Σταδιοποίηση σε Ca Λάρυγγος

Ca Λάρυγγικος
AJCC Stages/Prognostic Groups
Stage	T	N		M
0	Tis	N0		M0
I	T1	N0		M0
II	T2	N0		M0
III	T3	N0		M0
	T1	N1		M0
	T2	N1		M0
	T3	N1		M0
IVA	T4a	N0		M0
	T4a	N1		M0
	T1	N2		M0
	T2	N2		M0
	T3	N2		M0
	T4a	N2		M0
IVB	T4b	Any N		M0
	Any T	N3		M0
IVC	Any T	Any N		M1
(T) Primary Tumor
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ
Supraglottis
T1	Tumor limited to 1 subsite of supraglottis with normal vocal cord mobility
T2	Tumor invades mucosa of > 1 adjacent subsite of supraglottis or glottis or region outside the supraglottis (e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus) without fixation of the larynx
T3	Tumor limited to larynx with vocal cord fixation &/or invades any of the following: Postcricoid area, preepiglottic space, paraglottic space, &/or inner cortex of thyroid cartilage
T4a	Moderately advanced local disease: Tumor invades through the thyroid cartilage &/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
T4b	Very advanced local disease: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Glottis
T1	Tumor limited to the vocal cord(s) (may involve anterior or posterior commissure) with normal mobility
T1a	Tumor limited to 1 vocal cord
T1b	Tumor involves both vocal cords
T2	Tumor extends to supraglottis &/or subglottis, &/or with impaired vocal cord mobility
T3	Tumor limited to the larynx with vocal cord fixation &/or invasion of paraglottic space, &/or inner cortex of the thyroid cartilage
T4a	Moderately advanced local disease: Tumor invades through the outer cortex of the thyroid cartilage &/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
T4b	Very advanced local disease: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Subglottis
T1	Tumor limited to the subglottis
T2	Tumor extends to vocal cord(s) with normal or impaired mobility
T3	Tumor limited to larynx with vocal cord fixation
T4a	Moderately advanced local disease: Tumor invades cricoid or thyroid cartilage &/or invades tissues beyond the larynx (e.g., trachea, soft tissues of neck including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus)
T4b	Very advanced local disease: Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
(N) Regional Lymph Nodes
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis*
N1	Metastasis in a single ipsilateral lymph node, ≤ 3 cm in greatest dimension
N2	Metastasis in a single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension
N2a	Metastasis in a single ipsilateral lymph node > 3 cm but ≤ 6 cm in greatest dimension
N2b	Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension
N2c	Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension
N3	Metastasis in a lymph node > 6 cm in greatest dimension
*Metastases at level VII are considered regional lymph node metastases.
(M) Distant Metastasis
M0	No distant metastasis
M1	Distant metastasis
(G) Histologic Grade
GX	Grade cannot be assessed
G1	Well differentiated
G2	Moderately differentiated
G3	Poorly differentiated
G4	Undifferentiated
Χαρακτηριστικά Επέκτασης
Direct extension Supraglottic carcinoma Can invade deep laryngeal tissues, such as preepiglottic and paraglottic spaces Upstages to T3 disease Can extend inferiorly toward glottis and subglottis Lymph node spread common (level II) Glottic carcinoma Typically spreads horizontally across free margin of vocal cord in direction of anterior commissure Anatomic structures of glottis typically pose barrier to spread Tendon of anterior commissure prevents extension to opposite vocal cord In diseases of later stage, malignancy may eventually cross midline Cord fixation may result after eventual invasion of underlying thyroarytenoid muscle Extension into subglottis may occur by invasion through conus elasticus Subglottic carcinoma Spreads anteriorly into thyroid gland through cricothyroid membrane Spreads posteriorly to Cricoid cartilage, Esophagus Spreads cephalad to True vocal cords, Supraglottis Spreads inferiorly to Tracheal lumen, Cartilaginous rings Lymphatic spread Uncommon in early stage glottic and subglottic disease After fixation of vocal cords or extension into subglottis, cervical and paratracheal nodal involvement becomes more frequent Distant metastasis Common sites overall include: Lung, Liver, Diaphragm/pleura
Κατηγοριοποίηση (Ιστολογικοί Τύποι)
WHO histological classification for tumors of larynx Malignant epithelial tumors Squamous cell carcinoma (SCCa) Verrucous carcinoma Basaloid squamous cell CA Papillary squamous cell Ca Spindle cell carcinoma Acantholytic squamous cell Ca Adenosquamous carcinoma Lymphoepithelial carcinoma Giant cell carcinoma Neuroendocrine tumors Typical carcinoid Atypical carcinoid Small cell carcinoma, neuroendocrine Combined small cell Ca neuroendocrine Soft tissue tumors Malignant tumors Fibrosarcoma Malignant fibrous			histiocytoma Liposarcoma Leiomyosarcoma Rhabdomyosarcoma Angiosarcoma Kaposi sarcoma Malignant peripheral nerve sheath Synovial sarcoma Tumors with low malignant potential/borderline tumors Inflammatory myofibroblastic Hematolymphoid tumors Tumors of bone and cartilage Chondrosarcoma Osteosarcoma Chondroma Giant cell tumor Mucosal malignant melanoma Secondary tumors

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