22 - Types of Laryngeal Carcinoma - Differentiation

McQs in Otolaryngology and Head and Neck Surgery

21 - Carcinoma of Larynx - Staging

American Joint Committee on Cancer Sixth Edition Larynx Staging Scheme

Primary tumor (T)

• TX: Primary tumor cannot be assessed.
• T0: No evidence of primary tumor T is carcinoma in situ .

Supraglottis

• T1: Tumor is 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 (eg, mucosa of base of tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynx.
• T3: Tumor is 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 (eg, inner cortex).
• T4a: Tumor invades through the thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus).
• T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures.

Glottis

• T1: Tumor is limited to the vocal cord or cords (may involve anterior or posterior commissure) with normal mobility.
• T1a: Tumor is limited to one vocal cord.
• T1b: Tumor involves both vocal cords.
• T2: Tumor extends to the supraglottis and/or subglottis, and/or with impaired vocal cord mobility.
• T3: Tumor is limited to the larynx with vocal cord fixation and/or invades paraglottic space, and or minor thyroid cartilage erosion (eg, inner cortex).
• T4a: Tumor invades through the thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of the neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus).
• T4b: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures.

Subglottis

• T1: Tumor is limited to the subglottis.
• T2: Tumor extends to the vocal cord(s), with normal or impaired mobility.
• T3: Tumor is limited to the larynx with vocal cord fixation.
• T4a: Tumor invades the cricoid or thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of neck including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus).
• T4b: Tumor invades the prevertebral space, encases carotid artery, or invades mediastinal structures.

Regional lymph nodes (N)

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

Distant Metastasis (M)

• MX: Distant metastasis cannot be assessed.
• M0: No distant metastasis.
• M1: Distant metastasis.

Stage Grouping

Stage	Grouping
Stage 0	Tis	N0	M0
Stage I	T1	N0	M0
Stage II	T2	N0	M0
Stage III	T3	N0	M0
	T1	N1	M0
	T2	N1	M0
	T3	N1	M0
Stage IVA	T4a	N0	M0
	T4a	N1	M0
	T1	N2	M0
	T2	N2	M0
	T3	N2	M0
	T4a	N2	M0
Stage IV B	T4b	Any N	M0
	Any T	N3	M0
Stage IV C	Any T	Any N	M1

20 - Lymph nodes of the neck

Level I—the submental and submandibular nodes
Level Ia—the submental nodes; medial to the anterior belly of the digastric muscle bilaterally, symphysis of mandible superiorly, and hyoid inferiorly
Level Ib—the submandibular nodes and gland; posterior to the anterior belly of digastric, anterior to the posterior belly of digastric, and inferior to the body of the mandible

Level II—upper jugular chain nodes
Level IIa—jugulodigastric nodes; deep to sternocleidomastoid (SCM) muscle, anterior to the posterior border of the muscle, posterior to the posterior aspect of the posterior belly of digastric, superior to the level of the hyoid, inferior to spinal accessory nerve (CN XI)
Level IIb—submuscular recess; superior to spinal accessory nerve to the level of the skull base.

Level III—middle jugular chain nodes; inferior to the hyoid, superior to the level of the cricoid, deep to SCM muscle from posterior border of the muscle to the strap muscles medially.

Level IV—lower jugular chain nodes; inferior to the level of the cricoid, superior to the clavicle, deep to SCM muscle from posterior border of the muscle to the strap muscles medially.

Level V—posterior triangle nodes
Level Va—lateral to the posterior aspect of the SCM muscle, inferior and medial to splenius capitis and trapezius, superior to the spinal accessory nerve
Level Vb—lateral to the posterior aspect of SCM muscle, medial to trapezius, inferior to the spinal accessory nerve, superior to the clavicle

Level VI—anterior compartment nodes; inferior to the hyoid, superior to suprasternal notch, medial to the lateral extent of the strap muscles bilaterally.

Level VII—paratracheal nodes; inferior to the suprasternal notch in the upper mediastinum