Last Modified: 02/03/2012
Stage Information for Hypopharyngeal Cancer
The staging systems are all clinical staging and are based on the best possible estimate of the extent of disease before treatment. The assessment of the primary tumor is based on inspection and palpation, when possible, and by both indirect mirror examination and direct endoscopy. The tumor must be confirmed histologically, and any other pathologic data obtained from a biopsy may be included. Additional radiographic studies may be included. As an adjunct to clinical examination, computed tomography and/or magnetic resonance imaging are needed for an accurate staging of laryngeal and hypopharyngeal carcinomas because both cross-sectional imaging modalities are known to reliably evaluate deep tumor infiltration.[1-3] The appropriate nodal drainage areas are examined by careful palpation. If a patient relapses, complete restaging must be done to select the appropriate additional therapy.
Definitions of TNMThe American Joint Committee on Cancer has designated staging by TNM classification to define hypopharyngeal cancer.[4]
Table 1. Primary Tumor (T)a| TX | Primary tumor cannot be assessed. |
| T0 | No evidence of primary tumor. |
| Tis | Carcinoma in situ. |
| Hypopharynx | |
| T1 | Tumor limited to 1 subsite of hypopharynx and/or ≤2 cm in greatest dimension. |
| T2 | Tumor invades >1 subsite of hypopharynx or an adjacent site, or measures >2 cm but not >4 cm in greatest dimension without fixation of hemilarynx. |
| T3 | Tumor >4 cm in greatest dimension or with fixation of hemilarynx or extension to esophagus. |
| T4a | Moderately advanced local disease. |
| Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, or central compartment soft tissue.b | |
| T4b | Very advanced local disease. |
| Tumor invades prevertebral fascia, encases carotid artery, or involves mediastinal structures. | |
| aReprinted with permission from AJCC: Pharynx. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41-56. | |
| bCentral compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat. |
Table 2. Regional Lymph Nodes (N)a,b
| Oropharynx and Hypopharynx | |
| NX | Regional lymph nodes cannot be assessed. |
| N0 | No regional lymph node metastasis. |
| N1 | Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension. |
| N2 | Metastases in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension. |
| N2a | Metastasis in a single ipsilateral lymph node >3 cm but ≤6 cm in greatest dimension. |
| N2b | Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension. |
| N2c | Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension. |
| N3 | Metastasis in a lymph node >6 cm in greatest dimension. |
| aReprinted with permission from AJCC: Pharynx. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41-56. | |
| bMetastases at level VII are considered regional lymph node metastases. |
Table 3. Distant Metastasis (M)a
| aReprinted with permission from AJCC: Pharynx. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41-56. | |
| M0 | No distant metastasis. |
| M1 | Distant metastasis. |
Table 4. Anatomic Stage/Prognostic Groupsa
| Stage | T | N | M |
| Oropharynx, Hypopharynx | |||
| aReprinted with permission from AJCC: Pharynx. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41-56. | |||
| 0 | Tis | N0 | M0 |
| I | T1 | N0 | M0 |
| II | T2 | N0 | M0 |
| III | T3 | N0 | M0 |
| T1 | N1 | M0 | |
| T2 | N1 | M0 | |
| T3 | N1 | M0 | |
| IVA | T4a | N0 | M0 |
| T4a | N1 | M0 | |
| T1 | N2 | M0 | |
| T2 | N2 | M0 | |
| T3 | N2 | M0 | |
| T4a | N2 | M0 | |
| IVB | T4b | Any N | M0 |
| Any T | N3 | M0 | |
| IVC | Any T | Any N | M1 |
References
- Thabet HM, Sessions DG, Gado MH, et al.: Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope 106 (5 Pt 1): 589-94, 1996. [PUBMED Abstract]
- Becker M: Larynx and hypopharynx. Radiol Clin North Am 36 (5): 891-920, vi, 1998. [PUBMED Abstract]
- Keberle M, Kenn W, Hahn D: Current concepts in imaging of laryngeal and hypopharyngeal cancer. Eur Radiol 12 (7): 1672-83, 2002. [PUBMED Abstract]
- Pharynx. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41-56.