Stages of Laryngeal Cancer

After laryngeal cancer has been diagnosed, tests are done to find out if cancer cells have spread within the larynx or to other parts of the body.

The process used to find out if cancer has spread within the larynx or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage of the disease in order to plan treatment. The results of some of the tests used to diagnose laryngeal cancer are often also used to stage the disease.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if laryngeal cancer spreads to the lung, the cancer cells in the lung are actually laryngeal cancer cells. The disease is metastatic laryngeal cancer, not lung cancer.

The following stages are used for laryngeal cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the larynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in the supraglottis, glottis, or subglottis area of the larynx:

• Supraglottis: Cancer is in one area of the supraglottis and the vocal cords work normally.
• Glottis: Cancer is in one or both vocal cords and the vocal cords work normally.
• Subglottis: Cancer is in the subglottis only.

Stage II

In stage II, cancer has formed in the supraglottis, glottis, or subglottis area of the larynx:

• Supraglottis: Cancer is in more than one area of the supraglottis or has spread to the area at the base of the tongue or to tissues near the vocal cords. The vocal cords work normally.
• Glottis: Cancer has spread to the supraglottis, subglottis, or both, and/or the vocal cords do not work normally.
• Subglottis: Cancer has spread to one or both vocal cords and the vocal cords may not work normally.

Stage III

In stage III, cancer has formed in the supraglottis, glottis, or subglottis area of the larynx:

In stage III cancer of the supraglottis:

• cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in one area of the supraglottis and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in more than one area of the supraglottis or has spread to the area at the base of the tongue or to tissues near the vocal cords. The vocal cords work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.

In stage III cancer of the glottis:

• cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in one or both vocal cords and the vocal cords work normally. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer has spread to the supraglottis, subglottis, or both, and/or the vocal cords do not work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.

In stage III cancer of the subglottis:

• cancer is in the larynx only and the vocal cords do not work, and/or cancer has spread near or through the inner part of the thyroid cartilage. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer is in the subglottis only. Cancer has spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
• cancer has spread to one or both vocal cords and the vocal cords may not work normally. Cancer has also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller.

Stage IV

Stage IV is divided into stage IVA, stage IVB, and stage IVC. Each substage is the same for cancer in the supraglottis, glottis, or subglottis.

• In stage IVA:
  • Cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Cancer may have also spread to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller; or
  • Cancer may have spread from the supraglottis, glottis, or subglottis to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. The vocal cords may not work normally. Cancer has spread:
    • to one lymph node on the same side of the neck as the primary tumor and the lymph node is 3 centimeters or smaller. Cancer has spread through the outside covering of the lymph node; or
    • to one lymph node on the same side of the neck as the primary tumor and the lymph node is larger than 3 centimeters but not larger than 6 centimeters. Cancer has not spread through the outside covering of the lymph node; or
    • to more than one lymph node on the same side of the neck as the primary tumor and the lymph nodes are not larger than 6 centimeters. Cancer has not spread through the outside covering of the lymph nodes; or
    • to lymph nodes on both sides of the neck or on the side of the neck opposite the primary tumor and the lymph nodes are not larger than 6 centimeters. Cancer has not spread through the outside covering of the lymph nodes.

• In stage IVB:
  • Cancer may have spread from the supraglottis, glottis, or subglottis to the space in front of the spine, the area around the carotid artery, or the area between the lungs. The vocal cords may not work normally. Cancer has spread:
    • to one lymph node that is larger than 6 centimeters. Cancer has not spread through the outside covering of the lymph node; or
    • to one lymph node on the same side of the neck as the primary tumor and the lymph node is larger than 3 centimeters. Cancer has spread through the outside covering of the lymph node; or
    • to more than one lymph node anywhere in the neck. Cancer has spread through the outside covering of the lymph nodes; or
    • to one lymph node of any size on the side of the neck opposite the primary tumor. Cancer has spread through the outside covering of the lymph node;

    or

  • Cancer has spread from the supraglottis, glottis, or subglottis to the space in front of the spine, the area around the carotid artery, or the area between the lungs. Cancer may have also spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size.
• In stage IVC, cancer has spread to other parts of the body, such as the lungs, liver, or bone.

After surgery, the stage of the cancer may change and more treatment may be needed.

If the cancer is removed by surgery, a pathologist will examine a sample of the cancer tissue under a microscope. Sometimes, the pathologist’s review will result in a change to the stage of the cancer and more treatment after surgery.

Laryngeal cancer can recur (come back) after it has been treated.

The cancer may come back in the larynx or in other parts of the body, such as lungs, liver, or bone. It is most likely to come back in the first 2 to 3 years.