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. The tumor must be confirmed
histologically, and any other pathologic data obtained from a biopsy may be
included. Additional radiographic studies may be included. As an adjunct to clinical examination, computed tomography and/or magnetic resonance imaging are needed for an accurate staging of laryngeal and hypopharyngeal carcinomas because both cross-sectional imaging modalities are known to reliably evaluate deep tumor infiltration.[1-3] The appropriate nodal
drainage areas are examined by careful palpation. If a patient relapses,
complete restaging must be done to select the appropriate additional therapy.
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 greatest 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 confluent nodes or tumors in
soft tissues of the neck. There are three stages of clinically positive nodes:
N1, N2, and N3. The use of subgroups a, b, and c is not required but
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
- T4b, any N, M0
- Any T, N3, M0
Stage IVC
References
-
Thabet HM, Sessions DG, Gado MH, et al.: Comparison of clinical evaluation and computed tomographic diagnostic accuracy for tumors of the larynx and hypopharynx. Laryngoscope 106 (5 Pt 1): 589-94, 1996.
[PUBMED Abstract]
-
Becker M: Larynx and hypopharynx. Radiol Clin North Am 36 (5): 891-920, vi, 1998.
[PUBMED Abstract]
-
Keberle M, Kenn W, Hahn D: Current concepts in imaging of laryngeal and hypopharyngeal cancer. Eur Radiol 12 (7): 1672-83, 2002.
[PUBMED Abstract]
-
Pharynx (including base of tongue, soft palate and uvula). In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 31-46.
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