Laryngeal Cancer Stages

After someone is diagnosed with laryngeal cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

The earliest stage of laryngeal cancer is stage 0, also known as carcinoma in situ (CIS). The other main stages range from I (1) through IV (4). Some stages are split further, using capital letters (A, B, etc.).  As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is the stage determined?

The staging system most often used for laryngeal cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

  • The extent of the main tumor (T): Where is the tumor? How far has it grown into the larynx and nearby structures? Has it affected vocal cord movement?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes in the neck? If so, how many are affected, and how large are they?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body? (The most common sites of spread are the lungs, liver, or bones.)

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. 

Once the T, N, and M categories of the cancer have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.

The system described below is the most recent AJCC system, effective January 2018. 

Laryngeal cancer is typically given a clinical stage based on the results of any exams, biopsies, and imaging tests that might have been done (as described in How Are Laryngeal and Hypopharyngeal Cancers Diagnosed?). If surgery has been done, the pathologic stage (also called the surgical stage) can be determined.

The stages of laryngeal cancer are slightly different, based on which part of the larynx the cancer starts in:

  • The supraglottis (the area above the vocal cords)
  • The glottis (the area that includes the vocal cords)
  • The subglottis (the area below the vocal cords)

Laryngeal cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

Stages of supraglottic laryngeal cancer

AJCC stage

Stage grouping

Stage description*

0
 

Tis
N0
M0

The tumor is only in the top layer of cells lining the inside of the larynx and has not grown any deeper (Tis).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

I

T1
N0
M0

The tumor has grown deeper, but it is only in one part of the supraglottis, and the vocal cords move normally (T1).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

II

T2
N0
M0

The tumor has grown deeper, and it has grown into more than one part of the supraglottis (or glottis), and the vocal cords move normally (T2).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

 

III

T3
N0
M0

The tumor is still only in the larynx, but it has caused a vocal cord to stop moving, OR 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) (T3).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

OR

T1 to T3
N1
M0

The tumor might or might not have grown into structures just outside the larynx, and it might or might not have affected a vocal cord (T1 to T3). The cancer has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1).

The cancer has not spread to distant parts of the body (M0).

 

IVA

T4a
N0 or N1
M0

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 also known as moderately advanced local disease (T4a).

The cancer has not spread to nearby lymph nodes (N0), or it has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0).

OR

T1-T4a
N2
M0

The tumor might or might not have grown into structures outside the larynx (as far as moderately advanced disease), and it might or might not have affected a vocal cord (T1 to T4a). The cancer is N2:

  • It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 centimeters (cm) but no larger than 6 cm across, OR
  • It has spread to more than one lymph node on the same side of the neck as the tumor, none of which is larger than 6 cm across, OR
  • It has spread to at least one lymph node on the other side of the neck, none of which is larger than 6 cm across.

The cancer has not spread to distant parts of the body (M0).

 

IVB

T4b
Any N
M0

The tumor is growing into the area 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 (T4b).

The cancer might or might not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0).

OR

Any T
N3
M0

The tumor might or might not have grown into structures outside the larynx, and it might or might not have affected a vocal cord (any T).

The cancer has spread to at least one lymph node that is larger than 6 cm across, OR it has spread to a lymph node and then grown outside of the lymph node (N3). It has not spread to distant parts of the body (M0).

IVC

Any T
Any N
M1

The tumor might or might not have grown into structures outside the larynx, and it might or might not have affected a vocal cord (any T).

The cancer might or might not have spread to nearby lymph nodes (any N). The cancer has spread to distant parts of the body (M1).

* The following additional categories are not listed on the table above: 

  • TX: Main tumor cannot be assessed due to lack of information.
  • NX: Regional lymph nodes cannot be assessed due to lack of information. 
 

Stages of glottic laryngeal cancer

AJCC stage

Stage grouping

Stage description*

0
 

Tis
N0
M0

The tumor is only in the top layer of cells lining the inside of the larynx and has not grown any deeper (Tis).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

I

T1
N0
M0

The tumor has grown deeper, but it is only in the vocal cords, and they move normally (T1).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

II

T2
N0
M0

The tumor has grown into the supraglottis or subglottis, and/or the vocal cords do not move normally (T2).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

 

III

T3
N0
M0

The tumor is still only in the larynx, but it has caused a vocal cord to stop moving, OR the tumor is growing into the paraglottic space, OR 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) (T3).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

OR

T1 to T3
N1
M0

The tumor might or might not have grown into structures just outside the larynx, and it might or might not have affected a vocal cord (T1 to T3).

The cancer has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0).

 

IVA

T4a
N0 or N1
M0

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

The cancer has not spread to nearby lymph nodes (N0), or it has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0).

OR

T1-T4a
N2
M0

The tumor might or might not have grown into structures outside the larynx (as far as moderately advanced disease), and it might or might not have affected a vocal cord (T1 to T4a). The cancer is N2:

  • It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 centimeters (cm) but no larger than 6 cm across, OR
  • It has spread to more than one lymph node on the same side of the neck as the tumor, none of which is larger t han 6 cm across, OR
  • It has spread to at least one lymph node on the other side of the neck, none of which is larger than 6 cm across.

The cancer has not spread to distant parts of the body (M0).

 

IVB

T4b
Any N
M0

The tumor is growing into the area 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 (T4b). The cancer might or might not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0).

OR

Any T
N3
M0

The tumor might or might not have grown into structures outside the larynx, and it might or might not have affected a vocal cord (any T).

The cancer has spread to at least one lymph node that is larger than 6 cm across, OR it has spread to a lymph node and then grown outside of the lymph node (N3). It has not spread to distant parts of the body (M0).

IVC

Any T
Any N
M1

The tumor might or might not have grown into structures outside the larynx, and it might or might not have affected a vocal cord (any T).

The cancer might or might not have spread to nearby lymph nodes (any N). The cancer has spread to distant parts of the body (M1).

* The following additional categories are not listed on the table above: 

  • TX: Main tumor cannot be assessed due to lack of information.
  • NX: Regional lymph nodes cannot be assessed due to lack of information. 
 

Stages of subglottic laryngeal cancer

 

AJCC stage

Stage grouping

Stage description*

0
 

Tis
N0
M0

The tumor is only in the top layer of cells lining the inside of the larynx and has not grown any deeper (Tis).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

I

T1
N0
M0

The tumor has grown deeper, but it is only in the subglottis (T1).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

II

T2
N0
M0

The tumor has grown into the vocal cords, which might or might not move normally (T2).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

 

III

T3
N0
M0

The tumor is still only in the larynx, but it has caused a vocal cord to stop moving, OR the tumor is growing into the paraglottic space, OR 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) (T3).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

OR

T1 to T3
N1
M0

The tumor might or might not have grown into structures just outside the larynx, and it might or might not have affected a vocal cord (T1 to T3).

The cancer has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0).

 

IVA

T4a
N0 or N1
M0

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

The cancer has not spread to nearby lymph nodes (N0), or it has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0).

OR

T1-T4a
N2
M0

The tumor might or might not have grown into structures outside the larynx (as far as moderately advanced disease), and it might or might not have affected a vocal cord (T1 to T4a). The cancer is N2:

  • It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 centimeters (cm) but no larger than 6 cm across, OR
  • It has spread to more than one lymph node on the same side of the neck as the tumor, none of which is larger than 6 cm across, OR
  • It has spread to at least one lymph node on the other side of the neck, none of which is larger than 6 cm across.

The cancer has not spread to distant parts of the body (M0).

 

IVB

T4b
Any N
M0

The tumor is growing into the area 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 (T4b).

The cancer might or might not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0).

OR

Any T
N3
M0

The tumor might or might not have grown into structures outside the larynx, and it might or might not have affected a vocal cord (any T).

The cancer has spread to at least one lymph node that is larger than 6 cm across, OR it has spread to a lymph node and then grown outside of the lymph node (N3). It has not spread to distant parts of the body (M0).

IVC

Any T
Any N
M1

The tumor might or might not have grown into structures outside the larynx, and it might or might not have affected a vocal cord (any T).

The cancer might or might not have spread to nearby lymph nodes (any N). The cancer has spread to distant parts of the body (M1).

* The following additional categories are not listed on the table above: 

  • TX: Main tumor cannot be assessed due to lack of information.
  • NX: Regional lymph nodes cannot be assessed due to lack of information.

 

The American Cancer Society medical and editorial content team
Our team is made up of doctors and master’s-prepared nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Last Medical Review: December 20, 2017 Last Revised: December 20, 2017

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