Staging
Staging is a process that tells a doctor if the cancer has spread and if it has, how far. Staging for pharyngeal cancer depends on the location and extent of the tumor, and whether it has invaded any lymph nodes or nearby structures. Staging is an important step in evaluating prognosis and treatment options.
Staging of Oropharyngeal Cancer for tumors with the p16 marker (HPV-related)
Stage 0
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Description
- Cancer of unknown primary is staged at a “tumor stage” of 0. This is when HPV related cancer from the oropharynx spreads to the lymph nodes. However, overall the stage which the patient is assigned is related to the extent of lymph nodes and as such, “Stage 0” is not a realistic scenario. The situation of “carcinoma in-situ”, defined as abnormal but non-invasive cells found in top layer of tissue, is not an accepted entity as compared with the other regions of the head and neck such as the hypopharynx.
Stage I
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Description
- Tumor is less than 4cm in diameter AND less than 5 lymph nodes are involved with the cancer (none greater than 6 cm in size) OR the tumor site is not identified (Cancer of Unknown Primary) less than 5 lymph nodes are involved with the cancer (none greater than 6 cm in size).
Stage II
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Description
- Tumor is greater than 4 cm OR is growing onto the upper surface of the epiglottis OR cancer is in 5 or more lymph nodes (none greater than 6 cm in size) OR there are lymph nodes involved in cancer on both sides of the neck.
Stage III
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Description
- Tumor invades beyond the boundaries of the oropharynx such as invading the voice box, muscles of the tongue, or beyond, OR a tumor of any size with a single lymph nodes involved with cancer that has grown larger than 6cm.
Stage II
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Description
- Cancer has spread to distant organs or parts of the body, most often the lungs, bones, liver, or mediastinal lymph nodes (lymph nodes between the lungs).
Staging of Oropharyngeal Cancer for tumors without the p16 marker (Non-HPV-related)
Stage 0
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Description
- “Carcinoma in-situ.” Abnormal, but non-invasive cells found in top layer of tissue, generally considered "pre-cancerous".
Stage I
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Description
- Tumor is 2 cm or less in diameter and has no lymph node involvement.
Stage II
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Description
- Tumor is greater than 2 cm but no greater than 4 cm in diameter and has no lymph node involvement.
Stage III
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Description
- Tumor is greater than 4 cm in diameter or has invaded the epiglottis.
- OR
- Cancer has spread to a single lymph node on the same side of the neck that is 3 cm or less in diameter.
Stage IVa
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Description
Tumor has spread to nearby structures such as the larynx, muscles that move the tongue, the roof of the mouth, or the jaw bone. Cancer may or may not have spread to a single lymph node on the same side of the neck that is 3 cm or less in diameter.
OR
Cancer has spread to:
- One lymph node on the same side of the neck that is greater than 3 cm but no greater than 6 cm in diameter, or
- Multiple lymph nodes on the same side of the neck, none greater than 6 cm in diameter, or
- Lymph nodes on opposite or both sides of the neck, none more than 6 cm in diameter
Stage IVb
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Description
- Tumor has grown even deeper into nearby tissues, such as the nasopharynx, skull base, carotid artery, or the muscles that move the jaw. Cancer may or may not have spread to nearby lymph nodes.
- OR
- Cancer has spread to one or more lymph nodes that are greater than 6 cm in diameter.
Stage IVc
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Description
- Cancer has spread to distant organs or parts of the body, most often the lungs, bones, liver, or mediastinal lymph nodes (lymph nodes between the lungs).
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Staging of Nasopharyngeal Cancer
- Stage 0: “Carcinoma in-situ.” Abnormal, but non-invasive cells found in top layer of tissue, generally considered "pre-cancerous".
- Stage I: Cancer is located only in the nasopharynx, or cancer has spread into the oropharynx and/or nasal cavity.
- Stage II:
Cancer is located only in the nasopharynx, or has spread into the oropharynx and/or nasal cavity. Cancer has also spread to one lymph node in the neck on the same side as the tumor that is 6 cm or less in diameter, OR cancer has spread to lymph nodes behind the pharynx that are 6 cm or less.
OR
Cancer has spread to nearby tissue surrounding the nasopharynx (parapharyngeal space), and may or may not have spread to nearby lymph nodes.
- Stage III:
Tumor has spread to the base of the skull or the paranasal sinuses. Cancer may or may not have spread to lymph nodes in the neck or throat, but none are greater than 6 cm in diameter.
OR
Cancer has spread to lymph nodes on both sides of the neck, none of which are greater than 6 cm in diameter. Cancer may be confined to the nasopharynx, may have spread to the oropharynx or nasal cavity, or may have spread to tissues around the nasopharynx.
- Stage IVa: Moderately advanced local disease
Tumor has spread to the skull or cranial nerves, the hypopharynx, the eye socket, jaw bone, or nearby tissues. Cancer may have spread to lymph nodes in the neck, none of which are greater than 6 cm.
- Stage IVb: Very advanced local disease
Cancer has spread to one or more lymph nodes that are greater than 6 cm in diameter or to lymph nodes in the area above the shoulder/collarbone.
- Stage IVc: Cancer has spread to distant organs or parts of the body, most often the lungs, bones, liver, or mediastinal lymph nodes (lymph nodes between the lungs).
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Staging of Hypopharyngeal Cancer
- Stage 0: “Carcinoma in-situ.” Abnormal, but non-invasive cells found in top layer of tissue, generally considered "pre-cancerous".
- Stage I: Tumor is 2 cm and/or less and limited to one section of the hypopharynx.
- Stage II:
Tumor is greater than 2 cm but no greater than 4 cm in diameter, and the vocal cords move normally.
OR
Tumor has spread to more than one section of the hypopharynx or adjacent tissues near the hypopharynx.
- Stage III:
Tumor is greater than 4 cm in diameter OR has caused the vocal cords to stop moving OR has spread to the esophagus.
OR
Cancer has spread to a single lymph node on the same side of the neck that is 3 cm or less in diameter.
- Stage IVa: Moderately advanced local disease
Tumor has spread to the thyroid cartilage, thyroid gland, hyoid bone (bone under the tongue), or fat/muscles in front of the larynx. Cancer may or may not have spread to one lymph node on the same side of the neck that is 3 cm or less in diameter.
OR
Cancer has spread to:
-
- 1 lymph node on the same side of the neck that is between 3 cm and 6 cm in diameter, or
- multiple lymph nodes on the same side of the neck, none of which are greater than 6 cm, or
- lymph nodes on opposite or both sides of the neck, none of which are greater than 6 cm.
-
- Stage IVb: Very advanced local disease
Tumor has spread to the tissue in front of the spine, the carotid artery, or the area between the lungs.
OR
Cancer has spread to one or more lymph nodes that are greater than 6 cm in diameter.
- Stage IVc: Cancer has spread to distant organs or parts of the body, most often the lungs, bones, liver, or mediastinal lymph nodes (lymph nodes between the lungs).
