Stage Information
TNM Definitions
AJCC Stage Groupings
The staging systems are all clinical staging and are based on the best possible
estimate of the extent of disease before treatment. The assessment of the
primary tumor is based on inspection and palpation when possible and by both
indirect mirror examination and direct endoscopy when necessary. The tumor
must be confirmed histologically, and any other pathologic data obtained on
biopsy may be included. The appropriate nodal drainage areas are examined by
careful palpation. Information from diagnostic imaging studies may be used in
staging. Magnetic resonance imaging offers an advantage over computed
tomographic scans in the detection and localization of head and neck tumors and
in the distinction of lymph nodes from blood vessels.[1] If a patient
relapses, complete restaging must be done to select the appropriate additional
therapy.[2,3]
The American Joint Committee on Cancer (AJCC) has designated staging by TNM
classification.[4]
TNM Definitions
Primary tumor (T)
Regional lymph nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Metastasis in a single ipsilateral lymph node, no larger than 3 cm in greatest
dimension
- N2: Metastasis in a single ipsilateral lymph node, larger than 3 cm but no larger than 6 cm in greatest dimension; or in multiple ipsilateral lymph
nodes, no larger than 6 cm in greatest dimension; or in bilateral or
contralateral lymph nodes, no larger than 6 cm in greatest dimension
- N2a: Metastasis in a single ipsilateral lymph node larger than 3 cm but no larger than 6 cm in dimension
- N2b: Metastasis in multiple ipsilateral lymph nodes, no larger than 6 cm
in greatest dimension
- N2c: Metastasis in bilateral or contralateral lymph nodes, no larger than 6 cm in greatest dimension
- N3: Metastasis in a lymph node larger than 6 cm in greatest dimension
In clinical evaluation, the actual size of the nodal mass should be measured
and allowance should be made for intervening soft tissues. Most masses larger than 3 cm in diameter are not single nodes but are confluent nodes or
tumors in soft tissues of the neck. The three stages of clinically positive
nodes are: N1, N2, and N3. The use of subgroups a, b, and c is not required but
is recommended. Midline nodes are considered homolateral nodes.
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1: Distant metastasis
AJCC Stage Groupings
Stage 0
Stage I
Stage II
Stage III
- T3, N0, M0
- T1, N1, M0
- T2, N1, M0
- T3, N1, M0
Stage IVA
- T4a, N0, M0
- T4a, N1, M0
- T1, N2, M0
- T2, N2, M0
- T3, N2, M0
- T4a, N2, M0
Stage IVB
- Any T, N3, M0
- T4b, any N, M0
Stage IVC
References
-
Consensus conference. Magnetic resonance imaging. JAMA 259 (14): 2132-8, 1988.
[PUBMED Abstract]
-
Harrison LB, Sessions RB, Hong WK, eds.: Head and Neck Cancer: A Multidisciplinary Approach. Philadelphia, Pa: Lippincott-Raven, 1999.
-
Wang CC, ed.: Radiation Therapy for Head and Neck Neoplasms. 3rd ed. New York: Wiley-Liss, 1997.
-
Lip and oral cavity. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 23-32.
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