Nasopharyngeal Cancer Staging 

Updated: Feb 22, 2016
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Guy J Petruzzelli, MD, PhD, MBA, FACS  more...
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TNM Classification for Nasopharyngeal Cancers

The TNM classifications for nasopharyngeal cancers are provided below, along with histologic grades and anatomic stages. [1] In addition, the World Health Organization (WHO) criteria for nasopharyngeal cancer are supplied.

Table. WHO criteria (Open Table in a new window)

WHO criteria
Type 1 Differentiated squamous cell carcinoma
Type 2 Nonkeratinizing carcinoma
Type 3 Undifferentiated carcinoma

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

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor confined to the nasopharynx, or tumor extends to oropharynx and/or nasal cavity without parapharyngeal extension (eg, without posterolateral infiltration of tumor)
T2 Tumor with parapharyngeal extension (posterolateral infiltration of tumor)
T3 Tumor involves bony structures of skull base and/or paranasal sinuses
T4 Tumor with intracranial extension and/or involvement of cranial nerves, hypopharynx, or orbit, or with extension to the infratemporal fossa/masticator space
Regional lymph nodes (N)
NX Regional nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Unilateral 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 (midline nodes are considered ipsilateral nodes)
N2 Bilateral metastasis in cervical lymph node(s),  6 cm in greatest dimension, above the supraclavicular fossa (midline nodes are considered ipsilateral nodes)
N3 Metastasis in a lymph node or nodes > 6 cm and/or to the supraclavicular fossa
N3a > 6 cm in dimension
N3b Extension to the supraclavicular fossa
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis

Table. Histologic grade (Open Table in a new window)

Histologic grade (G)
GX Grade cannot be assessed
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated

Table. Anatomic stage/prognostic groups (Open Table in a new window)

Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T1 N1 M0
T2 N0 M0
T2 N1 M0
III T1 N2 M0
T2 N2 M0
T3 N0 M0
T3 N1 M0
T3 N2 M0
IVA T4 N0 M0
T4 N1 M0
T4 N2 M0
IVB T Any N3 M0
IVC T Any N Any M1