The Voice Foundation

This staging system only applies to squamous cell carcinoma of the larynx, the most common type of laryngeal cancer.

• The first letter, “T”, stands for the tumor itself and describes the size and extent of the original tumor (primary tumor).
• While tumors in other sites of the head and neck are mainly described using the T for different sizes of tumors, for laryngeal cancers, the T stands for which region and how many regions of the larynx are affected by cancer growth.

• Involve only one site on the larynx
• Have not spread to other sites on the larynx
• Have not resulted in any change in vocal fold movement
• No lymph nodes with cancer or metastatic spread of tumors

• Involve more than one location or site on the larynx, such as presence in a single vocal fold with spreading upward above the voice box (supraglottis) or downward below the voice box (subglottis)
• T2 can also mean that the vocal fold is not moving normally, although it should not be completely immobile for a T2 tumor

• T3 Glottic tumors cause complete non-movement of one of the vocal folds; non-movement is caused by:
  • tumor invasion of the main vocal fold muscle (thyroarytenoid muscle)
  • tumor invasion of voice box joints, preventing that vocal fold from moving
• T3 Supraglottic tumors are confined to the supraglottis but have spread to one of two critical sites:
  • region in front of the epiglottis in a fat-filled space (“pre-epiglottic space”)
  • region behind the larynx at the entrance to the food pipe (esophagus) called the “Post-Cricoid” Space

NOTE: If the tumor spreads to one of these two sites, even if the vocal fold(s) is not paralyzed, the tumor is classified as a T3.

Advanced laryngeal cancer has a high likelihood of spread to lymph nodes in the head and can also spread (metastasize) to distant sites in the body such as the lungs (although this is not common).

These features have prompted the classification of laryngeal cancers as to:

The letter “N” stands for the lymph node(s) in the neck. Lymph nodes are nodules of specialized tissues that are part of the body’s system to monitor and/or “clean up” the body. N-staging describes whether any tumor has spread to these lymph nodes directly from the tumor through lymphatic channels.

There are four “N” levels, from N0 to N3.

“M” stands for metastasis of the larynx tumor, which means spread of cancer cells from the tumor to other parts of the body outside of the head and neck.

After the TNM description is made, different combinations are grouped together as stages. The four stages of larynx cancer used in the management of patients with larynx cancer are presented below.

(For more information, see Laryngeal Atypia and Early Cancer.)

Advanced Laryngeal Cancer

There are several types of cancers of the larynx. These cancers are typed based on the cells comprising the cancer.

Squamous cells are cells that form the lining of the mouth, throat, and voice box (larynx), as well as skin. When squamous cells lose their growth control and regulation, they may grow uncontrollably and start invading their surroundings – thus becoming cancerous.Approximately 95% of all laryngeal cancer is squamous cell carcinoma/cancer.

This type of cancer is thought to arise from chronic irritation and the resulting genetic changes in the cell. Chronic irritation can come from the following:

Note: Alcohol may contribute to the development of laryngeal cancer by reducing the function of the immune system and/or by reducing the nutritional status of individuals who use heavy amounts of alcohol on a regular basis. In addition, desiccation (excessive drying) of tissues chronically exposed to alcohol may increase the risk of cancer.

A less common type of cancer in the larynx is called verrucous carcinoma (named because of its warty appearance). Verrucous carcinoma can occur elsewhere in the head and neck, including the mouth. In the larynx, this cancer is:

As such, often this type of cancer can be treated by surgical removal of the tumor (surgical excision).

Note: The association of verrucous carcinoma with cigarette smoking and alcohol use is much less well established than squamous cell carcinoma (although invasive squamous cell carcinoma can sometimes be found within a verrucous cancer, a condition called a “hybrid” tumor).

Another uncommon type of cancer in the larynx originates in the salivary gland. Many small salivary glands provide mucous, lubrication, and other secretions to aid in speaking, swallowing, and breathing in the larynx. Chronic irritation, exposure to tobacco and alcohol, and other causes may lead to salivary gland carcinoma in the larynx.

 Red Flag

Another rare type of cancer than can occur in the larynx is cancer of the cartilages in the voice box framework, e.g., chondrosarcoma of the thyroid cartilage. (For more information, see Anatomy & Physiology of Voice Production.)

Other tumor types can occur in the larynx – although rarely. These include spindle cell carcinoma, lymphoepithelioma, undifferentiated cancers, neuroendocrine carcinoma, neurofibrosarcoma, and cancers of the lymphoid tissues called lymphoma (usually non-Hodgkin’s lymphoma).

Increased amount and duration of smoking – cigarettes, cigars, and pipe smoking – directly increase risk for laryngeal cancer.

Heavy alcohol use, usually described as three or more alcoholic drinks, beers, or glasses of wine per day, increases laryngeal cancer risk.

  Red Flag