Laryngeal carcinoma (staging)

Laryngeal carcinoma staging refers to TNM staging of carcinomas involving the supraglottic, glottic, and subglottic larynx. The vast majority of applicable cases are squamous cell carcinomas, but other epithelial tumors are also included. The following article reflects the 8th edition published by the American Joint Committee on Cancer, which is used for staging starting January 1, 2018 .

Primary tumor (T)

TX and Tis

TX and Tis are the same for all three sites of the larynx:

• TX: primary tumor cannot be assessed
• Tis: carcinoma in situ

T1, T2, and T3

T1 through T3 are defined differently by laryngeal site:

Supraglottis

• T1: limited to one subsite of supraglottis, with normal vocal cord mobility:
  • suprahyoid epiglottis
  • aryepiglottic folds, laryngeal aspect
  • infrahyoid epiglottis
  • false vocal cords (ventricular folds/bands)
  • arytenoids
• T2: invades mucosa of more than one adjacent area, with normal vocal cord mobility:
  • subsite of supraglottis
  • glottis
  • region outside supraglottis, e.g., base of tongue, vallecula, medial wall of pyriform sinus
• T3: limited to larynx with vocal cord fixation and/or invasion of any of the following:
  • inner cortex of thyroid cartilage
  • paraglottic space
  • preepiglottic space
  • postcricoid area

Glottis

• T1: limited to vocal cord(s) with normal vocal cord mobility (may involve anterior or posterior commissure)
  • T1a: limited to one vocal cord
  • T1b: involves both vocal cords
• T2: extends to supraglottis and/or subglottis, and/or with impaired vocal cord mobility
• T3: limited to larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of thyroid cartilage

Subglottis

• T1: limited to subglottis
• T2: extends to vocal cord(s) with normal or impaired vocal cord mobility (no cord fixation)
• T3: limited to larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of thyroid cartilage

T4

T4 is the same for all three sites of the larynx:

• T4: moderately or very advanced
  • T4a: moderately advanced local disease:
    • invades through outer cortex of thyroid cartilage
    • invades cricoid cartilage
    • invades tissues beyond the larynx (e.g., trachea, deep extrinsic muscles of the tongue, strap muscles, thyroid gland, esophagus)
  • T4b: very advanced local disease:
    • invades the mediastinum
    • invades the prevertebral space
    • encases the carotid artery

Regional lymph node (N)

Regional nodal status is defined the same as for most other cancers of the head and neck. See the main article, cervical lymph node (staging).

Distant metastases (M)

The terms pM0 and MX are not valid TNM categories. The following categories may be used, either in the clinical classification (c) for patients with cancer identified before treatment and/or in the pathological classification (p) for patients for whom surgery is the first definitive therapy:

• cM0: no evidence of metastases
• cM1: distant metastasis
• pM1: distant metastasis, microscopically confirmed

Stage groups

The prognostic stage groups are defined the same as for most other cancers of the head and neck:

• stage 0
  • Tis, N0, M0
• stage I
  • T1, N0, M0
• stage II
  • T2, N0, M0
• stage III
  • T3, N0, M0
  • [T1, T2, T3], N1, M0
• stage IVA
  • T4a, [N0, N1], M0
  • [T1, T2, T3, T4a], N2, M0
• stage IVB
  • [Any T], N3, M0
  • T4b, [Any N], M0
• stage IVC
  • [Any T], [Any N], M1

Siehe auch:

• Larynx
• TNM staging system
• Larynxkarzinom

und weiter:

• cancer staging list
• Epiglottiskarzinom
• supraglottic cancer
• laryngeal sub sites