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Symptomatic-Anatomic-Comorbid (SAC) Staging System for Cancer of the Larynx

Purpose: To evaluate a patient with cancer of the larynx using the clinical staging system of Feinstein et al from 1977.

Description

Feinstein et al developed a clinical staging system for cancer of the larynx based on symptoms, anatomic extent and co-morbid factors. The authors were from Yale University.


Components:

(1) symptoms

(2) anatomic stage

(3) comorbid conditions

 

Symptom Stage

Group

Symptoms

I

primary

cord  and/ or local

II

obtrusive

respiratory, systemic, and/or referred

III

deleterious

pharyngo-esophageal and/or external

 

Cord: hoarseness, changes in quality of voice, change in volume of voice

Local: irritation of the throat, fullness of the throat, hemoptysis

Respiratory: change in cough, stridor, wheezing

Systemic: anorexia, significant weight loss, malaise, weakness, fatigue

Referred: otalgia, neck pain

Pharyngo-esophageal: odynophagia, dysphagia

External: neck mass or distant manifestation related to tumor

 

where:

• Significant weight loss is one or more of the following: (a) unintentional weight loss >= 10% of customary weight, (b) loss of >= 20 pounds if the customary weight is not known, or (c) eight loss is the chief complaint.

 

Anatomic Stage

Group

Symptoms

I

localized

tumor confined to 1 vocal cord without fixation of either cord

II

intermediate

(a) involvement confined to larynx but not localized (above), OR (b) tumor extending to pharyngeal, hypopharyngeal or tracheal structures

III

distant

metastasis to lymph nodes or to site beyond Stage 2

 

Co-morbid conditions are those present at the time of diagnosis that affect long term survival, such as:

(1) significant cardiac disease

(2) disseminated malignancy

(3) severe emphysema

(4) frailty from old age

 

S-A Stage

Anatomic Stage

Symptomatic Stage

I

II

III

I

A

A

D

II

B

B

D

III

C

C

D

 

 

S-A Stage

With no comorbidity

With comorbidity

A

alpha

delta

B

beta

delta

C

gamma

delta

D

delta

delta

 

 

S-A-C Stage

5 Year Survival

alpha

90%

beta

60%

gamma

44%

delta

15%

 

Limitation:

• The staging system was devised in 1977. The 5 year survival is likely to have changed since then.


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Specialty

Objective

ICD-10