TNM Definitions

The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification.[1]

There is no tumor classification (T) for occult primary cancer metastatic to neck lymph nodes.

Regional lymph nodes (N)

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension*
• N2: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension*
  • N2a: Metastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension*
  • N2b: Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension*
  • N2c: Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension*
• N3: Metastasis in a lymph node more than 6 cm in greatest dimension*

* [Note: A designation of "U" or "L" may be used to indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L).]

In clinical evaluation, the actual size of the nodal mass should be measured and allowance should be made for intervening soft tissues. Most masses more than 3 cm in diameter are not single nodes but are confluent nodes or tumor in soft tissues of the neck. There are three stages of clinically positive nodes: N1, N2, and N3. The use of subgroups a, b, and c is not required but recommended. Midline nodes are considered homolateral nodes.

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

There is no generally accepted Roman numeral staging system for this disease.

Untreated

Untreated metastatic squamous neck cancer with occult primary means that a patient is newly diagnosed and has had no prior treatment except supportive care.

References

1. Head and neck sites. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 17-88. 
   
   

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