## TNM Staging of Laryngeal Carcinoma ### Tumor (T) Classification for Glottic Laryngeal Cancer | T Stage | Definition | |---------|------------| | **T1** | Tumor limited to vocal cord(s) with normal mobility | | **T2** | Tumor extends to supraglottis and/or subglottis, or impaired vocal cord mobility | | **T3** | Tumor limited to larynx with vocal cord fixation | | **T4a** | Tumor invades thyroid cartilage and/or extends beyond larynx (soft tissues of neck, tongue base, epiglottis, vallecula) | | **T4b** | Tumor invades prevertebral space, mediastinum, or encases carotid artery | ### Analysis of This Case **Key Point:** The lesion extends to the anterior commissure, which is a supraglottic extension beyond the vocal cord alone. Although the arytenoid is mobile (vocal cord mobility is intact), the tumor crosses the midline to involve the anterior commissure. **High-Yield:** Anterior commissure involvement automatically upgrades a glottic tumor from T1 to T2, even if vocal cord mobility is preserved. The anterior commissure is considered a separate subsite. **Clinical Pearl:** The presence of otalgia (ear pain) in laryngeal cancer is a red flag for advanced disease or involvement of deep structures, though it does not change TNM staging directly—it reflects referred pain via the vagus nerve. ### Why This Is T2 N0 M0 1. **Tumor (T2):** Extends beyond vocal cord to anterior commissure (supraglottic extension) 2. **Nodes (N0):** No cervical lymphadenopathy on imaging 3. **Metastasis (M0):** No distant metastases **Mnemonic: ACME** — Anterior Commissure Means Elevation (from T1 to T2) [cite:Harrison 21e Ch 82] 
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