Larynx

TNM 7 classification

TNM 6 classification

1. Rules for Classification

The classification applies only to carcinomas. There should be histological confirmation of the disease.

The following are the procedures for assessing T, N, and M categories:

T categories. Physical examination, laryngoscopy, and imaging
N categories. Physical examination and imaging
M categories. Physical examination and imaging

2. Anatomical Sites and Subsites

1. Supraglottis (C32.1)

2. Glottis (C32.0)

I. Vocal cords
II. Anterior commissure
III. Posterior commissure

3. Subglottis (C32.2)

3. Regional Lymph Nodes

The regional lymph nodes are the cervical nodes.

4. TNM Clinical Classification

4.1. T - Primary Tumour
TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
Tis. Carcinoma in situ

4.1.1. Supraglottis
T1. Tumour limited to one subsite of supraglottis with normal vocal cord mobility
T2. Tumour invades mucosa of more than one adjacent subsite of supraglottis or glottis or region outside the supraglottis (e.g., mucosa of base of tongue, vallecula, medial wall of piriform sinus) without fixation of the larynx
T3. Tumour limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space, and/or with minor thyroid cartilage erosion (e.g., inner cortex)
T4a. Tumour invades through the thyroid cartilage and/or invades tissues beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid, oesophagus
T4b. Tumour invades prevertebral space, mediastinal structures, or encases carotid artery

4.1.2. Glottis
T1. Tumour limited to vocal cord(s) (may involve anterior or posterior commissure) with normal mobility
T1a. Tumour limited to one vocal cord
T1b. Tumour involves both vocal cords
T2. Tumour extends to supraglottis and/or subglottis, and/or with impaired vocal cord mobility
T3. Tumour limited to larynx with vocal cord fixation and/or invades paraglottic space, and/or with minor thyroid cartilage erosion (e.g. inner cortex)
T4a. Tumour invades through the thyroid cartilage, or invades tissues beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid, oesophagus
T4b. Tumour invades prevertebral space, mediastinal structures, or encases carotid artery

4.1.3. Subglottis
T1. Tumour limited to subglottis
T2. Tumour extends to vocal cord(s) with normal or impaired mobility
T3. Tumour limited to larynx with vocal cord fixation
T4a. Tumour invades through cricoid or thyroid cartilage and/or invades tissues beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid, oesophagus
T4b. Tumour invades prevertebral space, mediastinal structures, or encases carotid artery

4.2. N - Regional Lymph Nodes

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

Note: Midline nodes are considered ipsilateral nodes.

4.3. M - Distant Metastasis

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

5. pTNM Pathological Classification

The pT, pN, and pM categories correspond to the T, N, and M categories.

pN0. Histological examination of a selective neck dissection specimen will ordinarily include 6 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 10 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0. When size is a criterion for pN classification, measurement is made of the metastasis, not of the entire lymph node.

6. G Histopathological Grading

GX. Grade of differentiation cannot be assessed
G1. Well differentiated
G2. Moderately differentiated
G3. Poorly differentiated
G4. Undifferentiated

7. Stage Grouping

Stage 0 Tis N0 M0 Stage I T1 N0 M0 Stage II T2 N0 M0 Stage III T1, T2 N1 M0 T3 N0, N1 M0 Stage IVA T1,T2,T3, N2 M0 T4a N0, N1, N2 M0 Stage IVB T4b Any N M0 Any T N3 M0 Stage IVC Any T Any N M1

8. Summary

Larynx Supraglottis T1 One subsite, normal mobility T2 Mucosa of more than one adjacent subsite of supraglottis or glottis or adjacent region outside the supraglottis; without fixation T3 Cord fixation or invades postcricoid area, pre-epiglottic tissues, paraglottic space, thyroid cartilage erosion T4a Through thyroid cartilage; trachea, soft tissues of neck: deep/extrinsic muscle of tongue, strap muscles, thyroid, oesophagus T4b Prevertebral space, mediastinal structures, carotid artery Glottis T1 Limited to vocal cord(s), normal mobility a. one cord b. both cords T2 Supraglottis, subglottis, impaired cord mobility T3 Cord fixation, paraglottic space, thyroid cartilage erosion T4a Through thyroid cartilage; trachea, soft tissues of neck: deep/extrinsic muscle of tongue, strap muscles, thyroid, oesophagus T4b Prevertebral space, mediastinal structures, carotid artery Subglottis T1 Limited to subglottis T2 Extends to vocal cord(s) with normal/ impaired mobility T3 Cord fixation T4a Through cricoid or thyroid cartilage; trachea, deep/extrinsic muscle of tongue, strap muscles, thyroid, oesophagus T4b Prevertebral space, mediastinal structures, carotid artery All Sites N1 Ipsilateral single ≤3 cm N2 (a) Ipsilateral single >3 to 6 cm (b) Ipsilateral multiple ≤6 cm (c) Bilateral, contralateral ≤6 cm N3 >6 cm