Key Points for This Section

After lip and oral cavity cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lip and oral cavity or to other parts of the body. There are three ways that cancer spreads in the body. The following stages are used for lip and oral cavity cancer: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV

After lip and oral cavity cancer has been diagnosed, tests are done to find out if cancer cells have spread within the lip and oral cavity or to other parts of the body.

The process used to find out if cancer has spread within the lip and oral cavity or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The results of the tests used to diagnose lip and oral cavity cancer are also used to stage the disease. (See the General Information ¹ section.)

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• Through tissue. Cancer invades the surrounding normal tissue.
• Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
• Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for lip and oral cavity cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the lips and oral cavity. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Enlarge

Pea, peanut, walnut, and lime show tumor sizes.

Stage I

In stage I, cancer has formed and the tumor is 2 centimeters or smaller. Cancer has not spread to the lymph nodes.

Stage II

In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters, and cancer has not spread to the lymph nodes.

Stage III

In stage III, the tumor:

• may be any size and has spread to a single lymph node that is 3 centimeters or smaller, on the same side of the neck as the cancer; or
• is larger than 4 centimeters.

Stage IV

Stage IV is divided into stages IVA, IVB, and IVC as follows:

• In stage IVA, the tumor:
  • has spread to nearby tissues in the lip and oral cavity; or
  • is any size and may have spread to nearby tissues in the lip and oral cavity. Cancer has spread to 1 or more lymph nodes on one or both sides of the neck, and the involved lymph nodes are 6 centimeters or smaller.
• In stage IVB, the tumor:
  • may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters; or
  • has spread to the muscles or bones in the oral cavity, or to the base of the skull and/or the carotid artery. Cancer may have spread to one or more lymph nodes on one or both sides of the neck.
• In stage IVC, the tumor has spread beyond the lip and oral cavity to other parts of the body. The tumor may be any size and may have spread to the lymph nodes.

Glossary Terms

Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

Primary bone cancer is cancer that forms in cells of the bone. Some types of primary bone cancer are osteosarcoma, Ewing sarcoma, malignant fibrous histiocytoma, and chondrosarcoma. Secondary bone cancer is cancer that spreads to the bone from another part of the body (such as the prostate, breast, or lung).

Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

The smallest type of blood vessel. A capillary connects an arteriole (small artery) to a venule (small vein) to form a network of blood vessels in almost all parts of the body. The wall of a capillary is thin and leaky, and capillaries are involved in the exchange of fluids and gases between tissues and the blood.

A group of abnormal cells that remain in the place where they first formed. They have not spread. These abnormal cells may become cancer and spread into nearby normal tissue. Also called stage 0 disease.

A major artery that carries blood from the heart to the head. There is a carotid artery on each side of the neck, and each one splits into two branches. The interior branch carries blood to the brain and eyes, and the exterior branch carries blood to the face, tongue, and outside parts of the head.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

A measure of length in the metric system. There are 100 centimeters in a meter and 2½ centimeters in an inch.

The process of identifying a disease, such as cancer, from its signs and symptoms.

Cancer that has spread beyond the layer of tissue in which it developed and is growing into surrounding, healthy tissues. Also called infiltrating cancer.

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

The tissues and organs that produce, store, and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes, and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body.

The spread of cancer from one part of the body to another. A tumor formed by cells that have spread is called a “metastatic tumor” or a “metastasis.” The metastatic tumor contains cells that are like those in the original (primary) tumor. The plural form of metastasis is metastases (meh-TAS-tuh-SEEZ).

Refers to the mouth. It includes the lips, the lining inside the cheeks and lips, the front two thirds of the tongue, the upper and lower gums, the floor of the mouth under the tongue, the bony roof of the mouth, and the small area behind the wisdom teeth.

The original tumor.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

Abnormal cells are found in the lining of the lips and oral cavity (mouth). These abnormal cells may become cancer and spread into nearby normal tissue.

Cancer that is no larger than 2 centimeters (about 1 inch) and has not spread to nearby lymph nodes.

Cancer that is larger than 2 centimeters (about 1 inch) but not larger than 4 centimeters (about 2 inches) and has not spread to lymph nodes.

The cancer is larger than 4 centimeters (about 2 inches); or the cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer is no larger than 3 centimeters (just over one inch).

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, the tumor has spread to nearby tissues in the lip and oral cavity (mouth); and/or cancer has spread to one or more lymph nodes in the neck and the involved lymph nodes are 6 centimeters (about 2 inches) or smaller. In stage IVB, the tumor has spread to one or more lymph nodes that are larger than 6 centimeters; or cancer has spread to the muscles or bones in the oral cavity, or to the base of the skull, and/or the carotid artery (blood vessel that carries blood from the heart to the head). Cancer may also have spread to one or more lymph nodes in the neck. In stage IVC, the tumor has spread beyond the lip and oral cavity to other parts of the body. Cancer may have spread to the lymph nodes.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVA, the tumor has spread to nearby tissues in the lip and oral cavity (mouth); and/or cancer has spread to one or more lymph nodes in the neck and the involved lymph nodes are 6 centimeters (about 2 inches) or smaller.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVB, the tumor has spread to one or more lymph nodes that are larger than 6 centimeters (about 2 inches); or cancer has spread to the muscles or bones in the oral cavity (mouth), or to the base of the skull, and/or the carotid artery (blood vessel that carries blood from the heart to the head). Cancer may also have spread to one or more lymph nodes in the neck.

Stage IV is divided into stages IVA, IVB, and IVC. In stage IVC, the tumor has spread beyond the lip and oral cavity (mouth) to other parts of the body. Cancer may have spread to the lymph nodes.

Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from the original site to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

A group or layer of cells that work together to perform a specific function.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm.

A blood vessel that carries blood to the heart from tissues and organs in the body.