Understanding the Stages of Laryngeal Cancer

Click to Enlarge: How cancer spreads from carcinoma in situ to metastatic cancer.

After your diagnosis, your doctor will want to find out the stage of the cancer. The stage is based on these facts about the cancer:

• Size of the tumor

• Number of lymph nodes involved

• Whether the cancer has spread to distant organs, such as the lungs, liver, or bones

The TNM system

A standard system to describe the extent of a cancer's growth has been developed by both the International Union Against Cancer and the American Joint Committee on Cancer. This system is known as the TNM system.

Here is what each letter means in the TNM system:

• The T refers to the characteristics of the primary tumor in the larynx, such as its size and whether it has invaded nearby structures.

• The N indicates whether the surrounding lymph nodes in the area of the primary tumor have become cancerous.

• The M indicates whether the cancer has spread (metastasized) to other organs in the body, such as the lungs, liver, or bones.

Stage groupings

Once your doctor determines your T, N, and M stages, he or she will put these together in what is called stage grouping. Stage grouping is used to determine your overall disease stage. It is expressed in Roman numerals from I (the earliest stage) to IV (the most advanced stage). These are the stages of laryngeal cancer:

Stage I. At this stage, the cancer has not spread to the lymph nodes or other parts of the body. The exact definition of stage I depends on where the cancer started. It can start in any of these parts of the larynx:

• Supraglottis. The cancer is only in one area of the supraglottis (area above the vocal cords), and the vocal cords move normally.

• Glottis. The cancer is in only one area of the vocal cords, and the vocal cords move normally.

• Subglottis. The cancer has not spread out of the subglottis, which is the area where the larynx connects to the trachea, or windpipe.

Stage II. At this stage, the cancer is only in the larynx and has not spread to the lymph nodes or other parts of the body. The exact definition of stage II depends on where the cancer started and its effects on the area:

• Supraglottis. The cancer is in more than one area above the vocal cords (supraglottis), but they can move normally.

• Glottis. The cancer has spread to the supraglottis, or the subglottis, or both. The vocal cords may or may not be able to move normally.

• Subglottis. The cancer has spread to the vocal cords, which may or may not be able to move normally.

Stage III. At this stage, one of these two things may have happened:

• The vocal cords cannot move normally, but the cancer has not spread outside of the larynx. Or the cancer has spread to an area next to the larynx.

• The cancer has spread to one lymph node on the same side of the neck as the cancer, but the lymph node is no bigger than 3 centimeters (just more than 1 inch).

Stage IV. At this stage, any of these things may have happened:

• The cancer has spread to tissues around the larynx. The lymph nodes may or may not contain cancer.

• The cancer has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (more than 2 inches).

• The cancer has spread to other parts of the body.

Recurrent disease means that the cancer has come back after treatment. This sometimes happens when cancer cells remain in the area after treatment. It can also happen when the disease has already spread before treatment begins, but is too small to be noticed at that time and isn't treated as aggressively. The cancer can also come back, or you can develop a new cancer, if you continue to smoke and drink alcohol. The cancer may come back in the larynx or in another part of the body.