Staging (Larynx)                                                        
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Pathologic Staging (pTNM)

CAP Approved Head and Neck • Larynx 4.0.0.0 (AJCC 8th ed)

Note: The phrases in italics include clinical findings required for AJCC staging. This clinical information may not be available to the pathologist. However, if known, these findings should be incorporated into the pathologic staging.

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Cannot be assessed

___ pT0: No evidence of primary tumor

___ pTis: Carcinoma in situ

For All Carcinomas Excluding Mucosal Melanoma

Primary Tumor (pT): Supraglottis

___ pT1: 

Tumor limited to one subsite of supraglottis with normal vocal cord  mobility

___ pT2: 

Tumor invades mucosa of more than one adjacent subsite of  supraglottis or glottis or region outside the supraglottis (eg, mucosa of  base of tongue, vallecula, medial wall of pyriform sinus) without  fixation of the larynx

___ pT3: 

Tumor limited to larynx with vocal cord fixation and/or invades any of  the following: postcricoid area, preepiglottic space, paraglottic space,  and/or inner cortex of thyroid cartilage 

___ pT4a: 

Moderately advanced local disease. Tumor invades through the thyroid  cartilage and/or invades tissues beyond the larynx (eg, trachea, soft  tissues of neck including deep extrinsic muscle of tongue, strap  muscles, thyroid, or esophagus)

___ pT4b: 

Very advanced local disease. Tumor invades prevertebral space,  encases carotid artery, or invades mediastinal structures

Primary Tumor (pT): Glottis

___ pT1:

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

___ pT1a: 

Tumor limited to one vocal cord

___ pT1b: 

Tumor involves both vocal cords

___ pT2: 

Tumor extends to supraglottis and/or subglottis and/or with impaired  vocal cord mobility

___ pT3: 

Tumor limited to the larynx with vocal cord fixation and/or invasion of  paraglottic space and/or inner cortex of the thyroid cartilage

___ pT4a: 

Moderately advanced local disease. Tumor invades through the outer  cortex of the thyroid cartilage and/or invades tissues beyond the  larynx (eg, trachea, cricoid cartilage, soft tissues of neck including deep extrinsic  muscle of the tongue, strap muscles, thyroid, or esophagus)

___ pT4b: 

Very advanced local disease. Tumor invades prevertebral space,  encases carotid artery, or invades mediastinal structures

Primary Tumor (pT): Subglottis

___ pT1: 

Tumor limited to subglottis

___ pT2: 

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

___ pT3: 

Tumor limited to larynx with vocal cord fixation and/or invasion of paraglottic space and/or inner cortex of the thyroid cartilage

___ pT4a: 

Moderately advanced local disease. Tumor invades cricoid or thyroid  cartilage and/or invades tissues beyond the larynx (eg, trachea, soft  tissues of neck including deep extrinsic muscles of the tongue, strap  muscles, thyroid, or esophagus)

___pT4b: 

Very advanced local disease. Tumor invades prevertebral space,  encases carotid artery, or invades mediastinal structures

Regional Lymph Nodes (pN)#

               ___ pNX: Regional lymph nodes cannot be assessed

               ___ pN0: No regional lymph node metastasis

               ___ pN1: Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(-)

               ___ pN2: Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(+); or metastasis in a single ipsilateral lymph                                node, larger than 3 cm but not larger than 6 cm in greatest

               dimension and ENE(−);or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and

ENE(−); or metastasis in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(−)

       ___ pN2a: Metastasis in a single ipsilateral node, 3 cm or smaller in greatest dimension and ENE(+);

       or metastasis in a single ipsilateral node, larger than 3 cm but not larger than 6 cm in greatest

       dimension and ENE(−)

       ___ pN2b: Metastasis in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension and ENE(−)

       ___ pN2c: Metastasis in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and

       ENE(−)

___ pN3: Metastasis in a lymph node, larger than 6 cm in greatest dimension and ENE(−);

or metastasis in a single ipsilateral node, larger than 3 cm in greatest dimension and ENE(+);

or metastases in multiple ipsilateral, contralateral, or bilateral lymph nodes and any with ENE(+);

or a single contralateral node 3 cm or smaller and ENE(+)

       ___ pN3a: Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−)

       ___ pN3b: Metastasis in a single ipsilateral node, larger than 3 cm in greatest dimension and ENE(+);

       or metastases in multiple ipsilateral, contralateral, or bilateral lymph nodes and any with ENE(+);

       or a single contralateral node 3 cm or smaller and ENE(+)

Midline nodes are considered ipsilateral nodes.


Distant Metastasis (pM) (required only if confirmed pathologically in this case)

___ Not applicable

___ pM1:  Distant metastasis

                   Specify site(s), if known


For Mucosal Melanoma (starts with pT3)


Primary Tumor (pT)

___ pT3:         Tumors limited to the mucosa and immediately underlying soft tissue, regardless of thickness or greatest dimension; for example, polypoid nasal disease, pigmented or nonpigmented lesions of the oral cavity, pharynx, or larynx

___ pT4a:         Moderately advanced disease. Tumor involving deep soft tissue,  cartilage, bone, or overlying skin

___ pT4b:  Very advanced disease. Tumor involving brain, dura, skull base, lower  cranial nerves (IX, X, XI, XII), masticator space, carotid artery,  prevertebral space, or mediastinal structures

Regional Lymph Nodes (pN)

___ pNX:         Regional lymph nodes cannot be assessed

___ pN0:         No regional lymph node metastases

___ pN1:         Regional lymph node metastases present

Distant Metastasis (pM) (required only if confirmed pathologically in this case)

___ Not applicable

___ pM1:  Distant metastasis present

Specify site(s), if known: ____________________________        


Larynx CAP 4.0.0.0 summary of pTNM changes AJCC7th to 8th edition

- Extranodal extension (ENE-or ENE+) is an important part pN staging. Changes seen in pN1, pN2a, 2b, 2c, pN3a, 3b.


Head & Neck


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