Stages

If laryngeal cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The Spreading of Cancer

There are three ways that cancer spreads in the body:

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 tumor and travel through the lymph or blood to other places in the body, another, or secondary tumor, may form. This process is called metastasis. The secondary, or metastatic, tumor is the same type of cancer as the primary tumor. For example, if laryngeal cancer spreads to the bones, the cancer cells in the bones are actually laryngeal cancer cells. The disease is metastatic laryngeal cancer, not bone cancer.

Stages of Laryngeal Cancer

Following are the stages 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 and depends on where the cancer began 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 and depends on where the cancer began 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 cannot move normally.
Subglottis - Cancer has spread to one or both vocal cords, which may not move normally.


Stage III - Stage III 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 cannot move 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 three centimeters or smaller.
Or
Cancer is in one area of the supraglottis and in one lymph node on the same side of the neck as the original tumor. The lymph node is three centimeters or smaller 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 three centimeters or smaller.

In stage III cancer of the glottis, cancer is in the larynx only and the vocal cords cannot move, 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 three centimeters or smaller.
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 three centimeters or smaller and the vocal cords can move normally.
Or
Cancer has spread to the supraglottis and/or the subglottis and/or the vocal cords cannot move normally. Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is three centimeters or smaller.

In stage III cancer of the subglottis, cancer is in the larynx and the vocal cords cannot move. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is three centimeters or smaller.
Or
Cancer is in the subglottis and in one lymph node on the same side of the neck as the original tumor. The lymph node is three centimeters or smaller.
Or
Cancer has spread to one or both vocal cords, which may not move normally. Cancer has also spread to one lymph node on the same side of the neck as the original tumor and the lymph node is three centimeters or smaller.

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. Cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is 3 centimeters or smaller.
Or
Cancer has spread to one lymph node on the same side of the neck as the original tumor and the lymph node is larger than three centimeters but not larger than six centimeters or has spread to more than one lymph node anywhere in the neck with none larger than six centimeters. Cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. The vocal cords may not move normally.

In stage IVB - Cancer has spread to the space in front of the spinal column, surrounds the carotid artery, or has spread to parts of the chest. Cancer may have spread to one or more lymph nodes anywhere in the neck and the lymph nodes may be any size.
Or
Cancer has spread to a lymph node that is larger than six 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. The vocal cords may not move normally.

Stage IVC - Cancer has spread to other parts of the body such as the lungs, liver or bone.

Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required. Generally, treatment for the different stages are as follows:

Stage I - Treatment of stage I depends on where cancer is found in the larynx:

If found in the supraglottis, treatment may include radiation therapy or supraglottic laryngectomy.

If found in the glottis, treatment may include radiation therapy, a cordectomy, a partial or total laryngectomy, a hemilaryngectomy or laser surgery.

If found in the subglottis, treatment may include radiation therapy with or without surgery or surgery alone.

Stage II - Treatment of stage I depends on where cancer is found in the larynx:

If found in the supraglottis, treatment may include radiation therapy, supraglottic laryngectomy or total laryngectomy with or without radiation therapy. It may also include clinical trials in radiation therapy or chemoprevention.

If found in the glottis, treatment may include radiation therapy, a partial or total laryngectomy, a hemilaryngectomy or laser surgery. It may also include clinical trials in radiation therapy or chemoprevention.

If found in the subglottis, treatment may include radiation therapy with or without surgery, surgery alone, or clinical trials in radiation therapy or chemoprevention.

Stage III - Treatment of stage I depends on where cancer is found in the larynx:

If found in the supraglottis or glottis, treatment may include surgery with or without radiation therapy or radiation therapy with or without surgery. It may also include clinical trials for chemotherapy, radiation therapy, radiosensitizers or chemoprevention.

If found in the subglottis, treatment may include a laryngectomy, plus total thyroidectomy and removal of lymph nodes in the throat (usually followed by radiation therapy) or clinical trials for chemotherapy, radiation therapy, radiosensitizers or chemoprevention.

Stage IV - Treatment of stage IV depends on where cancer is found in the larynx:
 
If found in the supraglottis or glottis, treatment may include a total laryngectomy with radiation therapy, radiation therapy with or without surgery or clinical trials for chemotherapy, radiation therapy, radiosensitizers or chemoprevention.

If found in the subglottis, treatment may include a laryngectomy plus total thyroidectomy and removal of lymph nodes in throat (usually with radiation therapy), radiation therapy or clinical trials for chemotherapy, radiation therapy, radiosensitizers or chemoprevention.

In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique.

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