Larynx and hypopharynx
Miscellaneous
TNM staging - larynx

Author: Nat Pernick, M.D. (see Authors page)

Revised: 27 March 2018, last major update December 2013

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Staging [title] larynx [title]

Cite this page: Pernick, N. TNM staging - larynx. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/larynxtnm.html. Accessed October 18th, 2018.

Pathologic TNM staging of larynx AJCC 7th edition
Definition / general
  • Excludes carcinomas of lateral or posterior pharyngeal wall, pyriform fossa, postcricoid area or base of tongue
  • Excludes nonepithelial tumors
  • Anatomical boundaries are described under normal anatomy / staging anatomy
Primary tumor (T)
  • TX: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • Tis: carcinoma in situ

  • Subsites (important for T categories):
    • Supraglottis: suprahyoid epiglottis, infrahyoid epiglottis, aryepiglottic folds (laryngeal aspect), arytenoids and false vocal cords
    • Glottis: true vocal cords, including anterior and posterior commissures
    • Subglottis: subglottis

    Supraglottis:
    • T1: tumor limited to one subsite of supraglottis with normal vocal cord mobility
    • T2: tumor invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis (e.g. mucosa of base of tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynx
    • T3: Tumor limited to larynx with vocal cord fixation or invades any of the following: postcricoid area, pre-epiglottic space, paraglottic space or inner cortex of thyroid cartilage erosion
    • T4a: moderately advanced local disease
      • Tumor invades thorough the thyroid cartilage or invades tissues beyond the larynx (e.g. trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid or esophagus)
    • T4b: very advanced local disease
      • Tumor invades prevertebral space, encases carotid artery or invades mediastinal structures

    Glottis:
    • T1: tumor limited to the vocal cord(s) (may involve anterior or posterior commissure) with normal mobility
    • T1a: tumor limited to one vocal cord
    • T1b: tumor involves both vocal cords
    • T2: tumor extends to supraglottis or subglottis, or with impaired vocal cord mobility
    • T3: tumor limited to the larynx with vocal cord fixation or invades paraglottic space, or inner cortex of the thyroid cartilage
    • T4a: moderately advanced local disease
      • Tumor invades thorough the outer cortex of the thyroid cartilage or invades tissues beyond the larynx (e.g. trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid or esophagus)
    • T4b: very advanced local disease
      • Tumor invades prevertebral space, encases carotid artery or invades mediastinal structures

    Subglottis:
    • T1: tumor limited to the subglottis
    • T2: tumor extends to vocal cord(s) with normal or impaired mobility
    • T3: tumor limited to larynx with vocal cord fixation
    • T4a: moderately advanced local disease
      • Tumor invades cricoid or thyroid cartilage or invades tissues beyond the larynx (e.g. trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid or esophagus)
    • T4b: very advanced local disease
      • Tumor invades prevertebral space, encases carotid artery or invades mediastinal structures
Regional lymph nodes (N)
  • Level I: submental, submandibular; contains the submental and submandibular triangles bounded by the anterior and posterior bellies of the digastric muscle, and by the hyoid bone inferiorly, and the body of the mandible superiorly
  • Level II: upper jugular; contains the upper jugular lymph nodes and extends from the level of the skull base superiorly to the hyoid bone inferiorly
  • Level III: mid jugular; contains the middle jugular lymph nodes from the hyoid bone superiorly to the level of the lower border of the cricoid cartilage inferiorly
  • Level IV: lower jugular; contains the lower jugular lymph nodes from the level of the cricoid cartilage superiorly to the clavicle inferiorly
  • Level V: posterior triangle; contains the lymph nodes in the posterior triangle bounded by the anterior border of the trapezius muscle posteriorly, the posterior border of the sternocleidomastoid muscle anteriorly, and the clavicle inferiorly; for description purposes, Level V may be further subdivided into upper, middle and lower levels corresponding to the superior and inferior planes that define Levels II, III and IV
  • Level VI: prelaryngeal, pretracheal and paratracheal; contains the lymph nodes of the anterior central compartment from the hyoid bone superiorly to the suprasternal notch inferiorly; on each side, the lateral boundary is formed by the medial border of the carotid sheath
  • Level VII: upper mediastinal; contains the lymph nodes inferior to the suprasternal notch in the superior mediastinum

  • NX: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
  • N2: metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
  • N2a: metastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension
  • N2b: metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
  • N2c: metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
  • N3: metastasis in a lymph node more than 6 cm in greatest dimension

    Notes:
    • Metastases at level VII are considered regional lymph node metastases
    • True vocal cords are nearly devoid of lymphatics, so nodal metastases are rare; supraglottis has rich and bilaterally interconnected lymphatic network
    • Midline nodes are considered ipsilateral nodes
Diagrams / tables

Images hosted on other servers:
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Levels of neck

Distant metastasis (M)
  • M0: no distant metastasis
  • M1: distant metastasis
Stage grouping
0:TisN0M0
I:T1N0M0
II:T2N0M0
III:T3N0M0orT1-T3N1M0
IVA:T4aN0-N1M0orT1-T4aN2M0
IVB:any TN3M0orT4bany NM0
IVC:any Tany NM1