general information

 

 

 

 

Facts & Figures

Statistics

It is now widely estimated that there are well over 57,000 laryngectomees living in the United States - and the ratio of men to women is about 6 to 1. According to the latest figures available, the American Cancer Society estimates that in 2006 about 9,510 people in the United States will be found to have contracted laryngeal cancer and about 3,740 (old and new patients) will die of this disease. The vast majority will survive diagnosis and treatment, via radiation, chemotherapy, or surgery, to go on to lead productive and meaningful lives, many often returning to their same profession. (The American Cancer Society estimates a total of 1,399,000 new cancer cases during 2006, and about 77% of all cancers are diagnosed in people age of 55 and older ... so new larynx cancer cases represented only a very tiny percentage of these new cancer cases - about .0067% ... we are a small group.)

 

Stages of Cancers

The most common system used to describe the stages of cancers is the American Joint Committee on Cancer (AJCC) TNM system.

T stands for tumor (its size and how far it has spread within the larynx and hypopharynx and to nearby organs).


N stands for spread to lymph nodes (bean-sized collections of immune system cells that help fight infections and cancers).


M is for metastasis (spread to distant organs).


Using the TNM staging system, information about the tumor, lymph nodes, and metastasis is combined to assign a stage. This process is called stage grouping. The stage is described in Roman numerals from I to IV. Patients with lower stage cancers have a better prognosis for a cure or long-term survival.

 

T Stages

The T stage of cancers of the larynx and hypopharynx depends on how far it has spread to the surrounding tissues from its origin. Spread may be evaluated by indirect examinations using mirrors, by direct endoscopy using scopes, and, if your doctor can reach it, by feeling the texture of the area.

Watching movement of the vocal cords with special mirrors while the patient makes certain sounds can tell the doctors about the extent of local spread. If your vocal cords move normally, it is unlikely that the cancer has affected deeper tissues. Vocal cord fixation (lack of movement) suggests involvement by cancer. Imaging studies such as CT or MRI scans may be used to add more detailed information.

T staging of laryngeal and hypopharyngeal cancers describes spread of the cancer precisely in relation to specific areas of the larynx, hypopharynx, and the surrounding structures. These areas are shown in an illustration in the section, "What Are Laryngeal and Hypopharyngeal Cancers?" Higher T stage numbers indicate more spread within the larynx or hypopharynx and to other nearby areas in the neck.

The features used to assign the T stage of laryngeal cancer vary according to the area of the larynx involved -- supraglottis, glottis, or subglottis. T staging for hypopharyngeal cancer differs from T staging for cancer of the larynx.

You may want to talk to your doctor about the stage of your cancer. It will be important that the doctor illustrate it using a diagram of the larynx.

T Stages Common to All Laryngeal and Hypopharyngeal Cancers

TX: Cannot be staged (information not available)

T0: No evidence of tumor

Tis: Carcinoma in situ. The cancer cells are limited to the epithelium, and there is no growth into the connective tissue of the larynx or hypopharynx. (Very few hypopharyngeal and larynx cancers are found at this early stage.)

T Stages of Supraglottic Cancer

The T stage of cancer of the supraglottis is based on how many subsites (different parts of the larynx) are involved and how far outside the larynx the cancer has spread. The 5 subsites of the supraglottic part of the larynx are the ventricular bands (also called false vocal cords), arytenoids, suprahyoid epiglottis, infrahyoid epiglottis, and aryteno-epiglottic folds.

T1: The tumor is limited to 1 subsite of the supraglottis, and the vocal cords move normally.

T2: The tumor invades more than 1 subsite of the supraglottis; the vocal cords move normally.

T3: The tumor is limited to the larynx, and the vocal cords do not move and/or invasion of the postcricoid area, paraglottic space, or pre-epiglottic (in front of the epiglottis) tissues.

T4a: The tumor invades through thyroid cartilage (firm tissue that separates the thyroid gland from the front of the larynx) and/or extends to tissues beyond the larynx.

T4b: The tumor invades prevertebral (in front of the cervical spine) space, is growing around a carotid artery, or is growing down into the front of the chest cavity.

T Stages of Glottic Cancer

T1: The tumor is limited to the vocal cord(s); the vocal cords move normally.

T1a: The tumor is limited to 1 vocal cord.
T1b: The tumor is on both vocal cords.
T2: The tumor is growing into the supraglottis and/or subglottis, and/or the vocal cords move only a little.
T3: The tumor is limited to the larynx and the vocal cords don't move and/or the tumor invades the paraglottic space, and/or there is minor erosion of thyroid cartilage (firm tissue that separates the thyroid gland from the front of the larynx).

T4a: The tumor invades through thyroid cartilage and/or extends to tissues beyond the larynx.

T4b: The tumor invades prevertebral space (in front of the cervical spine), surrounds a carotid artery, or is growing down into the front of the chest cavity.

T Stages of Subglottic Cancer

T1: The tumor is limited to the subglottis.

T2: The tumor extends to the vocal cords, with normal or reduced vocal cord movement

T3: The tumor is limited to the larynx; the vocal cords donÂ’t move

T4a: The tumor invades through the cricoid or thyroid cartilage and/or extends to tissues beyond the larynx.

T4b: The tumor invades prevertebral space (in front of the cervical spine), surrounds a carotid artery, is growing down into the front of the chest cavity.

T Stages of Hypopharyngeal Cancer

Spread of cancer within the hypopharynx is described according to the size of the tumor and how many subsites (areas of the hypopharynx) are involved by the cancer. The 3 subsites of the hypopharynx are the pharyngo-esophageal junction, pyriform sinus, and posterior pharyngeal wall.

T1: The tumor is limited to 1 subsite of the hypopharynx and is smaller than 2 centimeters (cm) (about 3/4 of an inch) in diameter.

T2: The tumor involves more than 1 subsite of the hypopharynx or an adjacent site or is 2 to 4 cm in size, and doesn't affect the vocal cords.

T3: The tumor is larger than 4 cm in diameter or is affecting the vocal cords.

T4a: The tumor invades the cricoid or thyroid cartilage, hyoid bone, thyroid gland, esophagus, or the strap muscles in front of the larynx.

T4b: The tumor invades the space in front of the cervical spine, is growing around a carotid artery, or is growing down into the front of the chest cavity.

 

N (Regional Lymph Node) Stages of Laryngeal and Hypopharyngeal Cancers

The N staging is the same for laryngeal and hypopharyngeal cancers. The stages are as follows:

NX: The lymph nodes cannot be assessed (information not available).

N0: There is no evidence of spread to the lymph nodes.

N1: The cancer has spread to a single lymph node not larger than 3 cm (about 1? inch) in diameter. The lymph node is on the same side of the neck as the primary tumor.

N2a: There is spread in 1 lymph node between 3 cm and 6 cm, on the same side of the neck as the origin of the cancer.

N2b: There is spread in multiple lymph nodes, none larger than 6 cm, and all on the same side of the neck as the origin of the cancer.

N2c: There is spread to 1 or more lymph nodes on both sides of neck or on the side opposite the origin of the cancer. None can be larger than 6 cm.

N3: There is spread to 1 or more lymph nodes larger than 6 cm.

 

M (Distant Metastasis) Stages of Laryngeal and Hypopharyngeal Cancers

The M staging for all head and neck cancers, including laryngeal and hypopharyngeal cancers, is the same. The stages are as follows:

MX: Information not available. Unable to tell if distant metastasis is present.

M0: No distant metastasis.

M1: Distant metastasis present.

Stage Grouping

 

Once the T, N, and M stages have been assigned, this information is combined (called stage grouping) to assign an overall stage of 0, I, II, III, or IV. Stage grouping rules are the same for all cancers of the hypopharynx and the supraglottic, glottic, and subglottic areas of the larynx.

Stage 0: Tis, N0, M0

Stage I: T1, N0, M0

Stage II: T2, N0, M0

Stage III: T1,2 or 3, N1, M0 or T3, N0, M0

Stage IVA: T1, 2 or 3, N2, M0, or
T4a, N0, 1 or 2, M0

Stage IVB: T4b, Any N, M0, or
Any T, N3, M0

Stage IVC: Any T, Any N, M1

These Stages are listed from the American Cancer Society Website - Sep 2007

 

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