TNM Classification for Oropharyngeal and Hypopharyngeal Cancers
The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classifications for oropharyngeal and hypopharyngeal cancers are provided below, along with the prognostic groups and histologic grade. With oropharyngeal cancers, TNM classification varies depending on whether the cancer is mediated by human papillomavirus (HPV). [1, 2]
Table 1. TNM Classification of HPV-Mediated (p16+) Oropharyngeal Cancer (Open Table in a new window)
Primary tumor (T) |
|
T0 |
No primary tumor identified |
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 |
T4 |
Moderately advanced local disease Tumor invades the larynx, extrinsic muscle of the tongue, medial pterygoid, hard palate, or mandible or beyond* |
* Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of the larynx. |
|
Regional lymph nodes (N) |
|
| Clinical N (cN) | |
NX |
Regional nodes cannot be assessed |
N0 |
No regional lymph node metastasis |
N1 |
One or more ipsilateral lymph nodes, none > 6 cm |
N2 |
Contralateral or bilateral lymph nodes, none > 6 cm |
N3 |
Lymph node(s) > 6 cm |
| Pathological N (pN) | |
| NX | Regional nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in 4 or fewer lymph nodes |
| N2 | Metastasis in more than 4 lymph nodes |
Distant metastasis (M) |
|
cM0 |
No distant metastasis |
cM1 |
Distant metastasis |
| pM1 | Distant metastasis, microscopically confirmed |
Table 2. Clinical Prognostic Groups for HPV-Mediated (p16+) Oropharyngeal Cancer (cTNM) (Open Table in a new window)
Stage |
T |
N |
M |
I |
T0–T2 |
N0 |
M0 |
| T0–T2 | N1 | M0 | |
II |
T0–T2 |
N2 |
M0 |
T3 |
N0–N2 |
M0 |
|
III |
T0–T3 |
N3 |
M0 |
| T4 | N0–N3 |
M0 |
|
IV |
T Any | N Any | M1 |
Table 3. Pathological Prognostic Groups for HPV-Mediated (p16+) Oropharyngeal Cancer (pTNM) (Open Table in a new window)
Stage |
T |
N |
M |
I |
T0–T2 |
N0 |
M0 |
T0–T2 |
N1 |
M0 |
|
II |
T0–T2 |
N2 |
M0 |
T3–T4 |
N0 |
M0 |
|
T3–T4 |
N1 |
M0 |
|
III |
T3–T4 |
N2 |
M0 |
| IV | T Any | N Any | M1 |
Table 4. TNM Classification of Non–HPV-Mediated (p16) Oropharyngeal Cancer (Open Table in a new window)
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| 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 |
| T4 | Moderately advanced or very advanced local disease Tumor invades the larynx, extrinsic muscle of the tongue, medial pterygoid, hard palate, or mandible or beyond* |
| T4a | Moderately advanced local disease Tumor invades the larynx, 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 carotid artery |
| * Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of the larynx. | |
| Regional Lymph Nodes (N) | |
| Clinical N (cN) | |
| 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 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) with clinically overt ENE (+) |
| N3a | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-) |
| N3b | Metastasis in any node(s) with 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 a single ipsilateral 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 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 5. Prognostic Stage Groups for Non–HPV-Mediated (p16 -) Oropharyngeal Cancer (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 |
Table 6. 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 7. Hypopharyngeal Cancer TNM Classification (Open Table in a new window)
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| Tis | Carcinoma in situ |
| T1 | Tumor limited to one subsite of hypopharynx and/or ≤2 cm in greatest dimension |
| T2 | Tumor invades more than one subsite of hypopharynx or an adjacent site, or measures >2 cm but not more than 4 cm in greatest dimension without fixation of hemilarynx |
| T3 | Tumor >4 cm in greatest dimension or with fixation of hemilarynx or extension to esophageal mucosa |
| T4 | Moderately advanced or very advanced local disease |
| T4a | Moderately advanced local disease Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, esophageal muscle or central compartment soft tissue* |
| T4b | Very advanced local disease Tumor invades prevertebral fascia, encases carotid artery, or involves mediastinal structures |
| *Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat | |
Regional lymph nodes (N) |
|
| Clinical N (cN) | |
| 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 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) with clinically overt ENE (+) |
| N3a | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-) |
| N3b | Metastasis in any node(s) with 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 a single ipsilateral 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 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 8. Prognostic Stage Groups for Hypopharyngeal Cancer (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 |
Tables
- Table 1. TNM Classification of HPV-Mediated (p16+) Oropharyngeal Cancer
- Table 2. Clinical Prognostic Groups for HPV-Mediated (p16+) Oropharyngeal Cancer (cTNM)
- Table 3. Pathological Prognostic Groups for HPV-Mediated (p16+) Oropharyngeal Cancer (pTNM)
- Table 4. TNM Classification of Non–HPV-Mediated (p16) Oropharyngeal Cancer
- Table 5. Prognostic Stage Groups for Non–HPV-Mediated (p16 -) Oropharyngeal Cancer
- Table 6. Histologic grade
- Table 7. Hypopharyngeal Cancer TNM Classification
- Table 8. Prognostic Stage Groups for Hypopharyngeal Cancer
Primary tumor (T) |
|
T0 |
No primary tumor identified |
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 |
T4 |
Moderately advanced local disease Tumor invades the larynx, extrinsic muscle of the tongue, medial pterygoid, hard palate, or mandible or beyond* |
* Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of the larynx. |
|
Regional lymph nodes (N) |
|
| Clinical N (cN) | |
NX |
Regional nodes cannot be assessed |
N0 |
No regional lymph node metastasis |
N1 |
One or more ipsilateral lymph nodes, none > 6 cm |
N2 |
Contralateral or bilateral lymph nodes, none > 6 cm |
N3 |
Lymph node(s) > 6 cm |
| Pathological N (pN) | |
| NX | Regional nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in 4 or fewer lymph nodes |
| N2 | Metastasis in more than 4 lymph nodes |
Distant metastasis (M) |
|
cM0 |
No distant metastasis |
cM1 |
Distant metastasis |
| pM1 | Distant metastasis, microscopically confirmed |
Stage |
T |
N |
M |
I |
T0–T2 |
N0 |
M0 |
| T0–T2 | N1 | M0 | |
II |
T0–T2 |
N2 |
M0 |
T3 |
N0–N2 |
M0 |
|
III |
T0–T3 |
N3 |
M0 |
| T4 | N0–N3 |
M0 |
|
IV |
T Any | N Any | M1 |
Stage |
T |
N |
M |
I |
T0–T2 |
N0 |
M0 |
T0–T2 |
N1 |
M0 |
|
II |
T0–T2 |
N2 |
M0 |
T3–T4 |
N0 |
M0 |
|
T3–T4 |
N1 |
M0 |
|
III |
T3–T4 |
N2 |
M0 |
| IV | T Any | N Any | M1 |
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| 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 |
| T4 | Moderately advanced or very advanced local disease Tumor invades the larynx, extrinsic muscle of the tongue, medial pterygoid, hard palate, or mandible or beyond* |
| T4a | Moderately advanced local disease Tumor invades the larynx, 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 carotid artery |
| * Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of the larynx. | |
| Regional Lymph Nodes (N) | |
| Clinical N (cN) | |
| 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 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) with clinically overt ENE (+) |
| N3a | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-) |
| N3b | Metastasis in any node(s) with 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 a single ipsilateral 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 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 |
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 |
Histologic grade (G) |
|
GX |
Grade cannot be assessed |
G1 |
Well differentiated |
G2 |
Moderately differentiated |
G3 |
Poorly differentiated |
G4 |
Undifferentiated |
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| Tis | Carcinoma in situ |
| T1 | Tumor limited to one subsite of hypopharynx and/or ≤2 cm in greatest dimension |
| T2 | Tumor invades more than one subsite of hypopharynx or an adjacent site, or measures >2 cm but not more than 4 cm in greatest dimension without fixation of hemilarynx |
| T3 | Tumor >4 cm in greatest dimension or with fixation of hemilarynx or extension to esophageal mucosa |
| T4 | Moderately advanced or very advanced local disease |
| T4a | Moderately advanced local disease Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, esophageal muscle or central compartment soft tissue* |
| T4b | Very advanced local disease Tumor invades prevertebral fascia, encases carotid artery, or involves mediastinal structures |
| *Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat | |
Regional lymph nodes (N) |
|
| Clinical N (cN) | |
| 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 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) with clinically overt ENE (+) |
| N3a | Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-) |
| N3b | Metastasis in any node(s) with 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 a single ipsilateral 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 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 |
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 |
