Nasopharyngeal Cancer Staging 

Nasopharyngeal Cancer Staging 

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The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classifications and prognostic stage groups for nasopharyngeal cancers are provided below. [1]

Table 1. TNM classification (Open Table in a new window)

Primary tumor (T)

TX

Primary tumor cannot be assessed

T0

No tumor ifentified, but EBV-positive cervical node(s) involvement

Tis

Carcinoma in situ

T1

Tumor confined to the nasopharynx, or extenion to oropharynx and/or nasal cavity without parapharyngeal involvement

T2

Tumor with extension to parapharyngeal space, and/or adjacent soft tissue involvement (medial pterygoid, lateral pterygoid, prevertebral muscles)

T3

Tumor with infiltration of bony structures at skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses

T4

Tumor with intracranial extension, involvement of cranial nerves, hypopharynx, orbit, parotid gland, and/or extensive soft tissue infiltration beyond the lateral surface of the lateral pterygoid muscle 

Regional lymph nodes (N)

NX

Regional nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Unilateral metastasis in cervical lymph node(s) and/or unilateral or bilateral metastasis in retropharyngeal lymph node(s), 6 cm or smaller in greatest dimension, above the caudal border of cricoid cartilage

N2

Bilateral metastasis in cervical lymph node(s),  6 cm or smaller in greatest dimension, above the caudal border of cricoid cartilage

N3

Unilateral or bilateral metastasis in cervical lymph node(s),  larger than 6 cm in greatest dimension, and/or extension below the caudal border of cricoid cartilage

Distant metastasis (M)

cM0

No distant metastasis

cM1

Distant metastasis

Table 2. Prognostic stage groups (Open Table in a new window)

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T0–T1

N1

M0

T2

N0–N1

M0

III

T0–T3

N2

M0

T3

N1–N2

M0

IVA

 

T4

N0–N2

M0

T Any

N3

M0

IVB

T Any

N Any

M1

Head and Neck. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 8th edition. New York, NY: Springer; 2016.

Primary tumor (T)

TX

Primary tumor cannot be assessed

T0

No tumor ifentified, but EBV-positive cervical node(s) involvement

Tis

Carcinoma in situ

T1

Tumor confined to the nasopharynx, or extenion to oropharynx and/or nasal cavity without parapharyngeal involvement

T2

Tumor with extension to parapharyngeal space, and/or adjacent soft tissue involvement (medial pterygoid, lateral pterygoid, prevertebral muscles)

T3

Tumor with infiltration of bony structures at skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses

T4

Tumor with intracranial extension, involvement of cranial nerves, hypopharynx, orbit, parotid gland, and/or extensive soft tissue infiltration beyond the lateral surface of the lateral pterygoid muscle 

Regional lymph nodes (N)

NX

Regional nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Unilateral metastasis in cervical lymph node(s) and/or unilateral or bilateral metastasis in retropharyngeal lymph node(s), 6 cm or smaller in greatest dimension, above the caudal border of cricoid cartilage

N2

Bilateral metastasis in cervical lymph node(s),  6 cm or smaller in greatest dimension, above the caudal border of cricoid cartilage

N3

Unilateral or bilateral metastasis in cervical lymph node(s),  larger than 6 cm in greatest dimension, and/or extension below the caudal border of cricoid cartilage

Distant metastasis (M)

cM0

No distant metastasis

cM1

Distant metastasis

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T0–T1

N1

M0

T2

N0–N1

M0

III

T0–T3

N2

M0

T3

N1–N2

M0

IVA

 

T4

N0–N2

M0

T Any

N3

M0

IVB

T Any

N Any

M1

Marvaretta M Stevenson, MD Assistant Professor, Division of Medical Oncology, Duke University Medical Center

Disclosure: Nothing to disclose.

Jasmeet Anand, PharmD, RPh Adjunct Instructor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital; Medical Director, Deaconess Hospital Outpatient Infusion Centers; Chairman, Deaconess Hospital Cancer Committee

Christopher D Braden, DO is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology

Disclosure: Nothing to disclose.

Guy J Petruzzelli, MD, PhD, MBA, FACS Physician-in-Chief and Vice President of Oncology Programs, Curtis and Elizabeth Anderson Cancer Institute at Memorial University Medical Center; Professor of Surgery-Head, Neck, and Endocrine Surgery, Mercer University School of Medicine-Savannah Campus

Guy J Petruzzelli, MD, PhD, MBA, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Association for the Advancement of Science, American Association of Clinical Anatomists, American College of Surgeons, American Head and Neck Society, American Medical Association, American Society of Clinical Oncology, Chicago Medical Society, Georgia Society of Otolaryngology-Head and Neck Surgery, International Academy of Oral Oncology, International Head and Neck Scientific Group, North American Skull Base Society, Society of Surgical Oncology, Society of University Otolaryngologists-Head and Neck Surgeons, SWOG

Disclosure: Nothing to disclose.

Nasopharyngeal Cancer Staging 

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