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Oropharyngeal Cancer Treatment (PDQ®)

  • Last Modified: 11/18/2014

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Stage Information for Oropharyngeal Cancer

Definitions of TNM

The staging systems for oropharyngeal cancer are all clinical 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 indirect mirror examination. The appropriate nodal drainage areas are examined by careful palpation.

The tumor must be confirmed histologically. Any other pathologic data obtained from a biopsy and additional radiographic studies may be included. As an adjunct to clinical examination, magnetic resonance imaging is used to evaluate the extent of disease in the soft tissues; computed tomography is used to evaluate the mandible and maxilla.[1] Positron emission tomography has been investigated as an imaging modality for recurrent oropharyngeal cancer.[2]

Complete endoscopy, typically under general anesthesia, is performed after completion of other staging studies to assess the surface extent of the tumor accurately, to assess deep involvement by palpation for muscle invasion, and to facilitate biopsy. Because of the incidence of multiple primary tumors occurring simultaneously, a careful search for other primary tumors of the upper aerodigestive tract is indicated.[3]

Definitions of TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define oropharyngeal cancer.[3] Nonepithelial tumors such as those of lymphoid tissue, soft tissue, bone, and cartilage are not included.

Table 1. Primary Tumor (T)a
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinoma in situ.
T1Tumor ≤2 cm in greatest dimension.
T2Tumor >2 cm but ≤4 cm in greatest dimension.
T3Tumor >4 cm in greatest dimension or extension to lingual surface of epiglottis.
T4aModerately advanced local disease. Tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible.b
T4bVery advanced local disease. Tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base, or encases carotid artery.

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.
bMucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of larynx.

Table 2. Regional Lymph Nodes (N)a,b
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastasis in a single ipsilateral lymph node, ≤3 cm in greatest dimension.
N2Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension, or metastasis in multiple ipsilateral lymph nodes, ≤6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, ≤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, ≤6 cm in greatest dimension.
N2cMetastases in bilateral or contralateral lymph nodes, ≤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 
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. Weber AL, Romo L, Hashmi S: Malignant tumors of the oral cavity and oropharynx: clinical, pathologic, and radiologic evaluation. Neuroimaging Clin N Am 13 (3): 443-64, 2003.  [PUBMED Abstract]

  2. Wong RJ, Lin DT, Schöder H, et al.: Diagnostic and prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol 20 (20): 4199-208, 2002.  [PUBMED Abstract]

  3. 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.