Staging and grading laryngeal (larynx) cancer

Staging of laryngeal cancer

The stage of a cancer describes:

its size
whether it has spread from where it first started.

Knowing this helps doctors decide the best treatment for you.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. We are here if you need someone to talk to. You can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.

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Laryngeal (larynx) cancer

TNM staging system

Doctors usually use the TNM system to stage cancer of the larynx. TNM stands for tumour, node and metastases. This system gives the complete stage of the cancer:

T describes how much of the larynx and surrounding area is affected by the primary tumour.
N describes whether the cancer has spread to any nearby lymph nodes.
M describes whether the cancer has spread to other parts of the body, such as the lungs. This is called metastases or secondary cancer.

Doctors put numbers after the T, N and M. The numbers give more details about the size and spread of the cancer. Higher numbers mean the cancer is more advanced.

Your doctor or nurse can give you more information about this staging system.

Number staging system

Another staging system uses numbers to describe the stage of the cancer.

This is a simplified number staging system for cancer of the larynx:

Stage 0 laryngeal cancer

This is sometimes called carcinoma in situ or CIS. The cancer cells are only in the lining of the larynx. There are usually no symptoms, so the cancer is not usually diagnosed at this stage. Your doctor may sometimes call this stage pre-cancerous.
Stage 1 and 2 laryngeal cancer

Early stage cancers that have not grown outside of the larynx.
Stage 3 and 4 laryngeal cancer
More advanced tumours that may have:

affected the movement of the vocal cords

spread outside the larynx, either in the tissues around the larynx or to lymph nodes in the neck

spread to other areas of the body.

In this information, we use the terms early stage, locally advanced, and advanced to describe larynx cancer:

Early stage

Cancers of the larynx that are stage 0, 1 or 2.
Locally advanced

Cancers that have spread into the area surrounding the larynx but have not spread to other areas of the body. This covers stage 3 and some stage 4 cancers.
Advanced

Cancers that have spread to other areas of the body. These are stage 4 cancers.

Staging for cancer of the larynx is complex. It depends on where in the larynx the cancer started. For example, cancer that starts in the vocal cords, also known as the glottis, rarely spreads to other areas of the body. Your doctor can tell you more about your individual situation.

Grading of laryngeal cancer

Grading is about how the cancer cells look under the microscope compared with normal cells. The grade helps your doctor to plan your treatment. The grades used for laryngeal cancer are the following:

Grade 1 (low-grade or well-differentiated cancer) – the cancer cells look similar to normal cells. They usually grow slowly and are less likely to spread.
Grade 2 (moderate or intermediate-grade cancer) – the cancer cells look more abnormal and are slightly faster growing.
Grade 3 (high-grade or poorly differentiated cancer) – the cancer cells look very different from normal cells and may grow more quickly.

About our information

References

Below is a sample of the sources used in our laryngeal cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

ESMO Annals of Oncology. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx. EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow up. 2020. Available from www.esmo.org/guidelines/head-and-neck-cancers/squamous-cell-carcinoma-of-the-head-and-neck (accessed Jan 2022).

NICE Guideline NG36. Cancer of the upper aerodigestive tract: assessment and management in people aged 16 and over. 2018. Available from www.nice.org.uk/guidance/ng36 (accessed Jan 2022).

NICE Technology Appraisal TA736. Nivolumab for treating recurrent of metastatic squamous cell carcinoma of the head and neck after platinum-based chemotherapy. 2021. Available from www.nice.org.uk/guidance/ta736 (accessed Jan 2022).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Claire Paterson, Consultant Clinical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.