Key Points for This Section

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. There are three ways that cancer spreads in the body. The following stages are used for laryngeal cancer: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV

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 ¹ used to diagnose laryngeal cancer are often also used to stage the disease.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone 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. Stage I laryngeal cancer depends on where cancer is found in the larynx:

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

Stage II

In stage II, cancer is in the larynx only. Stage II laryngeal cancer depends on where cancer is found in the larynx:

• Supraglottis: Cancer is in more than one area of the supraglottis or surrounding tissues.
• Glottis: Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords do not move normally.
• Subglottis: Cancer has spread to one or both vocal cords, which may not move normally.

Enlarge

Pea, peanut, walnut, and lime show tumor sizes.

Stage III

Stage III laryngeal cancer depends on whether cancer has spread from the supraglottis, glottis, or subglottis.

In stage III cancer of the supraglottis:

• cancer is in the larynx only and the vocal cords do not move normally, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
• cancer is in one area of the supraglottis only and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and the vocal cords can move normally; or
• cancer is in more than one area of the supraglottis or surrounding tissues and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and/or the vocal cords do not move normally.

In stage III cancer of the glottis:

• cancer is in the larynx only and the vocal cords do not move normally, and/or cancer is in tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
• cancer is in one or both vocal cords and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters and the vocal cords can move normally; or
• cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords do not move normally. The cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters.

In stage III cancer of the subglottis:

• cancer is in the larynx only and the vocal cords do not move normally; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or
• cancer is in the subglottis only and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or
• cancer has spread to one or both vocal cords, which may not move normally, and to one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters.

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, and may have spread to one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or
  • cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Vocal cords may not move normally.
• In stage IVB:
  • cancer has spread to the space in front of the spinal column and surrounds the carotid artery, or has spread to parts of the chest and may have spread to one or more lymph nodes anywhere in the neck (the lymph nodes may be any size); or
  • cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery or to parts of the chest. Vocal cords may not move normally.
• In stage IVC, cancer has spread beyond the larynx to other parts of the body.

Glossary Terms

Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.

A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.

A tough, flexible tissue that lines joints and gives structure to the nose, ears, larynx, and other parts of the body.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.

The process of identifying a disease, such as cancer, from its signs and symptoms.

The muscular tube through which food passes from the throat to the stomach.

The middle part of the larynx; the area where the vocal cords are located.

Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.

Cancer that forms in tissues of the larynx (area of the throat that contains the vocal cords and is used for breathing, swallowing, and talking). Most laryngeal cancers are squamous cell carcinomas (cancer that begins in flat cells lining the larynx).

The area of the throat containing the vocal cords and used for breathing, swallowing, and talking. Also called voice box.

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.

The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).

The original tumor.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Abnormal cells are found in the lining of the larynx. These abnormal cells may become cancer and spread into nearby normal tissue.

Cancer is found only in the area where it started. Stage I laryngeal cancer depends on where cancer is found in the larynx. If it started in the supraglottis, then cancer is in one area of the supraglottis only and the vocal cords can move normally. If it started in the glottis, then cancer is in one or both vocal cords and the vocal cords can move normally. If it started in the subglottis, then cancer is in the subglottis only.

Cancer that is found in the larynx. The exact definition of stage II depends on where the cancer started. If it started in the supraglottis, then cancer is in more than one area of the supraglottis or glottis or region near the supraglottis. If it started in the glottis, then cancer has spread to the supraglottis and/or the subglottis, and/or the vocal cords do not move normally. If it started in the subglottis, then cancer has spread to the vocal cords, which may not move normally.

In stage III laryngeal cancer, one of the following is found: (1) cancer is in the larynx only and the vocal cords do not move normally; cancer may have spread to tissues next to the larynx; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or (2) cancer is in one area of the larynx, the vocal cords move normally, and cancer is found in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters; or (3) cancer is in more than one area of the larynx or in the vocal cords (which may not move normally) and in one lymph node on the same side of the neck as the original tumor; the lymph node is smaller than 3 centimeters.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, one of the following is true: (1) 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 spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or (2) cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Vocal cords may not move normally. In stage IVB, one of the following is true: (1) cancer has spread to the space in front of the spinal column and surrounds the carotid artery, or has spread to parts of the chest and may have spread to one or more lymph nodes anywhere in the neck (the lymph nodes may be any size); or (2) cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest. Vocal cords may not move normally. In stage IVC, cancer has spread beyond the larynx to distant parts of the body.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, one of the following is found: (1) 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 spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or (2) cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Vocal cords may not move normally.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVB, one of the following is found: (1) cancer has spread to the space in front of the spinal column and surrounds the carotid artery, or has spread to parts of the chest and may have spread to one or more lymph nodes anywhere in the neck (the lymph nodes may be any size); or (2) cancer has spread to a lymph node that is larger than 6 centimeters and may have spread as far as the space in front of the spinal column, around the carotid artery, or to parts of the chest. Vocal cords may not move normally.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVC, cancer has spread beyond the larynx to distant parts of the body.

Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

The lowest part of the larynx; the area from just below the vocal cords down to the top of the trachea.

The upper part of the larynx (voice box), including the epiglottis; the area above the vocal cords.

A gland located beneath the voice box (larynx) that makes thyroid hormone and calcitonin. The thyroid helps regulate growth and metabolism.

A group or layer of cells that work together to perform a specific function.

The airway that leads from the larynx (voice box) to the bronchi (large airways that lead to the lungs). Also called windpipe.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

A blood vessel that carries blood to the heart from tissues and organs in the body.

One of two small bands of muscle within the larynx that vibrates to produce the voice.