Oropharyngeal and Hypopharyngeal 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 Oropharyngeal and Hypopharyngeal Cancers

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

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

Primary tumor (T)
Oropharynx:
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 or extension to lingual surface of the epiglottis
T4a Moderately advanced, local disease
  • Tumor invades the larynx, deep/extrinsic muscle of the 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 the carotid artery
Hypopharynx:
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor limited to 1 subsite of the hypopharynx and/or ≤2cm in greatest dimension
T2 Tumor invades more than 1 subsite of the hypopharynx or an adjacent site or measures >2 cm but not more than 4 cm in greatest dimension, without fixation of the hemilarynx
T3 Tumor >4 cm in greatest dimension or with fixation of the hemilarynx or extension to the esophagus
T4a Moderately advanced, local disease
  • Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, or central compartment soft tissue (including prelaryngeal strap muscles and subcutaneous fat)
T4b Very advanced, local disease
  • Tumor invades prevertebral fascia, encases carotid artery, or involves 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 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
N2a Metastasis in a single ipsilateral lymph node >3 cm but not more than 6cm in greatest dimension
N2b Metastasis in multiple ipsilateral lymph nodes, none >6cm in greatest dimension
N2c Metastasis in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension
N3 Metastasis in a lymph node >6cm 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



T4a



N2



N2



M0



M0



IVB T Any N3 M0
T4b N Any M0
IVC T Any N Any M1