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Laryngeal Cancer Stages
If you are diagnosed with laryngeal (voice box) 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.
Each person’s cancer experience is unique. But cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
How is laryngeal cancer staged?
Each stage of laryngeal cancer is assigned a number. The earliest is stage 0, also known as carcinoma in situ (CIS). Other stages range from I through IV. Some stages are further divided using the letters A and B.
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.
- Within each numbered stage (I-IV), an earlier letter means a lower stage.
Stage grouping
The staging system most often used for laryngeal cancer is the American Joint Committee on Cancer (AJCC) TNM system. The staging system in the tables below is based on the most recent AJCC system, effective January 2018.
This system uses 3 key pieces of information.
- Extent of the tumor (T): How large is the main (primary) tumor? Which tissues of the larynx has it spread to, if any?
- Spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many? Are they on the same side as where the cancer started, and how large are they?
- Spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs?
Numbers or letters after T, N, and M give more detail about each of these factors. Higher numbers mean the cancer is more advanced.
Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.
Pathological vs. clinical stage
Pathological stage (surgical stage): The staging systems shown below use the pathologic stage, also called the surgical stage. This is determined by examining the tissue removed during an operation.
Clinical stage: If surgery is not possible right away or at all, the cancer will sometimes be given a clinical stage instead. This is based on the results of a physical exam, endoscopy exam, biopsy, and imaging tests. The clinical stage will be used to help plan treatment. However, sometimes the cancer has spread further than the clinical stage estimates. It may not predict a person’s outlook as accurately as a pathologic stage. Clinical stage is not shown in the tables below.
Area where the cancer started
Staging also depends on which part of the larynx the cancer started in:
- Supraglottis, above the vocal cords
- Glottis, includes the vocal cords
- Subglottis, below the vocal cords
The staging for each of these areas differs slightly.
Cancer staging can be complex. If you have any questions about your cancer’s stage and what it might mean for you, ask your doctor to explain it in a way you understand.
Stages of supraglottic laryngeal cancer
- 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).
- It has not spread to distant parts of the body (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).
- It has not spread to distant parts of the body (M0).
- The tumor has grown deeper and into more than one part of the supraglottis (or glottis). The vocal cords move normally (T2).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
Stage grouping: 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 tissues (in front of the epiglottis), or the inner part of the thyroid cartilage* (T3).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
*Thyroid cartilage is the firm tissue that separates the thyroid gland from the front of the larynx.
Stage grouping: T1 to T3, N1, M0
- The tumor may or may not have grown into structures just outside the larynx. It may or may 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. The lymph node is no larger than 3 cm* across. The cancer has not grown outside the lymph node (N1).
- It has not spread to distant parts of the body (M0).
*3 cm = about 1 ¼ inches
Stage grouping: 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, the lymph node is no larger than 3 cm* across, and the cancer has not grown outside the lymph node (N1).
- The cancer has not spread to distant parts of the body (M0).
*3 cm = about 1 ¼ inch
Stage grouping: T1 to T4a, N2, M0
The tumor may have grown into structures outside the larynx as far as moderately advanced disease, or it may not have grown into structures outside the larynx. It may or may not have affected a vocal cord (T1 to T4a).
The cancer has spread to the lymph nodes in one of the following ways (N2):
- It has spread to a single lymph node on the same side of the neck as the tumor. The lymph node is 3 cm or smaller and the cancer has grown outside the lymph node, or
- It 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 no larger than 6 cm* across and the cancer has not grown outside the lymph node, or
- It has spread to more than one lymph node on the same side of the neck as the tumor. None of these lymph nodes are larger than 6 cm across, and the cancer has not grown outside the lymph nodes, or
- It has spread to lymph nodes on the side of the neck opposite the tumor, or to lymph nodes on both sides of the neck. None of these lymph nodes are larger than 6 cm across. It has not grown outside the lymph nodes.
The cancer has not spread to distant parts of the body (M0).
*6 cm = about 2 ½ inches
Stage grouping: T4b, any N, M0
- The tumor is growing into the area in the neck in front of the spine (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).
Stage grouping: any T, N3, M0
The tumor may or may not have grown into structures outside the larynx, and it may or may not have affected a vocal cord (any T).
The cancer has spread to the lymph nodes in one of the following ways (N3):
- It has spread to a lymph node larger than 6 cm* across, but it has not grown outside the lymph node, or
- It 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 across and the cancer has grown outside the lymph node, or
- It has spread to more than one lymph node on any side of the neck and it has grown outside the lymph nodes, or
- It has spread to a single lymph node on the side of the neck opposite the tumor, and it has grown outside the lymph node.
The cancer has not spread to distant parts of the body (M0).
*6 cm = about 2 ½ inches
- The tumor may or may not have grown into structures outside the larynx. It may or may not have affected a vocal cord (any T).
- It may or may not have spread to nearby lymph nodes (any N).
- It has spread to distant parts of the body (M1).
Other staging categories you might see
- TX: The 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
- 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).
- It has not spread to distant parts of the body (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).
- It has not spread to distant parts of the body (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).
- It has not spread to distant parts of the body (M0).
Stage grouping: 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*. (T3).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
* Thyroid cartilage is the firm tissue that separates the thyroid gland from the front of the larynx.
Stage grouping: T1 to T3, N1, M0
- The tumor may or may not have grown into structures just outside the larynx, and it may or may 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. The lymph node is no larger than 3 cm* across. The cancer has not grown outside the lymph node (N1).
- It has not spread to distant parts of the body (M0).
*3 cm = about 1 ¼ inches
Stage grouping: T4a, N0 or N1, M0
- The tumor has grown through the thyroid cartilage and/or it 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, the lymph node is no larger than 3 cm* across, and the cancer has not grown outside the lymph node (N1).
- It has not spread to distant parts of the body (M0).
*3 cm = about 1 ¼ inches; *6 cm = about 2 ½ inches
Stage grouping: T1 to T4a, N2, M0
The tumor may or may not have grown into structures outside the larynx as far as moderately advanced disease. It may or may not have affected a vocal cord (T1 to T4a).
The cancer has spread to nearby lymph nodes in one of the following ways (N2):
- It has spread to a single lymph node on the same side of the neck as the tumor. The lymph node is 3 cm or smaller and the cancer has grown outside the lymph node, or
- It 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 no larger than 6 cm* across and the cancer has not grown outside the lymph node, or
- It has spread to more than one lymph node on the same side of the neck as the tumor. None of these lymph nodes are larger than 6 cm across and the cancer has not grown outside the lymph nodes, or
- It has spread to lymph nodes on the side of the neck opposite tumor, or to lymph nodes on both sides of the neck. None of these lymph nodes are larger than 6 cm across. The cancer has not grown outside the lymph nodes.
The cancer has not spread to distant parts of the body (M0).
Stage grouping: T4b, any N, M0
- The tumor is growing into the area in the neck in front of the spine (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).
Stage grouping: any T, N3, M0
The tumor may or may not have grown into structures outside the larynx. It may or may not have affected a vocal cord (any T).
The cancer has spread to nearby lymph nodes in one of the following ways (N3):
- It has spread to a single lymph node larger than 6 cm* across, but it has not grown outside the lymph node, or
- It 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 across and the cancer has grown outside the lymph node, or
- It has spread to more than one lymph node on any side of the neck and it has also grown outside the lymph nodes, or
- It has spread to a single lymph node on the side of the neck opposite the tumor and it has grown outside the lymph node.
The cancer has not spread to distant parts of the body (M0).
*6 cm = about 2 ½ inches
- The tumor may or may not have grown into structures outside the larynx, and it may or may not have affected a vocal cord (any T).
- The cancer might or might not have spread to nearby lymph nodes (any N).
- It has spread to distant parts of the body (M1).
Other staging categories you might see
- TX: The 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
- The tumor is only in the top layer of cells lining the inside of the larynx. It has not grown any deeper (Tis).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
- The tumor has grown deeper than the top layer of cells lining the inside of the larynx, but it is only in the subglottis (T1).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
- The tumor has grown into the vocal cords. The vocal cords may or may not move normally (T2).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
Stage grouping: 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 inner part of the thyroid cartilage*. (T3).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
*Thyroid cartilage is the firm tissue that separates the thyroid gland from the front of the larynx.
Stage grouping: T1 to T3, N1, M0
- The tumor may or may not have grown into structures just outside the larynx. It may or may 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. This lymph node is no larger than 3 cm* across. The cancer has not grown outside the lymph node (N1).
- The cancer has not spread to distant parts of the body (M0).
*3 cm = about 1¼ inches
Stage grouping: T4a, N0 or N1, M0
- The tumor is growing through the cricoid or thyroid cartilage and/or it 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, no larger than 3 cm* across, and has not grown outside the lymph node (N1).
- It has not spread to distant parts of the body (M0).
*3 cm = about 1¼ inches; *6 cm = about 2½ inches
Stage grouping: T1 to T4a, N2, M0
The tumor may or may not have grown into structures outside the larynx as far as moderately advanced disease. It may or may not have affected a vocal cord (T1 to T4a).
The cancer has spread to nearby lymph nodes in one of the following ways (N2):
- It has spread to a single lymph node on the same side of the neck as the tumor. The lymph node is 3 cm or smaller and the cancer has grown outside the lymph node, or
- It 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 no larger than 6 cm* across and the cancer has not grown outside the lymph node, or
- It has spread to more than one lymph node on the same side of the neck as the tumor. None of the lymph nodes are larger than 6 cm across and the cancer has not grown outside the lymph nodes, or
- It has spread to lymph nodes on the other side of the neck or both sides of the neck. None of these lymph nodes are larger than 6 cm across and the cancer has not grown outside the lymph nodes.
The cancer has not spread to distant parts of the body (M0).
Stage grouping: T4b, any N, M0
- The tumor is growing into the area in the neck in front of the spine (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).
Stage grouping: any T, N3, M0
The tumor may or may not have grown into structures outside the larynx. It may or may not have affected a vocal cord (any T).
The cancer has spread to nearby lymph nodes in one of the following ways (N3):
- It has spread to a lymph node larger than 6 cm* across but it has not grown outside the lymph node, or
- It 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 across and the cancer has grown outside the lymph node, or
- It has spread to more than one lymph node on any side of the neck and it has grown outside the lymph nodes, or
- It has spread to a single lymph node on the side of the neck opposite the tumor and it has grown outside the lymph node.
The cancer has not spread to distant parts of the body (M0).
*6 cm = about 2½ inches
- The tumor may or may not have grown into structures outside the larynx. It may or may not have affected a vocal cord (any T).
- The cancer might or might not have spread to nearby lymph nodes (any N).
- It has spread to distant parts of the body (M1).
Other staging categories you might see
- TX: The main tumor cannot be assessed due to lack of information.
- NX: Regional lymph nodes cannot be assessed due to lack of information.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Joint Committee on Cancer. Oropharynx (p16-) and Hypopharynx. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 123-135.
Last Revised: May 28, 2026
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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