Laryngeal SCC: T Staging
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Hello everyone, Dr. Sidney Levy here.
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3 00:00:04,850 --> 00:00:06,780 I'm continuing our discussion of the
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diagnosis and staging of laryngeal squamous
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cell malignancy, using our example case of a
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large transglottic squamous cell carcinoma.
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I would like to talk about the staging of laryngeal
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squamous cell malignancy in general terms now.
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This tumor is a challenge because it has
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predominant glottic and some supraglottic
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components with less involvement of the subglottis.
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So, a decision needs to be made as to
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where we think the tumor is centered.
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And sometimes the best way to do that is to look
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at where the level of the vocal cords are and then
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decide whether the bulk of the tumor is centered
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at that level, superior or inferior to that level.
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So, let's do that.
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First thing.
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There are a lot of structures that are effaced
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here, so let's find something we can recognize.
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This is the cricoid cartilage here.
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So, it's a good place to start.
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If we go a few slices superiorly, we
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should see the arytenoid cartilages.
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And they are at this level, but abnormal.
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So, they are involved by tumor, but abnormal.
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As soon as we see the arytenoid cartilages,
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we know that we are at the level of the vocal
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cords because the vocal cords attach to the
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arytenoid cartilages in the axial plane.
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Once we are at the level of the arytenoid
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cartilages, we can cross-reference and identify
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the relevant position in the sagittal projection.
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And from there we can extend superiorly as far as
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the tumor goes, which is about this level here.
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And we can make an assessment as to
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where the tumor ends inferiorly.
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And in this case, it's a large tumor.
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It's extending over approximately this distance.
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And the center of the tumor is indeed
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at a similar level to what we identified
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as the arytenoid cartilages here.
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So hopefully through that little process,
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I've demonstrated to you that this
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tumor is primarily a glottic tumor.
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So therefore, let us use the
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staging system for glottic tumors.
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So, glottic tumors have T staging, which
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goes from T1, T2, T3, T4a, and T4b.
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There is a separate staging system for
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supraglottic tumors and for subglottic tumors.
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And I will not go into detail of both of those because
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we don't have a specific example case to show you.
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So what I will do is I will focus on this
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transglottic tumor using the glottic tumor staging.
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And I would refer you to the AJCC 8th edition
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guidelines where you can see specific details of
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the staging of supraglottic and subglottic tumors.
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In our next vignette, I will go into detail
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as to what constitutes a glottic tumor.
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T staging, N staging, and M staging of glottic tumors.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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