Oral Cavity and Laryngeal Cancer Staging 

  • Author: Marvaretta M Stevenson, MD; Chief Editor: Jules E Harris, MD   more...
 
Updated: Aug 25, 2011
 

TNM Classification for Oral Cavity and Laryngeal Cancers

The TNM classifications for oral cavity and laryngeal cancers are provided below, along with histologic grades and anatomic stages.[1]

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

Primary tumor (T)
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor ≤2cm in greatest dimension
T2Tumor >2cm but ≤4cm in greatest dimension
T3Tumor >4cm in greatest dimension
T4aModerately advanced, local disease
  • Lip - Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face
  • Oral cavity - Tumor invades adjacent structures (eg, through cortical bone or into deep extrinsic muscle of the tongue, maxillary sinus, or skin of face)
T4bVery advanced, local disease
  • Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery
Glottis:
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor limited to the vocal cord(s) (may involve anterior or posterior commissure), with normal mobility
T1aTumor limited to 1 vocal cord
T1bTumor involves both vocal cords
T2Tumor extends to the supraglottis and/or subglottis, and/or with impaired vocal cord mobility
T3Tumor limited to the larynx with vocal cord fixation and/or invasion of the paraglottic space and/or inner cortex of the thyroid cartilage
T4aModerately advanced, local disease
  • Tumor invades through the outer cortex of the thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of the neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
T4bVery advanced, local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Supraglottis:
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor limited to 1 subsite of the supraglottis, with normal vocal cord mobility
T2Tumor invades mucosa of more than 1 adjacent subsite of the supraglottis or glottis or region outside the supraglottis (eg, mucosa of base of the tongue, vallecula, medial wall of piriform sinus), without fixation of the larynx
T3Tumor limited to the larynx, with vocal cord fixation, and/or invades any of the following: postcricoid area, preepiglottic space, paraglottic space, and/or inner cortex of the thyroid cartilage
T4aModerately advanced, local disease
  • Tumor invades through the thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of the neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
T4bVery advanced local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Subglottis:
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor limited to the subglottis
T2Tumor extends to vocal cord(s), with normal or impaired mobility
T3Tumor limited to the larynx, with vocal cord fixation
T4aModerately advanced, local disease
  • Tumor invades cricoids or thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of the neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
T4bVery advanced, local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Regional lymph nodes (N)
NXRegional nodes cannot be assessed
N0No regional lymph node metastasis
N1Metastasis in a single ipsilateral lymph node ≤3cm in greatest dimension
N2Metastasis in a single ipsilateral lymph node >3cm but ≤6cm in greatest dimension; or in multiple ipsilateral lymph nodes, none >6cm in greatest dimension; or in bilateral or contralateral lymph nodes, none >6cm in greatest dimension
N2aMetastasis in a single ipsilateral lymph node >3cm but ≤6cm in greatest dimension
N2bMetastasis in multiple ipsilateral lymph nodes, none >6cm in greatest dimension
N2cMetastasis in bilateral or contralateral lymph nodes, none >6cm in greatest dimension
N3Metastasis in a lymph node >6cm in greatest dimension
Distant metastasis (M)
M0No distant metastasis
M1Distant metastasis

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

Histologic grade (G)
GXGrade cannot be assessed
G1Well differentiated
G2Moderately differentiated
G3Poorly differentiated
G4Undifferentiated

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

Stage T N M
0TisN0M0
IT1N0M0
IIT2N0M0
IIIT3N0M0
T1N1M0
T2N1M0
T3N1M0
IVAT4aN0M0
T4aN1M0
T1N2M0
T2N2M0
T3N2M0
T4aN2M0
IVBT AnyN3M0
T4bN AnyM0
IVCT AnyN AnyM1
 
Contributor Information and Disclosures
Author

Marvaretta M Stevenson, MD  Medical Instructor, Thoracic Oncology Program, Duke University Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

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; Hematologist/Oncologist, St Francis Hospital System Cancer Center

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD  Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine; Consulting Staff, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research

Disclosure: GlobeImmune Salary Consulting

References

  1. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Head and Neck Cancers. V 2.2011. Available at http://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed Mar 28, 2011.

 
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Table. TNM classification
Primary tumor (T)
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor ≤2cm in greatest dimension
T2Tumor >2cm but ≤4cm in greatest dimension
T3Tumor >4cm in greatest dimension
T4aModerately advanced, local disease
  • Lip - Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face
  • Oral cavity - Tumor invades adjacent structures (eg, through cortical bone or into deep extrinsic muscle of the tongue, maxillary sinus, or skin of face)
T4bVery advanced, local disease
  • Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery
Glottis:
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor limited to the vocal cord(s) (may involve anterior or posterior commissure), with normal mobility
T1aTumor limited to 1 vocal cord
T1bTumor involves both vocal cords
T2Tumor extends to the supraglottis and/or subglottis, and/or with impaired vocal cord mobility
T3Tumor limited to the larynx with vocal cord fixation and/or invasion of the paraglottic space and/or inner cortex of the thyroid cartilage
T4aModerately advanced, local disease
  • Tumor invades through the outer cortex of the thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of the neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
T4bVery advanced, local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Supraglottis:
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor limited to 1 subsite of the supraglottis, with normal vocal cord mobility
T2Tumor invades mucosa of more than 1 adjacent subsite of the supraglottis or glottis or region outside the supraglottis (eg, mucosa of base of the tongue, vallecula, medial wall of piriform sinus), without fixation of the larynx
T3Tumor limited to the larynx, with vocal cord fixation, and/or invades any of the following: postcricoid area, preepiglottic space, paraglottic space, and/or inner cortex of the thyroid cartilage
T4aModerately advanced, local disease
  • Tumor invades through the thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of the neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
T4bVery advanced local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Subglottis:
TXPrimary tumor cannot be assessed
T0No evidence of primary tumor
TisCarcinoma in situ
T1Tumor limited to the subglottis
T2Tumor extends to vocal cord(s), with normal or impaired mobility
T3Tumor limited to the larynx, with vocal cord fixation
T4aModerately advanced, local disease
  • Tumor invades cricoids or thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, soft tissues of the neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus)
T4bVery advanced, local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Regional lymph nodes (N)
NXRegional nodes cannot be assessed
N0No regional lymph node metastasis
N1Metastasis in a single ipsilateral lymph node ≤3cm in greatest dimension
N2Metastasis in a single ipsilateral lymph node >3cm but ≤6cm in greatest dimension; or in multiple ipsilateral lymph nodes, none >6cm in greatest dimension; or in bilateral or contralateral lymph nodes, none >6cm in greatest dimension
N2aMetastasis in a single ipsilateral lymph node >3cm but ≤6cm in greatest dimension
N2bMetastasis in multiple ipsilateral lymph nodes, none >6cm in greatest dimension
N2cMetastasis in bilateral or contralateral lymph nodes, none >6cm in greatest dimension
N3Metastasis in a lymph node >6cm in greatest dimension
Distant metastasis (M)
M0No distant metastasis
M1Distant metastasis
Table. Histologic grade
Histologic grade (G)
GXGrade cannot be assessed
G1Well differentiated
G2Moderately differentiated
G3Poorly differentiated
G4Undifferentiated
Table. Anatomic stage/prognostic groups
Stage T N M
0TisN0M0
IT1N0M0
IIT2N0M0
IIIT3N0M0
T1N1M0
T2N1M0
T3N1M0
IVAT4aN0M0
T4aN1M0
T1N2M0
T2N2M0
T3N2M0
T4aN2M0
IVBT AnyN3M0
T4bN AnyM0
IVCT AnyN AnyM1
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