How is oral cavity and oropharyngeal cancer classified by stages?
After the diagnosis of cancer of the oral cavity or oropharynx, doctors will try to find out if the cancer has spread and if so, at what distance. This process is called staging (or stage determination). The stage (stage) of a cancer describes how much cancer is in the body, and helps to know how serious the cancer is, as well as the best way to treat it. Doctors also use the stage of a cancer when they talk about survival statistics.
Cancers of the oral cavity and oropharynx in earlier stages are identified as stage 0 (carcinoma in situ) and then go from stages I (1) to IV (4). As a rule, the lower the number, the less cancer has spread. A higher number, such as stage IV, means a greater spread of the cancer. In addition, within a stage, a lower letter means a less advanced stage. Although each person's cancer experience is unique, cancers with similar stages often have a similar prognosis, and are often treated very similarly.
How is the stage determined?
The most commonly used staging system for oral cavity and oropharyngeal cancer is the TNM system of the American Joint Committee on Cancer (AJCC), which is based on three key pieces of information:
The extent of the tumor (T): How large is the primary (primary) tumor and to which tissues, if any, of the oral cavity or oropharynx has spread.
Propagation to adjacent lymph nodes (nodes) (N): Has the cancer spread to nearby lymph nodes?
Propagation (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs?
The numbers and letters after the T, N and M provide more details about each of these factors. The higher numbers mean that the cancer is more advanced. Once a person's T, N, and M categories have been determined, this information is combined in a process called staging to assign a general stage.
The staging system detailed in the table below is the most recent AJCC system, in effect since January 2018. This system uses the pathological stage (also called the surgical stage). This is determined by examining the tissue removed during an operation. Often, if surgery is not possible immediately or not at all, the cancer will be assigned a clinical stage (which is not listed below). This is based on the results of a medical examination, endoscopy, biopsy, and imaging studies. The clinical stage will be used to help plan the treatment. Often, however, the cancer has spread more than the estimate of the clinical stage and may not provide a patient's prognosis as accurate as the pathological stage.
Oropharyngeal cancers that contain HPV DNA (called p16 positive) usually have a better prognosis than those that do not contain HPV (p16 positive). Because p16 positive cancers have a better prognosis than p16 negative oropharyngeal cancers, a different staging system has been created. Both systems are described below.
Cancer staging can be complex, so ask your doctor to explain it to you in a way that you can understand.
Stages of lip cancers, oral cavity and oropharynx p16 negative
Stage AJCC
Grouping to establish the stage
Description of the stages of cancers of the lip, oral cavity and oropharynx p16 negative
0
Tis
N0
M0
The cancer is still inside the epithelium (the superficial layer of the cells that line the oral cavity and the oropharynx) and has not yet expanded to the deeper layers.
It has not spread to nearby lymph nodes (N0) or distant sites (M0). This stage is also known as carcinoma in situ (Tis).I
T1
N0
M0
The cancer is 2 cm (approximately 3/4 of an inch) or less. It is not growing in nearby tissues (T1). It has not spread to adjacent lymph nodes (N0) or to distant sites (M0).
II
T2
N0
M0
The cancer measures more than 2 cm but is no more than 4 centimeters (approximately 1 1/2 inches). It is not growing in nearby tissues (T2). It has not spread to adjacent lymph nodes (N0) or to distant sites (M0).
III
T3
N0
M0
The cancer measures more than 4 cm (T3). For oropharyngeal cancers, T3 also includes tumors that are growing in the epiglottis (the base of the tongue). It has not spread to adjacent lymph nodes (N0) or to distant sites (M0).
OR
T1, T2, T3
N1
M0
The cancer has any size and may have grown into nearby structures of the oropharyngeal cancer (T1-T3) and has spread to a lymph node on the same side of the primary tumor. The cancer has not spread outside the lymph node and the lymph node is no more than 3 cm (approximately 1¾ inches) (N1). It has not spread to distant sites (M0).
VAT
T4a
N0 or N1
M0
Cancer has any size and is growing in nearby structures such as:
For lip cancers: the tumor is expanding into the adjacent bone, the inferior alveolar nerve (the nerve of the jaw), the floor of the mouth, or the skin of the chin or nose (T4a)
For oral cavity cancers: the tumor is expanding into the bones of the jaws or face, the internal muscle of the tongue, the skin of the face or the maxillary sinuses (T4a)
For oropharyngeal cancers: the tumor is expanding into the larynx (voice organ), muscle of the tongue or bones such as the middle pterygoid, hard palate or jaw (T4a).
This is also known as moderately advanced local disease (T4a).
ALSO one of the following:
It has not spread to adjacent lymph nodes (N0)
It has spread to 1 lymph node on the same side of the primary tumor, however it has not grown outside the lymph node and the lymph node does not measure more than 3 cm (about 1 ¼ inches) (N1).
It has not spread to distant sites (M0).
OR
T1, T2, T3 or T4a
N2
M0
The cancer has any size and could have grown in adjacent structures (T0-T4a). It has not spread to distant organs (M0). It has spread to one of the following sites:
1 lymph node on the same side of the primary tumor, however it has not grown outside the lymph node and the lymph node is no more than 3 cm but less than 6 cm (about 2 ½ inches) (N2a) OR
It has spread to more than one lymph node on the same side of the primary tumor, but it has not grown outside any of the lymph nodes and none is larger than 6 cm (N2b) OR
It has spread to one or more lymph nodes either on the opposite side of the primary tumor or on both sides of the neck, but has not grown outside any of the lymph nodes and none is larger than 6 cm (N2c).
IVB
Any T
N3
M0
The cancer has any size and may have grown into soft tissue or nearby structures (Any T) and any of the following:
It has spread to a lymph node that measures more than 6 cm but has not grown outside the lymph node (N3a) OR
It has spread to a lymph node that measures more than 3cm and has clearly grown outside the lymph node (N3b) OR
It has spread to more than one lymph node on the same side, on the opposite side, or on both sides of the primary cancer with growth outside of the lymph node (s) (N3b) OR
It has spread to a lymph node on the opposite side of the primary cancer which is 3 cm or less and has grown outside the lymph node (N3b).
It has not spread to distant organs (M0).
OR
T4b
Any N
M0
The cancer is any size and is growing in nearby structures such as the base of the skull or other nearby bones or surrounds the carotid artery. This is known as very advanced local disease (T4b). It may or may not have spread to adjacent lymph nodes (Any N). It has not spread to distant organs (M0).
IVC
Any T
Any N
M1The cancer has any size and may have grown in soft tissues or nearby structures (Any T) and may or may not have spread to adjacent lymph nodes (Any N). It has spread to distant organs such as the lungs (M1).
* The following additional categories are not described in the previous table:
TX: The main tumor can not be evaluated due to lack of information.
T0: There is no evidence of a primary tumor.
NX: Regional lymph nodes can not be evaluated due to lack of information.
Stages of oropharyngeal cancer p16 positive
Stage AJCC
Grouping to establish the stage
Description of stages of oropharyngeal cancer p16 positive *
I
T0, T1 or T2
N0 or N1
M0
The cancer does not measure more than 4 cm (about 1 1/2 inches) (T0 to T2) and any of the following:
It has not spread to adjacent lymph nodes (N0) OR
It has spread to one or more lymph nodes on the same side as the primary cancer, but none is larger than 6 cm (N1)
It has not spread to distant sites (M0).
II
T0, T1 or T2
N2
M0
The cancer does not measure more than 4 cm (about 1 1/2 inches) (T0 to T2) and has spread to one or more lymph nodes on the opposite side of the primary cancer or on both sides of the neck, none more than 6 cm (N2). It has not spread to distant sites (M0).
OR
T3 or T4
N0 or N1
M0
Cancer is more than 4 cm (about 1 1/2 inches) (T3) OR is growing in the epiglottis (the base of the tongue) (T3) O is growing in the larynx (voice organ), the muscle of the tongue, or in bones such as the middle pterygoid plate, the hard palate, or the jawbone (T4) any of the following:
It has not spread to adjacent lymph nodes (N0) OR
It has spread to one or more lymph nodes on the same side as the primary cancer, but none is larger than 6 cm (N1)
It has not spread to distant sites (M0).
III
T3 or T4
N2
M0
Cancer is more than 4 cm (about 1 1/2 inches) (T3) OR is growing in the epiglottis (the base of the tongue) (T3) O is growing in the larynx (voice organ), the muscle of the tongue, or in bones such as the middle pterygoid plate, the hard palate, or the jaw (T4) AND has spread to one or more lymph nodes on the side opposite the primary cancer or on both sides of the neck, none more than 6 cm (N2). It has not spread to distant sites (M0).
IV
Any T
Any N
M1
The cancer has any size and may have grown in nearby structures (Any T) and may or may not have spread to adjacent lymph nodes (Any N). It has spread to distant sites such as the lungs or bones (M1).
* The following additional categories are not described in the previous table:
TX: The main tumor can not be evaluated due to lack of information.
T0: There is no evidence of a primary tumor.
NX: Regional lymph nodes can not be evaluated due to lack of information.
Recurrent (recurrent) cancer
In the TNM system, this is not a real stage. A recurrent (relapsing) disease means that the cancer has come back (come back) after treatment. Recurrent cancer of the oral cavity or oropharynx may recur in the mouth or throat (local recurrence), in adjacent lymph nodes (regional recurrence), or in another part of the body, such as the lungs (distant recurrence).
Check with your doctor if you have any questions about the stage of your cancer or how it affects your treatment.
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