Oral Cavity and Laryngeal Cancer Staging 

Updated: Feb 06, 2018
  • 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 American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classifications for oral cavity and laryngeal cancers are provided below, along with histologic grades and anatomic stages. [1]

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

Primary tumor (T)
Oral Cavity
TX Primary tumor cannot be assessed
Tis Carcinoma in situ
T1 Tumor ≤ 2 cm,  ≤ 5 mm depth of invasion (DOI)
T2 Tumor ≤ 2 cm, DOI > 5 mm and ≤ 10 mm;



or tumor > 2 cm but ≤ 4 cm, and DOI ≤ 10 mm



T3 Tumor > 4 cm;



or any tumor with DOI > 10 mm but ≤ 20 mm



T4 Moderately advanced or very advanced local disease
T4a Moderately advanced local disease



Tumor invades adjacent structures (eg, through cortical bone of the mandible or maxilla, or involves maxillary sinus or skin of the face) or extensive tumor with bilateral tongue involvement and/or DOI > 20 mm



Note:  Superficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4.



T4b Very advanced local disease



Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery



Larynx: Glottis:
TX Primary tumor cannot be assessed
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
T4 Moderately advanced or very advanced
T4a Moderately advanced, local disease



Tumor invades through the outer cortex of the thyroid cartilage and/or invades tissues beyond the larynx (eg, trachea, cricoid cartilage, 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



Larynx: Supraglottis:
TX Primary tumor cannot be assessed
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
T4 Moderately advanced or very advanced
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



Larynx: Subglottis:
TX Primary tumor cannot be assessed
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 and/or invasion of paraglottic space and/or inner cortex of the thyroid cartilage
T4 Moderately advanced or very advanced
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 muscles 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)
  Clinical N (cN)
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 and no extranodal extension (ENE [-])
N2 Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-);



or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-);



or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N3 Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or metastasis in any node(s) and clinically overt ENE (+)
N3a Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b Metastasis in any node(s) and clinically overt ENE (+)
  Pathological N (pN)
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and ENE (-)
N2 Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+);



or  > 3 cm but not more than 6 cm in greatest dimension and ENE (-);



or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-);



or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+);or  a single ipsilateral node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c Metastasis in bilateral or contralateral lymph node(s), none > 6 cm in greatest dimension and ENE (-)
N3 Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-);



or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+);



or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+);



or a single contralateral node of any size and ENE (+)
N3a Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+);



or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+);



or a single contralateral node of any size and ENE (+)
Distant metastasis (M)
cM0 No distant metastasis
cM1 Distant metastasis
pM1 Distant metastasis, microscopically confirmed

Table 2. 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

Table 3. 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–T3 N1 M0
IVA T4a N0–N1 M0
T1–T4a N2 M0
IVB T Any N3 M0
T4b N Any M0
IVC T Any N Any M1