Chapter 084. Head and Neck Cancer (Part 4) pot

Chapter 084. Head and Neck Cancer
(Part 4)

Table 84-2 Definition of TNM–Nasopharynx

Primary Tumor (T) Stage Grouping
TX

Cannot be
assessed
Stage
0
Tis N0 M0

T0

No evidence
Stage
I
T1 N0 M0

Tis

Carcinoma in situ

Stage
IIA
T2a

N0 M0

T1

Tumor conf
ined
to the nasopharynx
Stage
IIB
T1 N1 M0

T2

Tumor extends to
soft tissues
T2 N1 M0


T2a Tumor
extends to the
oropharynx and/or nasal
cavity w/o
parapharyngeal
extension
T2a

N1 M0


T2b Any tumor
with parapharyngeal
extension

T2b

N1 M0

T3

Tumor
involves
bony structures and/or
paranasal sinuses
T2b

N1 M0

T4

Stage
III
T1

N2

M0

Tumor with
intracranial extension
and/or involvement of
cranial nerves,
infratemporal fossa,
hypopharynx, orbit, or

masticator space
T2a

N2 M0

Regional Lymph No
des
(N)
T2b

N2 M0

The distribution and the
prognostic impact of regional
lymph node spread from
nasopharynx cancer, particularly of
the undifferentiated type, are
different from those of other head
and neck mucosal cancers and
justify the use of a diff
erent N
classification scheme.
T3 N0 M0

NX Regional lymph nodes
cannot be assessed
T3 N1 M0

N0 No regional lymph node
metastasis

T3 N2 M0

N1 Unilateral metastasis in
lymph node(s),
≤6 cm in greatest
dimension, above the
supraclavicular fossa
T4 N0 M0

N2 Bilateral metastasis in
lymph node(s),
≤6 cm in greatest
dimension, above the
supraclavicular fossa
T4 N1 M0

N3 Metastasis in lymph
no
de(s), >6 cm and/or to
supraclavicular fossa
T4 N2 M0

N3a Greater than 6 cm in
dimension

Any
T
N3 M0

N3b Extension to the

supraclavicular fossa

Any
T
Any
N
M1


In patients with lymph node involvement and no visible primary, the
diagnosis should be made by lymph node excision. If the results indicate
squamous cell carcinoma, a panendoscopy should be performed, with biopsy of all
suspicious-appearing areas and directed biopsies of common primary sites, such as
the nasopharynx, tonsil, tongue base, and pyriform sinus.