## TNM Staging of Laryngeal Carcinoma **Key Point:** TNM staging for laryngeal cancer is based on tumor size, location, vocal cord mobility, and involvement of specific anatomical subsites. ### T Stage Classification for Glottic Laryngeal Cancer | T Stage | Definition | |---------|------------| | T1a | Tumor limited to one vocal cord (can involve anterior or posterior commissure) | | T1b | Tumor involves both vocal cords | | T2 | Tumor extends beyond vocal cord(s) to involve supraglottis or subglottis, or with impaired vocal cord mobility | | T3 | Tumor limited to larynx with vocal cord fixation | | T4a | Tumor invades through thyroid cartilage and/or extends to soft tissues of neck | | T4b | Tumor invades prevertebral space, mediastinum, or encases carotid artery | ### Clinical Analysis of This Case The lesion is: - Confined to the **left vocal cord only** (unilateral) - No involvement of anterior commissure - No subglottic extension - No lymph node involvement - Vocal cord mobility not mentioned as impaired (implies normal mobility) **High-Yield:** When a glottic tumor is limited to one vocal cord with normal mobility and no extension beyond the cord, it is classified as **T1a**, regardless of lesion size or appearance. **Clinical Pearl:** T1a lesions are the most favorable for voice-preserving treatment options such as laser microsurgery (CO₂ laser) or radiation therapy, with cure rates exceeding 85–90%. **Warning:** Do not confuse T1a (one cord) with T1b (both cords). The presence of necrosis or ulceration does not change the T stage — only anatomical extent matters. 
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