Laryngeal and Hypopharyngeal Cancer

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Early Detection, Diagnosis, and Staging TOPICS

How are laryngeal and hypopharyngeal cancers staged?

The stage (extent of spread) of laryngeal or hypopharyngeal cancer is one of the most important factors in selecting treatment options and estimating a person’s outlook (prognosis). Laryngeal and hypopharyngeal cancers are staged based on the results of exams, imaging tests, endoscopies, and biopsies, which are described in “How are laryngeal and hypopharyngeal cancers diagnosed?

If you have laryngeal or hypopharyngeal cancer, ask your cancer care team to explain the stage of your cancer in a way that you understand. Knowing all you can about the stage can help you take a more active role in making informed decisions about your treatment.

The TNM staging system

A staging system is a way for members of the cancer care team to sum up the extent of a cancer’s spread. The most common system used to describe cancer stages is the American Joint Committee on Cancer (AJCC) TNM system. For laryngeal and hypopharyngeal cancers, the TNM system is based on 3 key pieces of information:

  • T stands for tumor (its size and how far it has spread within the larynx or hypopharynx and to nearby organs).
  • N stands for spread to nearby lymph nodes in the neck. (Cancers often first spread to lymph nodes, which are bean-sized collections of immune system cells.)
  • M is for metastasis (spread to distant organs). These cancers most often spread to the lungs, although they may also spread to the bones, liver, or other organs.

T groups for laryngeal and hypopharyngeal cancers

The T group describes how far the cancer has spread within the larynx or hypopharynx and to any nearby structures. This is based on the results of exams such as laryngoscopy and on any imaging tests of the area, such as CT or MRI scans. Higher T group numbers mean more advanced spread.

The T group of laryngeal cancer also depends on the movement of the vocal cords. The doctor will watch the vocal cords with an endoscope or special mirrors while the person makes certain sounds. If the vocal cords move normally, the cancer probably has not affected deeper tissues. If a vocal cord isn’t moving normally (vocal cord fixation) it can be because cancer is growing into it.

The features used to assign the T group of laryngeal cancer are based on the area of the larynx involved (supraglottis, glottis, or subglottis). The T groups for hypopharyngeal cancer differ from those for cancer of the larynx.

T groups common to all laryngeal and hypopharyngeal cancers

TX: Not enough information available to stage the tumor

T0: No tumor can be found

Tis: Carcinoma in situ. The cancer cells are only growing in the inner lining layer (the epithelium) of the larynx or hypopharynx, with no cancer growing into the underlying connective tissue. (Very few hypopharyngeal and larynx cancers are found at this early stage.)

T groups for supraglottic cancer

For cancer of the supraglottis (the area above the vocal cords), the T group is based on how many different parts (or sites) of the larynx the cancer has reached and how far outside the larynx the cancer has spread. The 5 subsites of the supraglottic part of the larynx are:

  • The false vocal cords (or ventricular bands)
  • Arytenoids
  • Suprahyoid epiglottis
  • Infrahyoid epiglottis
  • Aryepiglottic folds

Vocal cord movement is also considered. When the vocal cords do not move normally it often means that the cancer is growing into them and is therefore more advanced.

T1: The vocal cords move normally and the tumor is only in 1 subsite of the supraglottis.

T2: The tumor is in at least 2 subsites of the supraglottis (or glottis). The vocal cords still move normally.

T3: One or both of the following applies:

  • The tumor is only in the larynx but has caused a vocal cord to stop moving.
  • The tumor is growing into nearby areas such as the postcricoid area, paraglottic space, pre-epiglottic (in front of the epiglottis) tissues, or the inner part of the thyroid cartilage (firm tissue that separates the thyroid gland from the front of the larynx).

T4a: The tumor is growing through the thyroid cartilage and/or is growing into tissues beyond the larynx (such as the thyroid gland, trachea, esophagus, tongue muscles, or neck muscles). This is known as moderately advanced local disease.

T4b: The tumor is growing into the tissue in front of the spine in the neck (the prevertebral space), surrounds a carotid artery, or is growing down into the space between the lungs. This is also known as very advanced local disease.

T groups for glottic cancer

These cancers start in the glottis – the part of the larynx that includes the vocal cords.

T1: The tumor is only in the vocal cord(s). The vocal cords move normally.

T2: One or both of the following applies:

  • The tumor is growing into the supraglottis and/or subglottis.
  • The vocal cords do not move normally.

T3: One or more of the following applies:

  • The tumor is only in the larynx but has caused a vocal cord to stop moving.
  • The tumor is growing into the paraglottic space.
  • The tumor is growing into the inner part of the thyroid cartilage (firm tissue that separates the thyroid gland from the front of the larynx).

T4a: The tumor has grown through the thyroid cartilage and/or is growing into tissues beyond the larynx (such as the thyroid gland, trachea, esophagus, tongue muscles, or neck muscles). This is known as moderately advanced local disease.

T4b: The tumor is growing into the tissue in front of the spine in the neck (the prevertebral space), surrounds a carotid artery, or is growing down into the space between the lungs. This is also known as very advanced local disease.

T groups for subglottic cancer

These cancers start in the subglottis – the part of the larynx below the vocal cords.

T1: The tumor is only in the subglottis.

T2: The tumor has grown from the subglottis to the vocal cords, with normal or reduced vocal cord movement.

T3: The tumor is growing only in the larynx but has caused a vocal cord to stop moving.

T4a: The tumor is growing through the cricoid or thyroid cartilage and/or is growing into tissues beyond the larynx (such as the thyroid gland, trachea, esophagus, tongue muscles, or neck muscles). This is known as moderately advanced local disease.

T4b: The tumor is growing into the tissue in front of the spine in the neck (the prevertebral space), surrounds a carotid artery, or is growing down into the space between the lungs. This is also known as very advanced local disease.

T groups for hypopharyngeal cancer

Spread of cancer within the hypopharynx is described based on the size of the tumor and how many areas (subsites) of the hypopharynx are involved by the cancer. The 3 subsites of the hypopharynx are the:

  • Pyriform sinuses
  • Lateral (side) and posterior (back) hypopharyngeal walls
  • Pharyngo-esophageal junction (where the throat and esophagus meet)

T1: The tumor is only in 1 subsite of the hypopharynx and it is 2 centimeters (cm) (about ¾ of an inch) across or smaller.

T2: One or more of the following applies:

  • The tumor in in 2 or more subsites of the hypopharynx.
  • The tumor is in 1 subsite plus an area nearby.
  • The tumor is more than 2 cm but not more than 4 cm (about 1½ inches) across, and the vocal cords move normally.

T3: One or more of the following applies:

  • The tumor is larger than 4 cm across.
  • The tumor is affecting the movement of vocal cords.
  • The tumor has grown into the esophagus.

T4a: The tumor is growing into the cricoid or thyroid cartilage, hyoid bone, thyroid gland, or the strap muscles or fat in front of the larynx. This is known as moderately advanced local disease.

T4b: The tumor is growing into the space in front of the spine in the neck, surrounds a carotid artery, or is growing down into the space between the lungs. This is also known as very advanced local disease.

N groups for laryngeal and hypopharyngeal cancers

The N groups are based on spread of the cancer to nearby (regional) lymph nodes and on the size of the nodes. These groups are the same for all laryngeal and hypopharyngeal cancers:

NX: The lymph nodes cannot be assessed (information not available).

N0: There is no evidence the cancer has spread to the lymph nodes.

N1: The cancer has spread to a single lymph node on the same side of the neck as the tumor. The lymph node is not larger than 3 cm (about 1¼ inch) across.

N2: Separated into 3 sub-groups:

  • N2a: The cancer has spread to a single lymph node on the same side of the neck as the tumor. The lymph node is larger than 3 cm but not larger than 6 cm across.
  • N2b: The cancer has spread to 2 or more lymph nodes on the same side of the neck as the tumor. None of these lymph nodes is larger than 6 cm across.
  • N2c: The cancer has spread to lymph nodes on the side of the neck opposite the tumor or on both sides of neck. None of these lymph nodes is larger than 6 cm across.

N3: The cancer has spread to at least 1 lymph node that is larger than 6 cm across.

M groups for laryngeal and hypopharyngeal cancers

The M groups for all laryngeal and hypopharyngeal cancers are the same:

M0: The cancer has not spread to distant sites.

M1: The cancer has spread to distant sites.

Stage grouping

Once the T, N, and M groups have been assigned, this information is combined to assign an overall stage for the cancer. This process is called stage grouping. Stage grouping rules are the same for all cancers of the hypopharynx and the supraglottic, glottic, and subglottic areas of the larynx.

Stage 0: Tis, N0, M0

Stage I: T1, N0, M0

Stage II: T2, N0, M0

Stage III: T3, N0, M0, OR T1 to T3, N1, M0

Stage IVA: T4a, N0 or N1, M0, OR T1 to T4a, N2, M0

Stage IVB: T4b, Any N, M0, OR Any T, N3, M0

Stage IVC: Any T, Any N, M1

In general, patients with lower stage cancers tend to have a better outlook for a cure or long-term survival.


Last Medical Review: 04/08/2014
Last Revised: 04/17/2014