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Hypopharyngeal Cancer Treatment (PDQ®)

Health Professional Version
Last Modified: 02/28/2014

Stage Information for Hypopharyngeal Cancer

Definitions of TNM

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 TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define hypopharyngeal cancer.[4]

Table 1. Primary Tumor (T)a
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinoma in situ.
Hypopharynx
T1Tumor limited to 1 subsite of hypopharynx and/or ≤2 cm in greatest dimension.
T2Tumor invades >1 subsite of hypopharynx or an adjacent site, or measures >2 cm but not >4 cm in greatest dimension without fixation of hemilarynx.
T3Tumor >4 cm in greatest dimension or with fixation of hemilarynx or extension to esophagus.
T4aModerately advanced local disease.
Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, or central compartment soft tissue.b
T4bVery 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 
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension.
N2Metastases 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.
N2aMetastasis in a single ipsilateral lymph node >3 cm but ≤6 cm in greatest dimension.
N2bMetastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension.
N2cMetastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension.
N3Metastasis 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.
M0No distant metastasis.
M1Distant 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.
0TisN0M0
IT1N0M0
IIT2N0M0
IIIT3N0M0
T1N1M0
T2N1M0
T3N1M0
IVAT4aN0M0
T4aN1M0
T1N2M0
T2N2M0
T3N2M0
T4aN2M0
IVBT4bAny NM0
Any TN3M0
IVCAny TAny NM1

References
  1. 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]

  2. Becker M: Larynx and hypopharynx. Radiol Clin North Am 36 (5): 891-920, vi, 1998.  [PUBMED Abstract]

  3. Keberle M, Kenn W, Hahn D: Current concepts in imaging of laryngeal and hypopharyngeal cancer. Eur Radiol 12 (7): 1672-83, 2002.  [PUBMED Abstract]

  4. 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.