Staging is the process of finding out how far a cancer has spread. The extent of spread of laryngeal or hypopharyngeal cancer is the most important factor in selecting treatment options and estimating the course of a patient’s illness and their outlook for recovery and survival (prognosis). A staging system is a way for members of the cancer care team to summarize the extent of a cancer's spread.

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

The American Joint Committee on Cancer (AJCC) TNM System

The most common system used to describe the stages of cancers is the American Joint Committee on Cancer (AJCC) TNM system.

• T stands for tumor (its size and how far it has spread within the larynx and hypopharynx and to nearby organs).

• N stands for spread to nearby lymph nodes in the neck (lymph nodes are bean-sized collections of immune system cells that help fight infections and cancers).

• M is for metastasis (spread to distant organs).

Using the TNM staging system, information about the tumor, lymph nodes, and metastasis is combined to assign a stage. This process is called stage grouping. The stage is described in Roman numerals from I to IV. Patients with lower stage cancers have a better outlook for a cure or long-term survival.

The T stage of cancers of the larynx and hypopharynx depends on how far it has spread to the surrounding tissues from its origin. Spread may be evaluated by indirect examinations using mirrors, by direct endoscopy using scopes, and, if your doctor can reach it, by feeling the texture of the area.

The T stage of laryngeal cancer also depends upon the movement of the vocal cords. The doctor will watch the vocal cords with an endoscope or special mirrors while the patient makes certain sounds. If the vocal cords move normally, the cancer likely has not affected deeper tissues. Vocal cord fixation (lack of movement) suggests involvement by cancer. Imaging studies such as CT or MRI scans may be used to add more detailed information.

T staging of laryngeal and hypopharyngeal cancers describes spread of the cancer precisely in relation to specific areas of the larynx, hypopharynx, and the surrounding structures. Higher T stage numbers indicate more spread within the larynx or hypopharynx and to other nearby areas in the neck.

The features used to assign the T stage of laryngeal cancer vary according to the area of the larynx involved -- supraglottis, glottis, or subglottis. T staging for hypopharyngeal cancer differs from T staging for cancer of the larynx.

You may want to talk to your doctor about the stage of your cancer. It will be important that the doctor illustrate it using a diagram of the larynx.

T stages 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 most superficial layer (the epithelium), with no cancer growing into the underlying connective tissue of the larynx or hypopharynx. (Very few hypopharyngeal and larynx cancers are found at this early stage.)

T stages of supraglottic cancer

For cancer of the supraglottis, the T stage is based on how many different parts (or sites) of the larynx are involved 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

Whether or not the vocal cords move normally is also considered. When the vocal cords do not move normally it often means that the cancer is growing into them. This is a more advanced T stage.

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

T2: The tumor is growing into at least 2 subsites of the supraglottis; the vocal cords still move normally.

T3: Either:

1) The tumor is growing only in the larynx and has caused the vocal cords to stop moving.

OR

2) The tumor is growing into the postcricoid area, paraglottic space, or pre-epiglottic (in front of the epiglottis) tissues.

OR

3) Both #1 and #2 are true.

T4a: The tumor is growing through thyroid cartilage (firm tissue that separates the thyroid gland from the front of the larynx) and/or is growing into tissues beyond the larynx (such as the trachea, esophagus, tongue muscles, or neck muscles).

T4b: The tumor is growing into the tissue in front of the spine in the neck (the prevertebral space), is growing around a carotid artery, or is growing down into the front of the chest cavity. T4b tumors are not able to be removed completely with surgery.

T stages of glottic cancer

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

T1a: The tumor is only growing in 1 vocal cord.

T1b: The tumor is on both vocal cords.

T2: The tumor is growing into the supraglottis and/or subglottis, and/or the vocal cords move only a little.

T3: The tumor is growing only in the larynx and the vocal cords don’t move and/or the tumor is growing into the paraglottic space, and/or the tumor has started growing into 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 trachea, esophagus, tongue muscles, or neck muscles).

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 front of the chest cavity. T4b tumors are not able to be removed completely with surgery.

T stages of subglottic cancer

T1: The tumor is only growing 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 l growing only in the larynx and the vocal cords don’t move.

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

T4b: The tumor is growing into the tissue in front of the spine in the neck (the prevertebral space), surrounds a carotid artery, is growing down into the front of the chest cavity. T4b tumors are not able to be removed completely with surgery.

T stages of hypopharyngeal cancer

Spread of cancer within the hypopharynx is described according to 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:

• pharyngo-esophageal junction
• pyriform sinus
• posterior pharyngeal wall

T1: The tumor is growing only in 1 subsite of the hypopharynx and it is smaller than 2 centimeters (cm) (about 3/4 of an inch) across.

T2: Either

The tumor in growing in 2 or more subsites of the hypopharynx.

OR

The tumor is growing in 1 subsite plus an area nearby.

OR

The tumor is 2 to 4 cm in size with normal movement of the vocal cords.

T3: Either:

The tumor is larger than 4 cm (about 1 1/2 inches) across.

OR

The tumor is affecting the movement of vocal cords.

T4a: The tumor is growing into the cricoid or thyroid cartilage, hyoid bone, thyroid gland, esophagus, or the strap muscles in front of the larynx.

T4b: The tumor is growing into the space in front of the spine in the neck, is growing around a carotid artery, or is growing down into the front of the chest cavity. T4b tumors are not able to be removed completely with surgery.

N (regional lymph node) stages of laryngeal and hypopharyngeal cancers

The N staging is the same for laryngeal and hypopharyngeal cancers. The stages are as follows:

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

N0: There is no evidence of 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 is. The lymph node is not larger than 3 cm (about 1¼ inch) across.

N2

N2a: The cancer has spread to a single lymph node on the same side of the neck as the tumor is. The lymph node is between 3 cm and 6 cm across.

N2b: The cancer has spread to 2 or more lymph nodes on the same side of the neck as the tumor is. None of these lymph nodes is larger than 6 cm across.

N2c: The cancer has spread to lymph nodes on both sides of neck or on the side opposite the tumor. 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.

M (distant metastasis) stages of laryngeal and hypopharyngeal cancers

The M staging for all head and neck cancers, including laryngeal and hypopharyngeal cancers, is the same. The stages are as follows:

MX: Information not available. Unable to tell if the cancer has spread to distant sites is present.

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 stages 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.

Survival rates by stage

Below are listed the 5-year relative survival rates for cancers from each of the sites. These are data from the National Cancer Data Base, published in the AJCC staging manual (see the "References" section). The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Keep in mind that many of these patients live much longer than 5 years after diagnosis, and 5-year rates are used to produce a standard way of discussing outlook (prognosis). 5-year relative survival rates assume that some people will die of other causes and compare the observed survival with that expected for people without the cancer. This is a more accurate way to describe the prognosis for patients with a particular type and stage of cancer. Of course, 5-year rates are based on patients diagnosed and treated more than 5 years ago. Recently diagnosed patients with many types of cancer may have a more favorable outlook because of improvements in treatment.

Unfortunately, a recent study found that the average survival for patients cancer of the larynx has not improved during the past couple of decades (from 1974-1997) and the prognosis for hypopharyngeal cancer improved only slightly. Nonetheless, there has been some been very recent progress in treating these cancers, and there is hope that the outlook for patients diagnosed in the past few years will be better.

Supraglottis

Glottis

Subglottis (These numbers are less accurate because of the small number of patients.)

Hypopharynx

If you have any questions about the stage of your cancer or how it affects your treatment, do not hesitate to ask your doctor.

Last Medical Review: 05/07/2009
Last Revised: 05/07/2009