Radiation Oncology/Head & Neck/Larynx/Staging

Laryngeal Cancer Staging

AJCC 8th Edition
AJCC 8th Edition (2017): To be used for staging beginning Jan 1, 2018.

T-Stage
 * unchanged from 7th edition

N-Stage

Overall stage
 * unchanged from 7th edition

AJCC 7th Edition
AJCC 7th Edition (2009)

Supraglottis

 * Anatomy: the inferior boundary of the supraglottis is a horizontal plane passing through the lateral margin of the ventricle at its junction with the superior surface of the vocal cord.
 * Subsites: False cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglotic folds
 * T1: Tumor limited to one subsite of supraglottis with normal vocal cord 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, or medial wall of pyriform sinus) without fixation of the larynx
 * T3: Tumor limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space, and/or 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 the neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
 * Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus
 * T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

Glottis

 * Anatomy: The glottis is composed of the superior and inferior surfaces of the true vocal cords, including the anterior and posterior commissures. It occupies a horizontal plane 1 cm in thickness, extending inferiorly from the lateral margin of the ventricle.
 * T1: Tumor limited to the vocal cord(s), which may involve anterior or posterior commissure, with normal mobility
 * T1a: Tumor limited to one vocal cord
 * T1b: Tumor involves both vocal cords
 * T2: Tumor extends to supraglottis and/or subglottis and/or with impaired vocal cord mobility
 * T3: Tumor limited to the larynx with vocal cord fixation and/or invades paraglottic space, and/or 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 the tongue, strap muscles, thyroid, or esophagus)
 * Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus
 * T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

Subglottis

 * Anatomy: The subglottis is the region extending from the lower boundary of the glottis to the lower margin of the cricoid cartilage.
 * T1: Tumor limited to the subglottis
 * T2: Tumor extends to vocal cord(s) with normal or impaired mobility
 * T3: Tumor limited to larynx with vocal cord fixation
 * T4a: Tumor invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck, including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus)
 * Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus
 * T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures

Metastasis Stage

 * MX: Distant metastasis cannot be assessed
 * M0: No distant metastasis
 * M1: Distant metastasis

AJCC Overall Stage

 * I - T1 N0
 * II - T2 N0
 * III - T3 N0, T1-3 N1
 * IVA - T4a N0-2, T1-4a N2
 * IVB - T4b any N, any T N3
 * IVC - M1

Older staging systems
AJCC 6th edition (2002)
 * no changes compared to 7th edition
 * new since 5th edition: subdivided T4 into T4a and T4b

AJCC 5th edition (1997)
 * For all subsites, T4 is a single grouping, not divided into T4a and T4b
 * Supraglottis:
 * Unchanged compared to current edition (7th), except for T4 as noted above
 * Glottis:
 * Unchanged compared to current edition (7th), except for T4 as noted above
 * Subglottis:
 * Unchanged compared to current edition (7th), except for T4 as noted above

AJCC 3rd edition (1988)
 * Supraglottis:
 * no changes compared to 7th edition
 * Glottis:
 * T1 - no changes compared to current edition (7th)
 * T2 - no changes compared to current edition (7th)
 * T3 - tumor limited to larynx with vocal cord fixation (does not mention paraglottic space invasion or minor thyroid cartilage erosion)
 * Subglottis:
 * no changes compared to 7th edition

AJCC 2nd edition (1983)
 * Glottis:
 * T2a - normal mobility
 * T2b - decreased mobility