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Laryngeal Cancer: Diagnosis and Staging

Diagnosis:

There are a variety of procedures that are helpful in detecting and diagnosing laryngeal cancer by examining the neck and throat.

During a physical exam, the doctor will feel the neck and throat for lumps or swollen lymph nodes. The doctor will also look down the throat with a thin, long tube with a mirror in order to examine the throat for abnormal tissues.

An endoscopy will allow the doctor to examine the throat with a thin tube with a light on it (endoscope). During an endoscopy, the doctor will check for abnormal organs and tissues within the throat. The endoscope may be inserted through an incision or through the mouth.

During a laryngoscopy, the voice box will be examined with a long tube with a light and mirror (laryngoscope).

A CT scan takes a series of detailed pictures of the throat and neck region and surrounding tissues using x-rays and a computer imaging system. These pictures allow doctors to see tumors in the neck and throat. In some cases, a dye may be injected into the tissues of the throat and neck so that the tissues are more visible in x-ray images.

An MRI uses a powerful magnet linked to a computer to create images of a targeted area such as the neck or throat in order to see tumors and irregular tissues.

During a barium swallow, the patient swallows a liquid that contains barium. The liquid coats the esophagus and stomach. X-rays are then taken in order to get a better image of the affected area.

A biopsy allows doctors to sample tissue from the neck and throat. A pathologist will examine the tissue to check for cancerous cells.

Staging:

In order to better understand a patient's case and to assign an appropriate method of treatment, it is important for a doctor to determine the stage of a patient's laryngeal cancer.

Stage 0 - Carcinoma in Situ

  • Abnormal tissue is found in the lining of the larynx and has the potential to develop into cancer and/or spread to other normal tissues.

Stage I

  • At stage one, cancer has formed. The stage of the cancer depends on where the cancer has been found in the larynx: either in one area of the supraglottis, in the glottis in either one or both vocal cords, or in the subglottis. The cancer is found in only one of the three areas and the vocal cords can still function normally.

Stage II - The cancer is only found in the larynx; however, the stage depends on where it is found within the larynx.

  • Supraglottis - Cancer is found in more than one area and/or surrounding tissues.
  • Glottis - Cancer has migrated to the supraglottis and/or the subglottis. The vocal cords may or may not function normally.
  • Subglottis - Cancer has spread to one or both vocal chords. Vocal cords may not function properly.

Stage III - The stage depends on whether or not the cancer has spread from the supraglottis, glottis, or subglottis.

  • Supraglottis -
    • Cancer is only found in the larynx and the vocal cords do not function normally. The cancer may also be found in tissues surrounding the larynx or may have spread to a single lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm; or
    • Cancer is found in only one area of the supraglottis and only one lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm. Vocal cords can function normally; or
    • Cancer is in more than one area of the supraglottis or has spread to other tissues surrounding the area. One lymph node on the same side as the original tumor is affected but it is smaller than 3cm. The vocal cords may not function normally.
  • Glottis -
    • Cancer is only found in the larynx. Vocal cords do not function normally. Cancer may be in tissues surrounding the larynx. Cancer may have spread to a single lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm; or
    • Cancer is present in either one or both of the vocal cords. Cancer is also present in a single lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm. The vocal cords can function normally; or
    • Cancer has spread to the supraglottis and/or the subglottis. The vocal cords may or may not function normally. The cancer has spread to a single lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm.
  • Subglottis -
    • Cancer is only found in the larynx but may have spread to a single lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm. The vocal cords do not function normally; or
    • Cancer is only found in the subglottis. Cancer is found in a single lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm; or
    • Cancer has spread to either one or both vocal cords. The vocal cord(s) may or may not function normally. Cancer has spread to a single lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm.

Stage IV - This stage is divided into stages IVA, IVB, IVC. Each stage is the same for cancers located in the supraglottis, glottis, and subglottis.

  • IVA -
    • Cancer has spread through the thyroid cartilage and may have spread to other tissues beyond the larynx including the neck, trachea, thyroid, and/or esophagus. Cancer may have spread to a single lymph node on the same side of the neck as the original tumor. The lymph node is smaller than 3cm; or
    • Cancer has spread to one or more lymph nodes at any location in the neck. Lymph nodes are smaller than 6cm. Cancer may have spread to tissues beyond the larynx including the neck, trachea, thyroid, and/or esophagus. Vocal cords may not function normally.
  • IVB -
    • Cancer has spread to the space in front of the spinal column and surrounds the carotid artery. Cancer may have spread to areas of the chest or one or more lymph nodes of any size within the neck; or
    • Cancer has spread to a single lymph node that is larger than 6cm. Cancer may have spread to the area in front of the spinal column, around the carotid artery, or to parts of the chest. The vocal cords may not function normally.
  • IVC - Cancer has spread to other parts of the body beyond the larynx.