Oral cancer staging
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Oral cancer staging On the Web |
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American Roentgen Ray Society Images of Oral cancer staging |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
According to the TNM staging system by the American Joint Committee on Cancer, there are four stages of oral cancer based on the tumor size, lymph nodes involved, and metastasis.
Staging
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. If a patient relapses, complete restaging must be done to select the appropriate additional therapy.
| T Classification | Thickness |
|---|---|
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ |
| T1 | Tumor ≤2 cm in greatest dimension. |
| T2 | Tumor >2 cm but ≤4 cm in greatest dimension. |
| T3 | Tumor >4 cm in greatest dimension. |
| T4a | Moderately advanced local disease.
(Lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, that is, chin or nose. (Oral cavity) Tumor invades adjacent structures only (e.g., through cortical bone [mandible or maxilla] into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of face). |
| T4b | Very advanced local disease.
Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery. |
| N Classification | Nodal Mass |
|---|---|
| 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 |
| N2 | Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension.
Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension. Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension. |
| N2a | Metastasis in single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension |
| N2b | Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension |
| N2c | Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension. |
| N3 | Metastasis in a lymph node >6 cm in greatest dimension. |
| M Classification | Definition |
|---|---|
| M0 | No evidence of distant metastasis |
| M1 | Distant metastasis |
| 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 | AnyT | N3 | M0 |
| T4b | AnyN | M0 | |
| IVC | AnyT | AnyN | M1 |
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 Any T N3 M0
T4b Any N M0
IVC Any T Any N M1 Definitions of TNM
The American Joint Committee on Cancer has designated staging by TNM classification to define lip and oral cavity cancer.
Table 1. Primary Tumor (T)a
aReprinted with permission from AJCC: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40.
bSuperficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumor as T4.
TX Primary tumor cannot be assessed.
T0 No evidence of primary tumor.
Tis Carcinoma in situ.
T1 Tumor ≤2 cm in greatest dimension.
T2 Tumor >2 cm but ≤4 cm in greatest dimension.
T3 Tumor >4 cm in greatest dimension.
T4a Moderately advanced local disease.b
(Lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, that is, chin or nose.
(Oral cavity) Tumor invades adjacent structures only (e.g., through cortical bone [mandible or maxilla] into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus, and styloglossus], maxillary sinus, or skin of face).
T4b Very advanced local disease.
Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery.
Table 2. Regional Lymph Nodes (N)a
aReprinted with permission from AJCC: Lip and oral cavity. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 29-40.
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.
N2 Metastasis in a single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension.
Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension.
Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension.
N2a Metastasis in single ipsilateral lymph node, >3 cm but ≤6 cm in greatest dimension.
N2b Metastases in multiple ipsilateral lymph nodes, none >6 cm in greatest dimension.
N2c Metastases in bilateral or contralateral lymph nodes, none >6 cm in greatest dimension.
N3 Metastasis in a lymph node >6 cm in greatest dimension.