Oropharyngeal and Hypopharyngeal Cancer Staging 

Updated: Feb 05, 2018
  • 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 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