Last Modified: 07/16/2012
Stage Information for Lip and Oral Cavity 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 when necessary. The tumor must be confirmed histologically, and any other pathologic data obtained on biopsy may be included. The appropriate nodal drainage areas are examined by careful palpation. Information from diagnostic imaging studies may be used in staging. Magnetic resonance imaging offers an advantage over computed tomographic scans in the detection and localization of head and neck tumors and in the distinction of lymph nodes from blood vessels.[1] If a patient relapses, complete restaging must be done to select the appropriate additional therapy.[2,3]
Definitions of TNMThe American Joint Committee on Cancer has designated staging by TNM classification to define lip and oral cavity cancer.[4]
Table 1. Primary Tumor (T)a| TX | Primary tumor cannot be assessed. |
| T0 | No evidence of primary tumor. |
| Tis | Carcinoma in situ. |
| T1 | Tumor ≤2 cm in greatest dimension. |
| T2 | Tumor >2 cm but ≤4 cm in greatest dimension. |
| T3 | Tumor >4 cm in greatest dimension. |
| T4a | Moderately advanced local disease.b |
| (Lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, that is, chin or nose. | |
| (Oral cavity) Tumor invades adjacent structures only (e.g., through cortical bone [mandible or maxilla] into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of face). | |
| T4b | Very advanced local disease. |
| Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery. |
| aReprinted with permission from AJCC: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40. | |
| bSuperficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumor as T4. |
Table 2. Regional Lymph Nodes (N)a
| aReprinted with permission from AJCC: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40. | |
| 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 | Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension. |
| Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension. | |
| Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension. | |
| N2a | Metastasis in 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. |
Table 3. Distant Metastasisa
| aReprinted with permission from AJCC: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40. | |
| M0 | No distant metastasis. |
| M1 | Distant metastasis. |
Table 4. Anatomic Stage/Prognostic Groupsa
| Stage | T | N | M |
| aReprinted with permission from AJCC: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40. | |||
| 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 | Any T | N3 | M0 |
| T4b | Any N | M0 | |
| IVC | Any T | Any N | M1 |
References
- Consensus conference. Magnetic resonance imaging. JAMA 259 (14): 2132-8, 1988. [PUBMED Abstract]
- Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. 3rd ed. Philadelphia, PA: Lippincott, William & Wilkins, 2009.
- Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
- Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-35.