Staging and grading

The stage of a cancer describes its size and if it has spread from where it first started. This information helps your doctors decide on the best treatment for you.

Staging aims to find out how much of the larynx and surrounding area is affected. It also finds out whether the cancer has spread to lymph nodes nearby, or to other areas of the body (metastasised).

This is a simplified staging system for cancer of the larynx:

  • Stage 0 – The cancer cells are only in the lining of the larynx. There are usually no symptoms, so the cancer is not usually diagnosed at this stage.
  • Stage 1 – The cancer has grown further into the lining of the larynx where it started. The vocal cords still move normally.
  • Stage 2 – The cancer is affecting another part of the larynx, but the vocal cords still move. It has not spread outside the larynx.
  • Stage 3 – The movement of the vocal cords is affected. Or the cancer may have spread to one lymph node (no larger than 3cm). The cancer has spread within the larynx.
  • Stage 4 – The cancer has spread into the area surrounding the larynx. It may have spread to one or more lymph nodes (which may be larger than 3cm). It may have spread to other parts of the body.

In this information, we use the term early-stage cancer to describe laryngeal cancers that are stages 0, 1 and 2.

We use the term locally advanced cancer for stage 3 tumours and stage 4 tumours that have spread outside the larynx but not to other parts of the body.

We use the term advanced cancer for stage 4 tumours that have spread to other parts of the body.

Staging for cancer of the larynx is complex and will vary depending on where in the larynx the cancer started. For example, if the cancer started in the vocal cords (glottis), it rarely spreads to other parts of the body. Your doctor will be able to tell you more about your situation.


Grading is about how the cancer cells look under the microscope compared with normal cells. The grade helps your doctor to decide if you need further treatment after surgery.

  • Grade 1 or low-grade or well differentiated – the cancer cells look similar to normal cells and usually grow slowly and are less likely to spread.
  • Grade 2 or moderate- or intermediate-grade – the cancer cells look more abnormal and are slightly faster growing.
  • Grade 3 or high-grade or poorly differentiated – the cancer cells look very different from normal cells and may grow more quickly.

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