to one subsite of supraglottis with normal [[vocal fold]] [[mobility]]
| 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" |T2
:Stage 1
| colspan="1" rowspan="1" |[[Tumor]] 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
| 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" |T3
:Stage 2
| colspan="1" rowspan="1" |[[Tumor]] 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]])
| 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" |T4a
:Stage 3
| colspan="1" rowspan="1" |[[Tumor]] 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 of the neck|strap muscles]], [[thyroid]] and [[esophagus]]
| 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" |
:Stage 4A
| 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" |
:Stage 4B
| 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" |[[Tumor]] invades pre-vertebral 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===
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>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
|valign=top|
|+
! style="background: #4479BA; width: 100x;" | {{fontcolor|#FFF|Primary Tumor}}
! style="background: #4479BA; width: 700px;" | {{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |[[Glottis|'''Glottis''']]
:TX
| colspan="1" rowspan="1" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Primary tumor cannot be assessed
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| colspan="1" rowspan="1" |T1
:T0
| colspan="1" rowspan="1" |[[Tumor]] limited to [[vocal fold]](s) (may involve anterior or posterior commissure) with normal [[mobility]]
| style="padding: 5px 5px; background: #F5F5F5;" |
T1a. [[Tumor]] limited to one [[vocal fold]] T1b. [[Tumor]] involves both vocal folds
*No evidence of primary tumor
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T2
:Tis
| colspan="1" rowspan="1" |T2a. [[Tumor]] extends to supraglottis and/or subglottis with normal [[vocal fold]] [[mobility]]
| style="padding: 5px 5px; background: #F5F5F5;" |
T2b. [[Tumor]] extends to supraglottis and/or subglottis with impaired [[vocal fold]] [[mobility]]
*Carcinoma in situ/dysplasia (tumor size <0.5 mm), confined to [[mucosa]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T3
:T1
| colspan="1" rowspan="1" |[[Tumor]] limited to [[larynx]] with [[vocal fold]] fixation and/or invades paraglottic space, and/or with minor [[thyroid cartilage]] erosion (e.g. inner [[cortex]])
| style="padding: 5px 5px; background: #F5F5F5;" |
*Limited to 1 subsite
*Tumor size ≤ 2 cm in greatest dimension
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T4a
:T2
| colspan="1" rowspan="1" |[[Tumor]] 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 of the neck|strap muscles]], [[thyroid]] and [[esophagus]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*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
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T4b
:T3
| colspan="1" rowspan="1" |[[Tumor]] invades prevertebral space, [[mediastinal]] structures or encases [[carotid artery]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Tumor size > 4cm
*Fixation to hemilarynx
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |'''Subglottis'''
:T4
| colspan="1" rowspan="1" |
| style="padding: 5px 5px; background: #F5F5F5;" |
*Direct invasion of one or more of the following:
**Thyroid cartilage/cricoid cartilage
**[[Hyoid bone]]
**[[Thyroid gland]]
**[[Esophagus]]
**Central compartment
**Mediastinal structures
**Prevertebral fascia
**Encases carotid artery
|}
<br>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
|valign=top|
|+
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Nodal Involvement}}
! style="background: #4479BA; width: 700px;" | {{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T1
:NX
| colspan="1" rowspan="1" |[[Tumor]] limited to subglottis
| style="padding: 5px 5px; background: #F5F5F5;" |
*Regional lymph nodes cannot be assessed
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| colspan="1" rowspan="1" |T2
:N0
| colspan="1" rowspan="1" |[[Tumor]] extends to [[vocal fold]](s) with normal or impaired [[mobility]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*No regional lymph node metastasis
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T3
:N1
| colspan="1" rowspan="1" |[[Tumor]] limited to [[larynx]] with [[vocal fold]] fixation
| style="padding: 5px 5px; background: #F5F5F5;" |
*Regional lymph node metastasis
|}
<br>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px"
|valign=top|
|+
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Distant Metastasis}}
! style="background: #4479BA; width: 700px;" | {{fontcolor|#FFF|Description}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
| colspan="1" rowspan="1" |T4a
:M0
| colspan="1" rowspan="1" |[[Tumor]] 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 of the neck|strap muscles]], [[thyroid]] and [[esophagus]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*No distant metastases
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
| colspan="1" rowspan="1" |T4b
:M1
| colspan="1" rowspan="1" |[[Tumor]] invades prevertebral space, [[mediastinal]] structures or encases [[carotid artery]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Distant metastasis
|}
|}


==References==
== References ==
 
{{Reflist|2}}
{{Reflist|2}}
[[Category:Disease]]
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Types of cancer]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Otolaryngology]]

Latest revision as of 06:18, 18 March 2019

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

Overview

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

Staging

The following TNM staging is used for laryngeal cancer: [1]

Supraglottis
T1 Tumor limited to one subsite of supraglottis with normal vocal fold mobility
T2 Tumor 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 Tumor 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 Tumor 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 esophagus
T4b Tumor invades pre-vertebral space, mediastinal structures or encases carotid artery
Glottis
T1 Tumor limited to vocal fold(s) (may involve anterior or posterior commissure) with normal mobility

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

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

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

T3 Tumor limited to larynx with vocal fold fixation and/or invades paraglottic space, and/or with minor thyroid cartilage erosion (e.g. inner cortex)
T4a Tumor 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 esophagus
T4b Tumor invades prevertebral space, mediastinal structures or encases carotid artery
Subglottis
T1 Tumor limited to subglottis
T2 Tumor extends to vocal fold(s) with normal or impaired mobility
T3 Tumor limited to larynx with vocal fold fixation
T4a Tumor 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 esophagus
T4b Tumor invades prevertebral space, mediastinal structures or encases carotid artery

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.
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