Staging System: TNM
TNM is a tool that doctors use for describing the oropharyngeal cancer staging. Doctors also use outcomes of diagnostic scans and tests for answering questions. TNM stands for:
Tumor (T): What is the primary tumor’s size? What is its location?
Node (N): Has the tumor reached lymph nodes? If it is, where is it, and how much are there?
Metastasis (M): This is to know oropharyngeal cancer staging, i.e., has cancer spread to other body parts? If so, how much and where?
TNM systems can differ based on whether the diagnosis is oropharyngeal cancer, oral cancer, or HPV-based oropharyngeal cancer.
The TNM system outcomes are there to find the oropharyngeal cancer staging for one person. 4 to 5 stages are based on the diagnosis. Stage 0 (zero) is for non HPV oropharyngeal cancer. Stages 1 through 4 are for oropharyngeal and oral cancers. The stage is a common way to describe cancer, so the doctors work together to plan the best treatments.
More details on the TNM parts system for oropharyngeal cancer staging and oral cancers
The measurement of tumor size in centimeters (cm) and millimeters (mm); the centimeter is equal to a standard pencil or pen. Using the TNM system, “T” with a number or letter (0 to 4) describes the tumor’s location and size. Ten millimeters are 1 centimeter.
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Doctors also divide oropharyngeal cancer staging into small groups helping to describe the tumor in more detail. We’ve made a list of specific tumor info.
Oral Cavity Cancer
Here, you will get to know the most vital information about oropharyngeal cancer:
TX: You can’t elevate primary tumor
TIS: Is for describing the oropharyngeal cancer staging known as carcinoma (cancer) in situ. It is early cancer where cancer cells are only found in 1 tissue layer.
T1: The tumor is 2 cm less at the dimension. The tumor invades nearby tissues to 5mm depth or less; it is known as invasion depth.
T2: The tumor is 2 cm or small, and the invasion depth is around 5 to 10 mm. Or it can be larger than 2 cm but smaller than 4 cm, and the invasion depth is 10 mm or less.
T3: Tumor size is more than 4 cm, or it is any tumor with depth invasion better than 10 mm.
T4: This oropharyngeal cancer staging is a moderately advanced and very advanced local disease.
T4a (lip): The tumor starts on the lip but spreads or invades bone to the inferior alveolar nerve in the mouth, the floor of the mouth, or the face skin.
T4b: The tumor invades bones and muscles forming the base and mouth of the skull or/and encases internal arteries.
Oropharynx Cancer (Not Related To HPV)
TX: Doctors can’t find the primary tumor
TIS describes the oropharyngeal cancer staging known as carcinoma (cancer) in situ. It is early cancer with cancer cells in 1 tissue layer only.
T1: The tumor is 2 cm or small in dimension
T2: Tumor size is larger than 2 cm but not larger than 4 cm.
T3: Tumor is 4 cm larger or has spread on epiglottis, a flap of cartilage diverting food into the esophagus.
T4a: According to oropharyngeal cancer staging, the tumor invades the larynx, jaw muscles, tongue muscles, jawbone, or mouth roof.
T4b: Tumor invades bones and muscles in mouth region; nasopharynx, which is the air passageway at the upper throat region behind the nose; or the skull base or tumor encases carotid arteries.
Oropharyngeal Cancer Related To HPV
T0 (T plus zero): A tumor can’t be found in this oropharyngeal cancer staging.
T1: 2 cm size at most significant dimension.
T2: Tumor size exceeds 2 cm but is not larger than 4 cm.
T3: Tumor is 4cm larger and doesn’t spread to the epiglottis, meaning the cartilage flap keeps food from entering the airway while swallowing.
T4: Tumor invades larynx, tongue muscles, jaw muscles, or mouth roof or jawbone.
Node (N)
Careful lymph node assessment is a vital part of oropharyngeal cancer staging. We mean lymph nodes by a node in the TNM oropharyngeal cancer staging system. These bean-shaped small organs help fight infection. Lymph nodes where cancer begins are known as regional lymph nodes. There are lymph nodes in the neck and hand area.
After cancer spreads through lymph nodes into the surrounding tissue, it is known as the extranodal extension (ENE). Knowing whether the ENE is there also plays a vital part in evaluating lymph nodes in oropharyngeal and oral cancers that are not HPV-related.
Pathological and clinical methods are used to categorize N in the TNM oropharyngeal cancer staging system. “Pathological N” is for those having lymph node dissection. “Clinical N” is for patients without getting neck dissection (see “Surgery” in treatment types).
Oropharynx And Oral Cavity Cancers (Not Related To HPV) – Clinical N
NX: The regional lymph nodes can’t be evaluated
NO (N plus zero): There is no cancer evidence for oropharyngeal cancer staging in regional lymph nodes.
N1: Cancer spreads to a single lymph node on the same side of the primary tumor, and cancer in the node is 3 cm or small. There is not any presence of ENE.
N2a: Cancer spreads to a single lymph node on either body side, and none of these measures 6 cm larger. Any ENE is not there.
N2c: Cancer spreads to up to 1 lymph node on either body side. No presence of ENE is there. None of these measures are larger than 6 cm.
N3a: Cancer is present in lymph nodes larger than 6 cm. No ENE is there.
N3b: ENE is there in any lymph node.
Oropharynx And Oral Cavity Cancers (HPV Unrelated) – Pathological N
NX: No evaluation for regional lymph nodes.
N0 (N plus zero): Here, no cancer evidence is found for oropharyngeal cancer staging in regional lymph nodes.
N1: Cancer spreads to single lymph nodes on the same side as the primary tumor, and node tumor size is 3 cm or smaller. No ENE is there.
N2a: Cancer moved to a single lymph node and is 3 cm or smaller, but without any ENE. Or cancer also spreads to a single lymph node present on the primary tumor’s side, and its size exceeds 3 cm but is not larger than 6 cm, without any ENE.
N2b: Cancer spreads to up to 1 lymph node on the same side as the primary tumor, and none of these measures are more significant than 6 cm. No ENE is there.
N2c: Cancer is there in 1 lymph node on either body side, and none of it measures more than 6 cm. No ENE is there.
N3a: Cancer spreads to up to 1 lymph node, and its size is larger than 6 cm. No ENE is there.
N3b: Oropharyngeal cancer staging suggests a single lymph node is on the same side as the primary tumor with a size of 3 cm. Cancer spreads to different lymph nodes, and 1 of them has ENE. Or, ENE is there in a single lymph node on the opposite side of 3 cm or a small tumor.
HPV-Related Oropharyngeal Cancer – Clinical N
NX: You cannot evaluate regional lymph nodes
NO (N plus zero): There is no cancer evidence in regional lymph nodes.
N1: Cancer spreads to 1 or more lymph nodes on either body side, and none of these is 6 cm or more.
N3: Cancer location is a lymph node whose size is 6 cm or more.
Oropharyngeal Cancer Related To HPV – Pathological N
NX: Regional lymph nodes are not evaluated.
pNO (N plus zero): There is no cancer evidence in regional lymph nodes.
pN1: Cancer spreads from 1 to 4 lymph nodes
pN2: Cancer spreads to up to 4 lymph nodes.
Metastasis (M)
The “M” in the TNM oropharyngeal cancer staging system is for whether cancer spreads to other body parts, known as metastasis. It is for oropharyngeal and oral cancers.
M0 (M plus zero): Cancer didn’t spread to other body parts.
M1: Cancer is spread in other body parts.
Grouping Of Cancer Stage
Here doctors use a combination of T, N, and M info to say about oropharyngeal cancer staging.
The Cavity Of Oral Cancer
Stage 1: The tumor size is less than 2 cm, and the invasion depth is 5 mm or low. Cancer didn’t move to lymph nodes or other body areas (T1, N0, M0).
Stage 2: The tumor size is 2 cm or less, and invasion depth is 5 to 10 mm. Or tumor size is more than 2 cm but lesser than 4 cm. The invasion depth is 10 mm or less. Cancer hasn’t spread to the lymph nodes and other body parts (T2, N0, M0).
Stage 3: Either of the following is applicable for oropharyngeal cancer staging:
The tumor size is 4 cm or more, or it is a tumor with an invasion depth of more than 10 mm. Cancer didn’t spread to lymph nodes and other body parts (T3, N0, M0).
The tumor is of any size, but it didn’t invade nearby oral cavity structures. The tumor is present in one lymph node on the same side as a primary tumor, and the cancer is 3 cm or less. No presence of ENE is there. According to oropharyngeal cancer staging, cancer has not spread to other body parts (T1 to T3, N1, M0).
Stage IVA: Applicable for any of the following:
The tumor invaded nearby mouth structures, like sinuses, skin, jaw, or face. When cancer spreads to the lymph node, it is only one node on the same side as the primary tumor, and cancer is 3 cm or small, without any ENE. Cancer also spreads to other body parts (T4a, N0 or N1, M0).
Small tumor size, and it might have spread to nearby structures. The cancer spreads to 1 or more lymph nodes but is more than 6 cm. No ENE is there. Cancer doesn’t spread to other body parts (T1 to T4a, N2, M0).
Stage IVB: Either of the following applies for oropharyngeal cancer staging:
The tumor is any size. The cancer is found on the lymph node, up to 6 cm, but no ENE is there in any lymph node. Cancer doesn’t spread to other body parts (T, N3, M0).
The tumor invades bones and muscles, forming the base of the skull and mouth and/or encasing internal arteries. Cancer can involve lymph nodes, but it doesn’t spread to other body parts (T4b, any N, M0).
Stage IVC: Cancer reached other body parts (M1, any T, any N).
Oropharynx Cancer (Not Related To HPV)
Stage 0: carcinoma in situ, without spreading to lymph nodes and other body parts (Tis, N0, M0).
Stage 1: Tumor is 2cm or small, but you can’t spread cancer to lymph nodes and other body parts (T1, M0, N0).
Stage 2: Tumor size is 2 to 4 cm, but cancer hasn’t moved to lymph nodes and other body parts (T2, N0, M0).
Stage 3: Either of the following is possible for oropharyngeal cancer staging
Tumor size is up to 4 cm and moved to the epiglottis, but it hasn’t moved to lymph nodes and other body parts (T3, M0, N0)
The tumor didn’t invade nearby tissues, except epiglottis. The tumor is on 1 lymph node on the primary tumor’s side and is 3 cm or less in size, without any ENE. Cancer didn’t spread to other body parts (T1 to T3, M0, N1).
Stage IVA: Applicable for either of the following
The tumor invaded the larynx, tongue, jaw, jawbone, and mouth roof. Cancer spreads to a lymph node, but it doesn’t spread to other body parts (T4a, N1, M0, or N1).
The tumor can be small, or it might have reached nearby areas like the larynx, tongue muscles, mouth roof, jawbone, or jaw muscles. The cancer spreads to 1 or more lymph nodes, but none is larger than 6 cm. No ENE is there. Cancer doesn’t spread to other body parts (T1 to T4a, M0, or N2).
Stage IVB: You can apply either of the following
The tumor can be of any size. Cancer follows in lymph nodes and is larger than 6 cm, but there is no ENE or ENE in any lymph node. Cancer doesn’t spread to other body parts (any T, M0, N3).
The tumor is in bones and muscles in the mouth region; nasopharynx, the air passageway at the upper throat behind the nose; or skull base or tumor encasing carotid artery. It can or cannot involve lymph nodes. Cancer didn’t spread to other body parts (N, T4b, M0).
Stage IVC: Cancer reached other body parts (N, T, M1).
HPV Oropharyngeal Cancer
Here HPV related oropharyngeal cancer staging groups are different based on whether lymph nodes are present clinically or pathologically.
Groups According To Clinical Stage
Stage 1: Tumor is 4 cm or small. When cancer doesn’t spread to lymph nodes, none of the tumors is larger than 6 cm, and it is only for lymph nodes on body sides as the primary tumor. Cancer didn’t spread to other body parts (T0 to T2, N0 or N1, M0).
Stage 2: Any of these is applicable for oropharyngeal cancer staging:
The tumor size is 4 cm or less. One or more lymph nodes on either body side are affected, and none is lesser than 6. Cancer didn’t spread to other body parts (T0, T2, N2, M0).
The tumor is more than 4 cm and is present in the epiglottis. When lymph nodes are there, no cancer is up to 6 cm. Cancer didn’t spread to other body parts (N0, T3, M0, N2).
Stage 3: Any of the following is applicable for oropharyngeal cancer staging:
The tumor size is undetermined. Cancer is present in lymph nodes and is up to 6 cm. it hasn’t spread to other body parts (N3, any T, M0).
Tumor invades the larynx, tongue muscles, jaw muscles, jawbone, or mouth roof. Lymph nodes can or cannot be present. Cancer hasn’t spread to other body areas (N, M0, T4).
Stage 4: According to oropharyngeal cancer staging, cancer is in other body areas (any N, M1, any T)
Pathological Stage Groups
Stage 1: The cancer is 4 cm or less. The tumor has 4 or fewer lymph nodes. Cancer didn’t move to other body parts (T2, T0, pN1 or pN0, M0).
Stage 2: Any of the following is applicable for oropharyngeal cancer staging;
The tumor size is 4 cm or less. Cancer is present in 4 or more lymph nodes. It hasn’t spread to other body parts (T2, T0, M0, pN2).
The tumor measures up to 4 cm or reaches the surrounding structures. Cancer spread to 4 lymph nodes. It didn’t spread to other body parts (T4 or T3, pN1 or pN0, M0).
Stage 3: Tumor is up to 4 cm, or it also invaded areas nearby. The cancer moved to 4 lymph nodes or more. It didn’t spread to other body parts (T3 or T4, M0, pN2).
Stage 4: Cancer moved to other body parts (pN, T, M1).
Grade (G)
Doctors also do oropharyngeal cancer staging with a grade (G). With the grade, they know about the appearance of the cancer cells under a microscope view. It is only for oropharyngeal and oral cancers. Oropharyngeal and HPV-related cancer doesn’t have another grading system. It is only for oropharyngeal and oral cancers.
Doctors compare cancerous tissue and healthy tissue. The healthy tissue generally has different cell types grouped. It is known as a “low-grade tumor” or “poorly differentiated tumor.” The cancer grade helps the doctor know about oropharyngeal cancer staging. Generally, a lower grade tumor leads to a better prognosis.
Conclusion
Recurrent or relapsed cancer means that cancer comes again (recurred) even after the treatment. It is not an actual TNM system oropharyngeal cancer staging. Oropharyngeal recurrent oral cavity cancer returns in the throat or mouth, surrounding lymph nodes, or other body parts. To know more about the stages of oropharyngeal cancer and its correct treatment procedure, you can consult accredited cancer specialists at University Cancer Centers. At University Cancer Centers, our intent lies in treating and curing cancer patients with the most intensive care and holistic approach to ensure a speedy recovery and a normal balanced life. We are always patient-centric and are there with you in your journey towards good health and better well-being.
