Hostname: page-component-669899f699-ggqkh Total loading time: 0 Render date: 2025-04-24T18:37:47.564Z Has data issue: false hasContentIssue false
  • English
  • Français

Revision of classification of laryngeal cancer, is it long overdue?

(Proposals for an improved TN-Classification)

Published online by Cambridge University Press:  29 June 2007

O. Kleinsasser
O. Kleinsasser
Affiliation:
Semon Lecture (University of London) given at the Royal Society of Medicine, London, W.1, on 31 October, 1991.
Get access Rights & Permissions [Opens in a new window]

Abstract

The TNM-classification of laryngeal carcinomas of the UICC contains a number of weaknesses which diminish their prognostic relevance. Based on clinical observations and microscopic investigations of surgical specimens, several changes are proposed to improve the existing TN-classification.

The larynx is subdivided by the UICC into the supraglottic, the glottic and the subglottic main area and their tumours. There are embryological, anatomical, functional and oncological reasons to divide the larynx into two main areas only—the supraglottis and the glottis (vocal folds) without any further subsites and to abandon a separate group of subglottic tumours. The T size of a tumour should not be assessed according to the extent of an ill-defined anatomical region, but measured in millimetres of greatest surface extent only. The T2 category of vocal fold tumours should not contain those which lead to an inhibited mobility of the fold. All tumours with reduced vocal fold mobility or fixation should be classified as T3 or T4 according to the dimension of invasion. Post-operative pathological examinations (pT/pN) allow an assessment of the true extent of a tumour in three dimensions. A validation study using a ‘metric’ T pT-classification shows very distinct groups of tumours with a significantly different prognosis from Tis 1 to T4. Studies of lymph node metastases in the neck have shown that, number, size, site of metastasis and the presence of extracapsular tumour spread have a significant influence on the prognosis. An improved N/pN-classification taking these factors in consideration is proposed.

Keywords

Laryngeal neoplasmsCarcinomaNeoplasm staging
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 106 , Issue 3 , March 1992 , pp. 197 - 204
Copyright
Copyright © JLO (1984) Limited 1992

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Atkinson, L., Bridger, G. P. (1976) The problem of assessing spread of laryngeal cancer and utilizing the TNM classification. In Workshop from the Centennial Conference on Laryngeal Cancer (Alberti, P. W., Bryce, D. P., eds.) Appleton-Century-Crofts: New York. p. 90–100.Google Scholar
Bennet, S. M, Futrell, J. W., Roth, J. A., Hoye, R. C., Ketcham, A. S. (1971) Prognostic significance of histologic host response in cancer of the larynx or hypopharynx. Cancer, 28: 1255–1265.3.0.CO;2-A>CrossRefGoogle Scholar
Cachin, Y., Hamel, S., Gérard-Marchant, R., Sancho, H., Micheau, C., Caen, J.-L. (1971) Les métastases ganglionnaires cervicales à nombre élevé de ganglions envahis au cours des carcinomes des voies aéro-digistives supérieures. Annales d'otolaryngologie (Paris), 88: 547–554.Google Scholar
Carlon, G., Serafini, I. (1990) T clinico e T patologico nel carcinoma sopraglottico. In Il carcinoma delta larynge (Serafini, I., Carlon, G., eds.). Piccin, Padua p.171–178.Google Scholar
Denoix, P. F. (1944) Sur l'organisation d'une statistique permanente du cancer. Bulletin Internal National Hygiene (Paris), 1: 67–74.Google Scholar
Fleischer, J. (1977) Morphologische Untersuchungen an subglottischen Kehlkopfkarzinomen. Inaugural Dissertation, Marburg.Google Scholar
Glanz, H. (1979) Zur Frage der Entstehung von Karzinomen im Morgagnischen Ventrikel und in Laryngocelen. Archives ofOtorhinolaryngology, 223: 417.Google Scholar
Glanz, H. (1984) Carcinoma of the larynx. Growth, p-classification and grading of squamous cell carcinoma of the vocal cords. Advances in Otorhinolaryngology, 32: 1–123.Google Scholar
Glanz, H. (1985) pT Klassifikation der Larynxkarzinome. In Fortschritte der Chirurgie—Vol. 1: 156–158. Zuckerschwerdt: München 1986.Google Scholar
Glanz, H., Eichhorn, Th. (1989) Prognoserelevante pathohistologische Klassifikation von Halslymphknotenmetastasen (pN) laryngealer Karzinome. HNO (Berlin), 37: 481–484.Google Scholar
Harrison, D. F. N. (1971) The pathology and management of subglottic cancer. Annals of Otology, Rhinology and Laryngology, 80: 6–12.Google Scholar
Harrison, D. F. N. (1979) Intrinsic weakness of the TNM system for classification of laryngeal cancer. Journal of Oto-Rhino-Laryngology and its relative Specialities, 41: 241–251.Google Scholar
Harrison, D. F. N. (1984) Significance and means by which laryngeal cancer invades thyroid cartilage. Annals of Otology, Rhinology and Laryngology, 93: 293–296.Google Scholar
Harwood, A. R., DeBoehr, G. (1980) Prognostic factors in T 2 glottic cancer. Cancer, 45: 991–995.Google Scholar
Hast, M. H. (1976) Applied embryology of the larynx. In Workshops from the Centennial Conference on Laryngeal Cancer (Alberti, P. W., Bryce, D. P., eds.) Appleton-Century-Crofts: New York, p. 6–10.Google Scholar
Hirabayashi, H., Koshii, K., Uno, K., Ohgaki, H., Nakasone, Y., Fujisawa, T., Syouno, N., Hinohara, T., Hirabayashi, K. (1991) Extracapsular spread of squamous cell carcinoma in neck lymph nodes: Prognostic factor of laryngeal cancer. Laryngoscope, 101: 502–506.CrossRefGoogle ScholarPubMed
Johns, M. E., Neal, D. A., Cantrell, R. W. (1984) Staging of cervical lymph node metastasis: comparison of two systems. Annals of Otology, Rhinology and Laryngology, 93: 330–332.Google Scholar
Johnson, J. T., Barnes, E. L., Myers, E. N., Schramm, V. L., Borochovitz, D., Sigler, B. A. (1981) The extracapsular spread of tumours in cervical node metastasis. Archives of Otolaryngology, 107: 725–729.Google Scholar
Kirchner, J. A. (1984) Post-therapeutic histology and microstaging in vertical partial laryngectomy: Vertical partial resections of the larynx, post-therapeutic histology, microstaging. In Functional Partial Laryngectomy: Conservation Surgery for Carcinoma of the Larynx (Wigand, M. E., Steiner, W., Stell, P. M., eds.) Springer-Verlag: New York, pp. 127–131.Google Scholar
Kleinsasser, O. (1963) Über die Histogenese und das Wachstum junger Kehlkopfkrebse. Zeitschrift Laryngologie Rhinologie Otologie, 42: 499–520.Google Scholar
Kleinsasser, O. (1967) Wachstumsformen der Kehlkopfeingangskarzinome und Indikation zur Teilresektion. Wissen Zeitschrift Karl-Marx Universität, 16: 723–725.Google Scholar
Kleinsasser, O. (1983) Bösartige Geschwiilste des Kehlkopfes und des Hypopharynx. In Hals-Nasen-Ohrenheilkunde (Berendes, J., Link, A., Zöllner, E., eds). Second edn., Vol. 2, IV/part 2. Georg Thieme: Stuttgart.Google Scholar
Kleinsasser, O. (1986) TNM Klassifikation der Larynxkarzinome. Kritik der zur Zeit gültigen Klassifikation und Vorschlage zur Neugestaltung. In Fortschritte der Chirurgie, Vol. 1 (1985) (Hermannek, P., ed.) W. Zuckerschwerdt: München, pp. 151–155.Google Scholar
Kleinsasser, O. (1988) Tumors of the Larynx and Hypopharynx. Georg Thieme: Stuttgart, New York.Google Scholar
Lund, W. S. (1976) Classification of subglottic tumours and discussions of their growth and spread. In Workshop from the Centennial Conference on Laryngeal Cancer (Alberti, P. W., Bryce, D. P., eds.) Appleton-Century-Crofts: New York, pp. 63–66.Google Scholar
Meyer-Breiting, E. (1981) Zur Histopathologie bestrahlter and unbestrahlter Plattenepithelkarzinome des Kehlkopfes. Thesis-Medical Faculty, Frankfurt.Google Scholar
Meyer-Breiting, E. (1990) Überlegungen und Untersuchungen zur Klassifikation glottischer Karzinome. Laryngologie Rhinologie Otologie, 69: 6–12.CrossRefGoogle Scholar
Meyer-Breiting, E., Bettinger, R. (1991) Zur T Klassifikation supraglottischer Karzinome. European Archives of Oto-Rhino-Laryngology, Supplement II/S, pp. 189–190.Google Scholar
Meyer-Breiting, E., Burkhardt, A. (1988) Tumors of the Larynx. Springer: Berlin.CrossRefGoogle Scholar
Meyer-Breiting, E., Popescu, G. (1986) Morphometrische Untersuchungen zur Definition der Glottischen Region. European Archives ofOto-Rhino-Laryngology, Supplement II/S: 150–152.Google Scholar
Mösges, R., Heinen, A., Höfener, J. (1991) Semiautomatische TNM-Klassifikation maligner Tumore mit dem ESTHER-System am Beispiel des Kehlkopfs. HNO (Berlin), 39: 396–400.Google Scholar
Olofsson, J., van Nostrand, A. W. P. (1973) Growth and spread of laryngeal and hypopharyngeal carcinoma with reflections on the effect of pre-operative irradiation. Acta OtoLaryngologica, Supplement 308: 1–84.Google Scholar
Pillsbury, H. R. C, Kirchner, J. A. (1979) Clinical versus histopathologie staging in laryngeal cancer. Archives of Otolaryngology, 105: 157–159.CrossRefGoogle Scholar
Popella, Ch., Glanz, H., Kleinsasser, O. (1991) Prognoserelevanz einer pT pN-Klassifikation von Larynxkarzinomen und ihre Bedeutung fiir die Verbesserung de TN-Klassifikation. European Archives of Oto-Rhino-Laryngology, Supplement II/S, pp. 188–189.Google Scholar
Richard, J. M. (1990) Problemi del sistema TNM nel cancro della laringe. In ll cancro della larynge (Serafini, I., Carlon, G., eds.). Piccin, Padua, pp. 179–184.Google Scholar
Sessions, D. G., Ogura, J. H. (1976) Classification of laryngeal cancer. In Workshop from the Centennial Conference on Laryngeal Cancer (Alberti, P. W., Bryce, D. P., eds.) Appleton-Century-Crofts: New York. pp. 83–89.Google Scholar
Shepperd, H. W. H. (1976) Classification of Laryngeal carcinoma. In Workshop from the Centennial Conference on Laryngeal Cancer. (Alberti, P. W., Bryce, D. P., eds.) Appleton-Century-Crofts: New York. pp. 74–79.Google Scholar
Snow, G. B., Annyas, A. A., van Slooten, E. A., Bartelink, H., Hart, A. A. M. (1982) Prognostic factors of neck node metastasis. Clinical Otolaryngology, 7: 185–192.Google Scholar
Snyderman, N. L., Johnson, J. T., Schramm, V. L., Myers, E. N., Bedetti, Ch. D., Thearle, P. (1985) Extracapsular spread of carcinoma in cervical lymph nodes: Impact upon survival in patients with carcinoma of the supraglottic larynx. Cancer, 56: 1597–1599.Google Scholar
Stell, P. M., Tobin, K. E. (1975) The behaviour of cancer affecting the subglottic space. Canadian Journal of Otolarygnology, 4: 612–617.Google ScholarPubMed