[Further development in TNM classification of laryngeal cancers]

To prepare an improved TN classification of laryngeal carcinomas, a great number of serial sections of laryngeal cancers and neck dissection specimens has been investigated and corresponding studies of clinical relevance were performed. Our proposals have been accepted in the 1993 supplement of the TNM-UICC classification and will be tested within the frame of so-called ramification studies. The authors propose that the T-category of laryngeal carcinomas should no longer be determined by anatomical areas of different sizes, but by millimetres only (up to 15 mm T1, 15-25 mm T2 a, 25 mm and more without impaired mobility T2 b, to impaired mobility or fixation of vocal cords T3, or T4 if the tumour extends beyond the larynx. The pT categories correspond to the T categories. A histological depth of or less than 5 mm is pT 1 or 2. It is proposed that the differentiation into glottic and subglottic tumours of the larynx should be abandoned. In lymph node metastases, the size, number, level and extranodular spread are considered. N1 and N2 are metastases in the upper two thirds of the neck without fixation (extranodal spread). N1 are one or two ipsilateral metastases of 2 cm or less in diameter, N2 are metastases of more than 2 cm diameter or bilateral metastases. N3 are fixed metastases or metastases in the lower third of the neck. Our proposals are presented in tables, ramification tables, conversion tables and a documentation sheet.