EVMS Ear, Nose & Throat Surgeons
Head & Neck

Staging of Laryngeal Cancer

If you or a family member or friend has been diagnosed with cancer, your doctor may refer to it in terms of the letters T and N. These terms are called "staging" and are very important for determining what type of treatment is most appropriate. This sheet gives a brief description of the staging for laryngeal cancer.

The letter "T" stands for tumor and describes the size and extent of the original tumor, also called the primary tumor. For a tumor arising in the region of the vocal cords, the staging is as follows:

  • T1 Tumor at just one site of the larynx.
  • T2 Tumor at two sites of the larynx.
  • T3 Tumor in the larynx that has caused one of the vocal cords to stop moving.
  • T4 Tumor that has extended beyond the larynx.


The diagrams below show an example of a T1 laryngeal cancer on the midportion of the left vocal fold. Both images were taken with a laryngeal telescope; the image to the right was taken with a 70 degree slope that looks at an angle of 70 degrees. In these photos the front of the neck is at the top, and the vocal folds form an upside down "V". This tumor is sitting on the left true vocal fold.

The letter "N" stands for node, and describes whether any tumor has spread to the lymph nodes of the neck. There are four levels here as well, though they start at zero: N0, N1, N2 and N3

  • N0 No evidence of any spread to the neck.
  • N1 One suspicious lymph node that is less than 3 cm ( 1.25 inches) in diameter.
  • N2 Suspicious nodes on both sides of the neck, or more than one suspicious node on one side, or a large node on one side, up to 6 cm (2.5 inches).
  • N3 A suspicious node that is bigger than 6 cm in diameter.


The letter "M" stands for metastasis, is describes whether or not there has been metastisis (spread) of the cancer to other parts of the body:

  • M0 No metastisis.
  • M1 Metastasis present.


The T, N, and M levels are then combined as follows to produce the actual staging classification:

  • Stage I is T1, N0 and M0.
  • Stage II is T2, N0 and M0.
  • Stage III is T3, N0 and M0; also T1, T2, or T3, and N1, M0.
  • Stage IV is T4, N0 or N1, M0; any T with N2 or N3 and M0, or M1 with any T or N level.


A very small tumor is stage I.The presence of any metastatic disease, or a tumor that invades adjacent structures, results in stage IV classification.Stage IV is also the result for a tumor that has spread extensively to the neck lymph nodes (N2 or N3).The staging of the tumor is very important in determining the appropriate treatment for laryngeal cancer