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Nasopharyngeal Cancer Treatment (PDQ®)

  • Updated: 07/31/2014

Table 2. Regional Lymph Nodes (N)a, b

NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Unilateral metastasis in cervical lymph node(s), ≤6 cm in greatest dimension, above the supraclavicular fossa, and/or unilateral or bilateral, retropharyngeal lymph nodes, ≤6 cm in greatest dimension.c
N2Bilateral metastasis in cervical lymph node(s), ≤6 cm in greatest dimension, above the supraclavicular fossa.d
N3Metastasis in a lymph node(s)c >6 cm and/or to supraclavicular fossa.d
N3a>6 cm in dimension.
N3bExtension to the supraclavicular fossa.d

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 44-56.
bThe distribution and the prognostic impact of regional lymph node spread from nasopharyngeal cancer, particularly of the undifferentiated type, are different from those of other head and neck mucosal cancers and justify the use of a different N classification scheme.
cMidline nodes are considered ipsilateral nodes.
dSupraclavicular zone or fossa is relevant to the staging of nasopharyngeal carcinoma and is the triangular region originally described by Ho. It is defined by three points: (1) the superior margin of the sternal end of the clavicle, (2) the superior margin of the lateral end of the clavicle, (3) the point where the neck meets the shoulder. Note that this would include caudal portions of levels IV and VB. All cases with lymph nodes (whole or part) in the fossa are considered N3b.