Detection and Diagnosis

If your doctor suspects you may have larynx or hypopharynx cancer, you will undergo a complete medical history and physical exam, including a careful examination of your mouth, head, and neck.

Your larynx and hypopharynx are situated deep inside your neck but are easy to check. Your doctor will conduct the examination, a laryngoscopy, using mirrors and a special fiber-optic scope. This thin, flexible, lighted tube will go down your mouth or nose and extended to your throat. If you have a lump in your neck, your doctor may subsequently perform a fine needle aspiration (FNA) biopsy in the office to help establish a diagnosis. One or more imaging studies may also be ordered, including a CT scan, MRI, or PET-CT scan.

Staging

Staging defines a tumor's size and spread. Staging enables your doctor to determine your treatment plan.

T Stages of Supraglottic Cancer

For cancer of the supraglottis — the area above the vocal cords — "T" stages are based on how many different parts (or sites) of the larynx are involved and how far outside the larynx the tumor has spread.

The five subsites of the supraglottis are the:

  • Aryepiglottic folds
  • Arytenoids
  • False vocal cords (ventricular bands)
  • Infrahyoid epiglottis
  • Suprahyoid epiglottis

Whether or not the vocal cords move normally is also considered. When the vocal cords do not move normally, it often means that the cancer is growing into them. This is a more advanced T stage.

The T-stages of supraglottic cancer are:

T1: The vocal cords move normally and the tumor is only growing in one subsite of the supraglottis.

T2: The tumor is growing into at least two subsites of the supraglottis or glottis, and the vocal cords still move normally.

T3: Either:

  1. The tumor is growing only in the larynx and has caused the vocal cords to stop moving.
  2. The tumor is growing into the postcricoid area, paraglottic space, or pre-epiglottic (in front of the epiglottis) tissues.
  3. Both #1 and #2 are true.

T4a: The tumor is growing through thyroid cartilage (firm tissue that separates the thyroid gland from the front of the larynx) and/or is growing into tissues beyond the larynx, such as the thyroid gland, trachea, esophagus, tongue muscles, or neck muscles. This is known as moderately advanced local disease.

T4b: The tumor is growing into the tissue in front of the spine in the neck (the prevertebral space), is growing around a carotid artery, or is growing down into the front of the chest cavity. T4b tumors are known as very advanced local disease.

T stages of glottic cancer

The T stages of glottis cancer are:

T1: The tumor is growing only in the vocal cord(s); the vocal cords move normally.

T1a: The tumor is only growing in one 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 growing only in the larynx and the vocal cords don't move, and/or

  • The tumor is growing into the paraglottic space, and/or
  • The tumor has started growing into the thyroid cartilage (firm tissue that separates the thyroid gland from the front of the larynx)

T4a: The tumor has grown through the thyroid cartilage and/or is growing into tissues beyond the larynx, such as the thyroid gland, trachea, esophagus, tongue muscles, or neck muscles. This is known as moderately advanced local disease.

T4b: The tumor is growing into the tissue in front of the spine in the neck (the prevertebral space), surrounds a carotid artery, or is growing down into the front of the chest cavity. T4b tumors are known as very advanced local disease.

T stages of subglottic cancer

The T stages of subglottic cancer are:

T1: The tumor is only growing in the subglottis.

T2: The tumor has grown from the subglottis to the vocal cords, with normal or reduced vocal cord movement.

T3: The tumor is growing only in the larynx, and the vocal cords don't move.

T4a: The tumor is growing through the cricoid or thyroid cartilage and/or is growing into tissues beyond the larynx, such as the thyroid gland, trachea, esophagus, tongue muscles, or neck muscles. This is known as moderately advanced local disease.

T4b: The tumor is growing into the tissue in front of the spine in the neck (the prevertebral space), surrounds a carotid artery, and is growing down into the front of the chest cavity. T4b tumors are known as very advanced local disease.

N (regional lymph node) stages of laryngeal and hypopharyngeal cancers

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 on the same side of the neck as the tumor. The lymph node is no more than 3 cm (about 1¼ inch) across.

N2a: The cancer has spread to a single lymph node on the same side of the neck as the tumor. The lymph node is between 3 cm and 6 cm across.

N2b: The cancer has spread to two or more lymph nodes on the same side of the neck as the tumor. None of these lymph nodes is more than 6 cm across.

N2c: The cancer has spread to lymph nodes on both sides of neck or on the side opposite the tumor. None of these lymph nodes is more than 6 cm across.

N3: The cancer has spread to at least one lymph node that is more than 6 cm across.

M (distant metastasis) stages of laryngeal and hypopharyngeal cancers

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 the cancer has spread to distant sites.

M0: The cancer has not spread to distant sites.

M1: The cancer has spread to distant sites.

Stage grouping

Once the T, N, and M stages have been assigned, this information is combined to assign an overall stage for the cancer. This process is called stage grouping. Stage grouping rules are the same for all cancers of the hypopharynx, as well as 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: T3, N0, M0, or T1 to T3, N1, M0
Stage IVA: T4a, N0 or N1, M0, or T1 to T4a, N2, M0
Stage IVB: T4b, Any N, M0, or Any T, N3, M0
Stage IVC: Any T, Any N, M1

 


Contact Us

Ear, Nose and Throat/Head and Neck Services
5 East 98th Street
New York, NY 10029
Tel: 212-241-9410