Stages of Laryngeal Cancer

Once laryngeal cancer (cancer of the voice box) has been diagnosed, the first question doctors seek to answer is how far the disease has spread. The answer is expressed as the “stage”. Staging is the most important basis for planning treatment and for judging what can be expected from it.

Why is staging done?

The stage is a shared language that summarises the size of the tumour, its position within the larynx, and whether it has spread to the lymph nodes in the neck or to distant organs. Because diseases at the same stage behave in a similar way, doctors base their treatment decisions on this classification. The stage also makes it easier for doctors from different specialties (surgeon, radiation oncologist, medical oncologist) to draw up a shared plan for you.

How is staging done?

The system in widespread use around the world is the TNM system, summarised in letters:

• T (tumour): describes the size of the tumour, which parts of the larynx it has spread to, and whether it affects the movement of the vocal cords.
• N (lymph node): shows whether there is spread to the lymph nodes in the neck and, if so, their number and size.
• M (metastasis): indicates whether the disease has spread to distant organs such as the lungs, liver or bones.

This information is brought together to classify the disease from stage I to stage IV. The endoscopic examination, biopsy and imaging results are used together in the assessment.

Stage I and stage II: early stage

The tumour is confined to a single part of the larynx or extends slightly into a neighbouring area; the vocal cords move normally or their movement is only partly reduced. There is no spread to the lymph nodes. At these stages a single treatment method (limited surgery or radiotherapy) is usually sufficient, and the chance of preserving the voice is high.

Stage III: locally advanced stage

The tumour has grown, has stopped the movement of one of the vocal cords, or has advanced into the neighbouring tissues of the larynx. There may be spread to a single small lymph node in the neck. At this stage more than one treatment method is usually planned together; approaches that preserve the larynx can still be considered.

Stage IV: advanced stage

The tumour may have passed through the laryngeal cartilage and reached the soft tissues of the neck or neighbouring organs; there may be marked spread to the lymph nodes or involvement of distant organs. This stage is divided into subgroups, and not every subgroup means the same thing. Treatment usually requires a comprehensive plan in which surgery, radiotherapy and chemotherapy are used together.

How does the stage affect treatment?

• In the early stages, the aim is to treat the disease with the least loss of tissue and with the voice preserved.
• In the advanced stages, the priority is bringing the disease under control; even so, options aimed at preserving speech, swallowing and breathing are always considered.
• Whatever the stage, the treatment plan is drawn up for you personally, taking your age, general health and preferences into account.

What you should know about the stage

The stage is not a “verdict” but a map used in planning treatment. The course of the disease can differ from person to person even among patients at the same stage. Talking openly with your doctor about your stage and what it means for your treatment helps you to make more informed decisions at every step of the process.