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...
  • Print

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