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TNM and Stage Groupings > Pharynx
Pharynx
Primary Tumor (T)
| T Category |
Stage Category Definitions |
| TX |
Primary tumor cannot be assessed |
| T0 |
No evidence of primary tumor |
| Tis |
Carcinoma in situ |
Primary Tumor (T) - Nasopharynx
| T Category |
Stage Category Definitions |
| T1 |
Tumor confined to the nasopharynx, or extends to oropharynx and/or nasal
cavity without parapharyngeal extension* |
| T2 |
Tumor with parapharyngeal extension* |
| T3 |
Tumor involves bony structures of skull base and/or paranasal sinuses |
| T4 |
Tumor with intracranial extension and/or involvement of involvement of cranial
nerves, hypopharynx, orbit, or with extension to the infratemporal fossa/
masticator space |
* Parapharyngeal extension denotes posterolateral infiltration of tumor.
Primary Tumor (T) - Oropharynx
| T Category |
Stage Category Definitions |
| T1 |
Tumor 2 cm or less in greatest dimension |
| T2 |
Tumor more than 2 cm but not more than 4 cm in greatest dimension |
| T3 |
Tumor more than 4 cm in greatest dimension or extension to lingual surface of
epiglottis |
| T4a |
Moderately advanced local disease.
Tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard
palate, or mandible* |
| T4b |
Very advanced local disease.
Tumor invades lateral pterygoid muscle, pterygoid plates, lateral
nasopharynx, or skull base or encases carotid artery |
* Mucosal extension to lingual surface of epiglottis from primary tumors of the
base of the tongue and vallecula does not constitute invasion of larynx.
Primary Tumor (T) - Hypopharynx
| T Category |
Stage Category Definitions |
| T1 |
Tumor limited to one subsite of hypopharynx and/or 2 cm or less in greatest
dimension |
| T2 |
Tumor invades more than one subsite of hypopharynx or an adjacent site, or
measures more than 2 cm but not more than 4 cm in greatest dimension
without fixation of hemilarynx |
| T3 |
Tumor more than 4 cm in greatest dimension or with fixation of hemilarynx or
extension to esophagus |
| T4a |
Moderately advanced local disease.
Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, or central
compartment soft tissue* |
| T4b |
Very advanced local disease.
Tumor invades prevertebral fascia, encases carotid artery, or involves
mediastinal structures |
* Central compartment soft tissue includes prelaryngeal strap muscles and
subcutaneous fat.
Regional Lymph Nodes (N) - Nasopharynx
| N Category |
Stage Category Definitions |
| NX |
Regional lymph nodes cannot be assessed |
| N0 |
No regional lymph node metastasis |
| N1 |
Unilateral metastasis in lymph node(s), 6 cm or less in greatest dimension,
above the supraclavicular fossa, and/or unilateral or bilateral, retropharyngeal
lymph nodes, 6 cm or less, in greatest dimension* |
| N2 |
Bilateral metastasis in lymph node(s), 6 cm or less in greatest dimension, above
the supraclavicular fossa* |
| N3 |
Metastasis in a lymph node(s)* >6 cm and/or extension to supraclavicular fossa |
| N3a |
Greater than 6 cm in dimension |
| N3b |
Extension to the supraclavicular fossa** |
The distribution and the prognostic impact of regional lymph node spread from
nasopharynx 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.
* Midline nodes are considered ipsilateral nodes.
**Supraclavicular 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 (see Fig. 4.2). 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.
Regional Lymph Nodes (N) - Oropharynx and Hypopharynx
| N Category |
Stage Category Definitions |
| 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 |
* Metastases at Level VII are considered regional lymph node metastases.
Distant Metastasis (M)
| M Category |
Stage Category Definitions |
| M1 |
Distant metastasis |
No distant metastasis (no pathologic M0; use clinical M to complete stage group)
Anatomic Stage/Prognostic Groups - Nasopharynx
| Stage |
T |
N |
M |
| 0 |
Tis |
N0 |
M0 |
| I |
T1 |
N0 |
M0 |
| II |
T1 |
N1 |
M0 |
| II |
T2 |
N0 |
M0 |
| II |
T2 |
N1 |
M0 |
| III |
T1 |
N2 |
M0 |
| III |
T2 |
N2 |
M0 |
| III |
T3 |
N0 |
M0 |
| III |
T3 |
N1 |
M0 |
| III |
T3 |
N2 |
M0 |
| IVA |
T4 |
N0 |
M0 |
| IVA |
T1 |
N1 |
M0 |
| IVA |
T4 |
N2 |
M0 |
| IVB |
Any T |
N3 |
M0 |
| IVC |
Any T |
Any N |
M1 |
Anatomic Stage/Prognostic Groups - Oropharynx and Hypopharynx
| Stage |
T |
N |
M |
| 0 |
Tis |
N0 |
M0 |
| I |
T1 |
N0 |
M0 |
| II |
T2 |
N0 |
M0 |
| III |
T3 |
N0 |
M0 |
| III |
T1 |
N! |
M0 |
| III |
T2 |
N1 |
M0 |
| III |
T3 |
N1 |
M0 |
| IVA |
T4a |
N0 |
M0 |
| IVA |
T4a |
N1 |
M0 |
| IVA |
T1 |
N2 |
M0 |
| IVA |
T2 |
N2 |
M0 |
| IVA |
T3 |
N2 |
M0 |
| IVA |
T4a |
N2 |
M0 |
| IVB |
T4b |
Any N |
M0 |
| IVB |
Any T |
N3 |
M0 |
| IVC |
Any T |
Any N |
M1 |
