Oral Cavity and Laryngeal Cancer Staging 

Updated: Apr 22, 2016
  • Author: Marvaretta M Stevenson, MD; Chief Editor: Guy J Petruzzelli, MD, PhD, MBA, FACS  more...
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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)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor ≤ 2 cm in greatest dimension
T2 Tumor > 2 cm but not more than 4cm in greatest dimension
T3 Tumor > 4 cm in greatest dimension
T4a Moderately 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 into deep extrinsic muscle of the tongue, maxillary sinus, or skin of face)
T4b Very advanced, local disease
  • Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery
Glottis:
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor limited to the vocal cord(s) (may involve anterior or posterior commissure), with normal mobility
T1a Tumor limited to 1 vocal cord
T1b Tumor involves both vocal cords
T2 Tumor extends to the supraglottis and/or subglottis, and/or with impaired vocal cord mobility
T3 Tumor limited to the larynx with vocal cord fixation and/or invasion of the paraglottic space and/or inner cortex of the thyroid cartilage
T4a Moderately 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)
T4b Very advanced, local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Supraglottis:
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor limited to 1 subsite of the supraglottis, with normal vocal cord mobility
T2 Tumor 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
T3 Tumor 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
T4a Moderately 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)
T4b Very advanced local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Subglottis:
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor limited to the subglottis
T2 Tumor extends to vocal cord(s), with normal or impaired mobility
T3 Tumor limited to the larynx, with vocal cord fixation
T4a Moderately advanced, local disease
  • Tumor invades cricoid 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)
T4b Very advanced, local disease
  • Tumor invades prevertebral space, encases carotid artery, or invades mediastinal structures
Regional lymph nodes (N)
NX Regional nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension
N2 Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension
N2a Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension
N2b Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension
N2c Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension
N3 Metastasis in a lymph node > 6 cm in greatest dimension
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 T2 N0 M0
III T3 N0 M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
IVA T4a N0 M0
T4a N1 M0
T1 N2 M0
T2 N2 M0
T3 N2 M0
T4a N2 M0
IVB T Any N3 M0
T4b N Any M0
IVC T Any N Any M1