## TNM Staging of Laryngeal Carcinoma **Key Point:** The TNM staging of laryngeal carcinoma is based on anatomical subsites (supraglottis, glottis, subglottis) and vocal cord mobility. T2 disease is defined by involvement of multiple subsites or impaired vocal cord mobility. ### TNM T-Stage Classification for Laryngeal Carcinoma | T Stage | Definition | Vocal Cord Mobility | Subsites Involved | | --- | --- | --- | --- | | **T1** | Tumor confined to one subsite | Normal | Single subsite | | **T2** | Tumor invades multiple subsites or glottis | Impaired or normal | ≥2 subsites OR extends to adjacent subsites | | **T3** | Tumor fixed to larynx | Fixed | Any; may have minimal extralaryngeal extension | | **T4a** | Moderate extralaryngeal extension | Fixed | Invades thyroid cartilage, cricoid, hyoid bone, or soft tissues | | **T4b** | Massive extralaryngeal extension | Fixed | Invades prevertebral space, mediastinum, or encases carotid artery | **High-Yield:** The critical distinction between T1 and T2 is the number of subsites involved and vocal cord mobility. T2 tumors may have impaired (but not fixed) mobility, whereas T3 tumors have **fixed** vocal cords. **Clinical Pearl:** A tumor confined to the anterior commissure (part of the glottis) with normal mobility is T1. If it extends to involve the supraglottis or subglottis, it becomes T2. **Warning:** Do not confuse T2 (impaired mobility) with T3 (fixed cord). Fixed cord = T3 or higher. [cite:AJCC Cancer Staging Manual 8e] 
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