Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, one of the following is found: (1) cancer has spread through the thyroid cartilage and/or has spread to tissues beyond the larynx such as the neck, trachea, thyroid, or esophagus; cancer may have spread to one lymph node on the same side of the neck as the original tumor and the lymph node is smaller than 3 centimeters; or (2) cancer has spread to one or more lymph nodes anywhere in the neck and the lymph nodes are smaller than 6 centimeters; cancer may have spread to tissues beyond the larynx, such as the neck, trachea, thyroid, or esophagus. Vocal cords may not move normally.