Laryngeal squamous cell cancer (SCC) TNM

Primary Tumour (T)

 

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 space, paraglottic space, and/or inner cortex of thyroid cartilage

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, encases carotid artery, or mediastinal structures

 

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 inner cortex of the thyroid cartilage

T4a        Tumour invades through the outer cortex of 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, encases carotid artery, or mediastinal structures

 

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 cricoid or thyroid cartilage and/or invades tissues beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscles of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid, oesophagus

T4b        Tumour invades prevertebral space, encases carotid artery, or mediastinal structures

 

Regional Lymph Nodes (N)

Nx         Regional lymph nodes cannot be assessed

N0         No regional lymph node metastasis

N1         Metastasis in a single ipsilateral lymph node, ≤3 cm and no extranodal extension (ENE)

N2a       Metastasis in a single ipsilateral lymph node, >3cm but ≤6cm, no ENE

N2b       Metastasis in multiple ipsilateral lymph nodes, all ≤6cm and no ENE

N2c       Metastasis in bilateral or contralateral lymph nodes, ≤6cm and no ENE

N3a       Metastasis in any lymph node >6cm with no ENE

N3b       Metastasis in any lymph node(s) with clinical ENE *

Notes:  * The presence of skin involvement or soft tissue invasion with deep fixation/tethering to underlying muscle or adjacent structures or clinical signs of nerve involvement is classified as clinical extranodal extension. Midline nodes are considered ipsilateral nodes.

 

Distant Metastasis (M)

M0         No distant metastasis

M1         Distant metastasis

 

pTNM Pathological Classification of Malignant Tumours (8^th Edition, UICC, 2018)

 

Primary Tumour (T)

 Supraglottis

pTx        Primary tumour cannot be assessed

pT0        No evidence of primary tumours

pTis       Carcinoma in situ

pT1        Tumour limited to one subsite of supraglottis with normal vocal cord mobility

pT2        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

pT3        Tumour limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic space, paraglottic space, and/or inner cortex of thyroid cartilage

pT4a      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

pT4b      Tumour invades prevertebral space, encases carotid artery, or mediastinal structures

 

Glottis

pTx        Primary tumour cannot be assessed

pT0        No evidence of primary tumours

pTis       Carcinoma in situ

pT1        Tumour limited to vocal cord(s) (may involve anterior or posterior commissure) with normal mobility

              pT1a       Tumour limited to one vocal cord

              pT1b       Tumour involves both vocal cords

pT2        Tumour extends to supraglottis and/or subglottis, and/or with impaired vocal cord mobility

pT3        Tumour limited to larynx with vocal cord fixation and/or invades paraglottic space, and/or inner cortex of the thyroid cartilage

pT4a      Tumour invades through the outer cortex of 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

pT4b      Tumour invades prevertebral space, encases carotid artery, or mediastinal structures

 

Subglottis

pTx        Primary tumour cannot be assessed

pT0        No evidence of primary tumours

pTis       Carcinoma in situ

pT1        Tumour limited to subglottis

pT2        Tumour extends to vocal cord(s) with normal or impaired mobility

pT3        Tumour limited to larynx with vocal cord fixation

pT4a      Tumour invades cricoid or thyroid cartilage and/or invades tissues beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscles of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid, oesophagus

pT4b      Tumour invades prevertebral space, encases carotid artery, or mediastinal structures

 

Pathological classification of Regional Lymph Nodes (pN)

Histological examination of a selective neck dissection specimen will ordinarily include 10 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 15 or more lymph nodes.

pNx       Regional lymph nodes cannot be assessed

pN0       No regional lymph node metastasis

pN1       Metastasis in a single ipsilateral lymph node, ≤3cm, no ENE

pN2a    Metastasis in a single ipsilateral lymph node, ≤3cm With ENE+; OR single lymph node >3cm but ≤6cm and no ENE

pN2b    Metastasis in multiple ipsilateral lymph nodes, ≤6cm, no ENE

pN2c     Metastasis in bilateral or contralateral lymph nodes, ≤6cm, no ENE

pN3a    Metastasis in any lymph node >6cm, no ENE

pN3b    Metastasis in a single ipsilateral lymph node >3cm with ENE+; OR single contralateral node, any size with ENE+; OR multiple nodes, any size with ENE+

Note:    Midline nodes are considered ipsilateral nodes.

 

Distant Metastasis (M)

pM1       Distant metastasis