Pharyngeal Cancer Staging

Source: National Cancer Institute

Staging is the process of finding out if and how far a cancer has spread.

Nasopharyngeal cancer

Stage 0 (Carcinoma in Situ) In stage 0, abnormal cells are found in the lining of the nasopharynx.  These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I
In stage I, cancer has formed and is found in the nasopharynx only.

Stage II
Stage II nasopharyngeal cancer is divided into stage IIA and stage IIB as follows:

Stage IIA
Cancer has spread from the nasopharynx to the oropharynx (the middle part of the throat that includes the soft palate, the base of the tongue and the tonsils), and/or to the nasal cavity.

Stage IIB
Cancer is found in the nasopharynx and has spread to lymph nodes on one side of the neck, or has spread to the area surrounding the nasopharynx and may have spread to lymph nodes on one side of the neck. The involved lymph nodes are 6 centimeters or smaller.

Stage III

In stage III nasopharyngeal cancer, the cancer:

  • is found in the nasopharynx and has spread to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller; or
  • has spread into the soft tissues (oropharynx and/or nasal cavity) and to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller;or
  • has spread beyond the soft tissues into areas around the pharynx and to lymph nodes on both sides of the neck and the lymph nodes are 6 centimeters or smaller;or
  • has spread to nearby bones or sinuses and may have spread to lymph nodes on one or both sides of the neck and the involved lymph nodes are 6 centimeters or smaller.

Stage IV
Stage IV nasopharyngeal cancer is divided into stage IVA, stage IVB and stage IVC as follows:

Stage IVA
Cancer has spread beyond the nasopharynx and may have spread to the cranial nerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer may also have spread to lymph nodes on one or both sides of the neck, and the involved lymph nodes are 6 centimeters or smaller.

Stage IVB
Cancer has spread to lymph nodes above the collarbone and/or the involved lymph nodes are larger than 6 centimeters.

Stage IVC
Cancer has spread beyond nearby lymph nodes to other parts of the body.

Oropharyngeal cancer
 
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the lining of the oropharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I
In stage I, cancer has formed and is 2 centimeters or smaller and has not spread outside the oropharynx.

Stage II
In stage II, the cancer is larger than 2 centimeters, but not larger than 4 centimeters, and has not spread outside the oropharynx.

Stage III
In stage III, the cancer is either:
  • larger than 4 centimeters and has not spread outside the oropharynx; or
  • any size and has spread to only one lymph node on the same side of the neck as the cancer. The lymph node with cancer is 3 centimeters or smaller.

Stage IVA
In stage IVA, the cancer either:
  • has spread to tissues near the oropharynx, including the voice box, roof of the mouth, lower jaw, muscle of the tongue or central muscles of the jaw, and may have spread to one or more nearby lymph nodes, none larger than 6 centimeters; or
  • is any size and has spread to one lymph node that is larger than 3 centimeters but not larger than 6 centimeters on the same side of the neck as the cancer, or to more than one lymph node, none larger than 6 centimeters, on one of both sides of the neck.

Stage IVB
In stage IVB, the cancer either:
 
  • surrounds the main artery in the neck or has spread to bones in the jaw or skull, to muscle in the side of the jaw or to the upper part of the throat behind the nose, and may have spread to nearby lymph nodes; or
  • has spread to a lymph node that is larger than 6 centimeters and may have spread to tissues around the oropharynx.

Stage IVC
In stage IVC, cancer has spread to other parts of the body; the tumor may be any size and may have spread to lymph nodes.
 
Hypopharyngeal cancer
 
Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the lining of the hypopharynx.  These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
 
Stage I
In stage I, cancer has formed in one area of the hypopharynx only and the tumor is 2 centimeters or smaller.
 
Stage II
In stage II, the tumor is either:

larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx (voice box); or
found in more than one area of the hypopharynx or in nearby tissues.

Stage III
In stage III, one of the following is found:
 
 
  • The tumor is in only one area of the hypopharynx and is 2 centimeters or smaller; cancer has also spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.
  • Cancer is in more than one area of the hypopharynx, is in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and is not in the larynx; cancer has also spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.
  • The tumor is larger than 4 centimeters or has spread to the larynx; cancer may have spread to a single lymph node on the same side of the neck and the lymph node is 3 centimeters or smaller.

Stage IV
Stage IV is divided into stage IVA, IVB and IVC as follows:

In stage IVA, the tumor:
  • can be any size and has spread to nearby soft tissue, connective tissue, the thyroid or the esophagus; cancer may be found either in one lymph node on the same side of the neck (the lymph node is 3 centimeters or smaller) or in one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller);or
  • is in only one area of the hypopharynx, is 2 centimeters or smaller, and has also spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller);

    or
     
  • is in more than one area of the hypopharynx, is in nearby tissues, or is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx; cancer has spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller);or
  • is larger than 4 centimeters or has spread to the larynx; cancer has also spread to one or more lymph nodes anywhere in the neck (all of these lymph nodes are 6 centimeters or smaller).

In stage IVB, the tumor either:
 
  • has spread to nearby soft tissue, connective tissue, blood vessels, the thyroid or the esophagus, and may have spread to lymph nodes of any size; or
  • is any size and has spread to lymph nodes that are larger than 6 centimeters.
  • In stage IVC, cancer has spread beyond the hypopharynx to other parts of the body.