Radiation Oncology/Head & Neck/Larynx/Staging

Laryngeal Cancer Staging __TOC__ AJCC 8th Edition AJCC 8th Edition (2017): To be used for staging beginning Jan 1, 2018. T-Stage unchanged from 7th edition N-Stage Overall stage unchanged from 7th edition AJCC 7th Edition AJCC 7th Edition (2009) Tumor Stage Supraglottis Anatomy: the inferior boundary of the supraglottis is a horizontal plane passing through the lateral margin of the ventricle at its junction with the superior surface of the vocal cord. Subsites: False cords, arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, aryepiglotic folds 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, or medial wall of pyriform sinus) without fixation of the larynx T3: Tumor limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space, and/or minor thyroid cartilage erosion (e.g., inner cortex) T4a: Tumor invades through the thyroid cartilage, and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of the neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus) Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures Glottis Anatomy: The glottis is composed of the superior and inferior surfaces of the true vocal cords, including the anterior and posterior commissures. It occupies a horizontal plane 1 cm in thickness, extending inferiorly from the lateral margin of the ventricle. T1: Tumor limited to the vocal cord(s), which 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 and/or subglottis and/or with impaired vocal cord mobility T3: Tumor limited to the larynx with vocal cord fixation and/or invades paraglottic space, and/or minor thyroid cartilage erosion (e.g., inner cortex) T4a: Tumor invades through the thyroid cartilage and/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) Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures Subglottis Anatomy: The subglottis is the region extending from the lower boundary of the glottis to the lower margin of the cricoid cartilage. 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: Tumor invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck, including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus) Note: extrinsic muscles of the tongue are: genioglossus, hyoglossus, styloglossus, and palatoglossus T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures Lymph Node Stage Metastasis Stage MX: Distant metastasis cannot be assessed M0: No distant metastasis M1: Distant metastasis AJCC Overall Stage I - T1 N0 II - T2 N0 III - T3 N0, T1-3 N1 IVA - T4a N0-2, T1-4a N2 IVB - T4b any N, any T N3 IVC - M1 Older staging systems AJCC 6th edition (2002) no changes compared to 7th edition new since 5th edition: subdivided T4 into T4a and T4b AJCC 5th edition (1997) For all subsites, T4 is a single grouping, not divided into T4a and T4b Supraglottis: Unchanged compared to current edition (7th), except for T4 as noted above Glottis: Unchanged compared to current edition (7th), except for T4 as noted above Subglottis: Unchanged compared to current edition (7th), except for T4 as noted above AJCC 3rd edition (1988) Supraglottis: no changes compared to 7th edition Glottis: T1 - no changes compared to current edition (7th) T2 - no changes compared to current edition (7th) T3 - tumor limited to larynx with vocal cord fixation (does not mention paraglottic space invasion or minor thyroid cartilage erosion) Subglottis: no changes compared to 7th edition AJCC 2nd edition (1983) Glottis: T2a - normal mobility T2b - decreased mobility