What staging tells us

The stage of a cancer explains how far it has grown and whether it has spread. It is important
because your doctor takes the stage into account when deciding which treatment is best for
you. The tests and scans you have to diagnose your cancer will help to stage it. But your doctor
may not be able to tell you the exact stage until you have surgery.
There are different ways of staging cancers. Doctors often divide cancer of the larynx into early
stage disease, locally advanced disease and advanced disease. The TNM system is used to
stage cancer of the larynx.

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TNM stages of cancer of the larynx

TNM stands for Tumour, Node, and Metastasis. The system describes
The size of a primary tumour (T)
Whether the lymph nodes have cancer cells in them (N)
Whether the cancer has spread to a different part of the body (M)

The exact T staging of laryngeal cancer varies depending on which part of the larynx is involved.
The cancer may start above the vocal cords (supraglottis), on the vocal cords (glottis) or below
the vocal cords (subglottis). Tumours of the subglottis are rare.
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Early stage laryngeal cancer (T0 T2)

T stage 0, Tis
In very early cancer of the larynx, doctors may use the term T stage 0. This means there are
abnormal cells that may be precancerous. Tis (tumour in situ) means an early cancer that has
not broken through the basement membrane of the tissue it is growing in.

T stage 1
This means the tumour is in only one part of the larynx and the vocal cords are able to move
normally.

T stage 2
This means the tumour which may have started on the vocal cords (glottis), above the vocal
cords (supraglottis), or below the vocal cords (subglottis) has grown into another part of the
larynx.
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Locally advanced laryngeal cancer (T3)

T stage 3 means the tumour is throughout the larynx but has not spread further than the
covering of the larynx. One of the vocal cords can't move. Your doctor may describe it as fixed.
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Locally advanced and advanced laryngeal cancer (T4a T4b)

T stage 4a and 4b
This means the tumour has grown into body tissues outside the larynx. It may have spread to
the thyroid gland, windpipe (trachea) or food pipe (oesophagus).
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N stages of laryngeal cancer

There are 4 main lymph node stages in cancer of the larynx. N2 is divided into N2a, N2b and
N2c. The important points here are whether there is cancer in any of the nodes and if so, the
size of the node and which side of the neck it is on.
N0 means there are no lymph nodes containing cancer cells
N1 means there are cancer cells in one lymph node on the same side of the neck as the

cancer, but the node is less than 3cm across

N2a means there is cancer in one lymph node on the same side of the neck and it is

between 3cm and 6cm across

N2b means there is cancer in more than one lymph node, but none are more than 6cm

across. All the nodes must be on the same side of the neck as the cancer
N2c means there is cancer in lymph nodes on the other side of the neck from the

tumour, or in nodes on both sides of the neck, but none is more than 6cm across
N3 means that at least one lymph node containing cancer is larger than 6cm across
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M stages of laryngeal cancer

There are two stages to describe whether cancer of the larynx has spread
M0 means there is no cancer spread
M1 means the cancer has spread to other parts of the body, such as the lungs

Together, the T, N and M stages give a complete description of the stage of your cancer. For
example, if you have a T2, N0, M0 cancer, you have a tumour affecting more than one area of
your larynx, but there is no sign of cancer cells in the lymph nodes and there is no spread of
your cancer to other parts of the body.
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The grade of your cancer

The grade of a cancer tells you how much the cancer cells look like normal cells under a
microscope. There are 3 grades of laryngeal cancer:
Grade 1 (low grade) the cancer cells look very much like normal larynx cells (they are

well differentiated)
Grade 2 (intermediate grade) the cancer cells look slightly like normal larynx cells (they

are moderately differentiated)

Grade 3 (high grade) the cancer cells look very abnormal and very little like normal
larynx cells (they are poorly differentiated)
Differentiation is how developed or mature a cell is. The grade of the cancer gives your
specialist an idea about how the cancer is likely to behave. Low grade cancers are usually
slower to grow and less likely to spread. High grade cancers are likely to be faster growing and

are more likely to spread. This is only a guide. Your specialist will consider all your test results
when deciding which treatment is best for you.