A cancer of the nasopharynx can be staged using the TNM staging criteria of the American Joint Committee on Cancer (AJCC).
Anatomic extent of the nasopharynx:
(1) postero-superior wall: junction of the hard and soft palate to the base of the skull
(2) lateral wall: fossa of Rosenmuller
(3) inferior wall: superior surface of the soft palate
TNM |
Finding |
Designation |
T |
primary tumor cannot be assessed |
TX |
|
no evidence of primary tumor |
T0 |
|
carcinoma in situ |
Tis |
|
tumor confined to the nasopharynx |
T1 |
|
tumor extends to the oropharynx and/or nasal cavity without parapharyngeal extension (posterolateral invasion beyond the pharyngobasilar fascia) |
T2a |
|
any tumor with parapharyngeal extension (postero-lateral invasion beyond the pharyngobasilar fascia) |
T2b |
|
tumor involves bony structures and/or paranasal sinuses |
T3 |
|
tumor with intracranial extension and/or involvement of the cranial nerves, infratemporal fossa, hypopharynx, orbit, or masticator space |
T4 |
N |
regional lymph nodes cannot be assessed |
NX |
|
no regional lymph node metastasis |
N0 |
|
unilateral metastasis in lymph nodes <= 6 cm in greatest dimension, above the supraclavicular fossa |
N1 |
|
bilateral metastasis in lymph nodes <= 6 cm in greatest dimension, above the supraclavicular fossa |
N2 |
|
metastasis in lymph node > 6 cm in diameter |
N3a |
|
metastasis to a lymph node residing wholly or in part in the supraclavicular fossa |
N3b |
M |
presence of distant metastases cannot be assessed |
MX |
|
no distant metastasis |
M0 |
|
distant metastasis present |
M1 |
where:
• T4a lesions are potentially resectable while T4b are unresectable.
• Midline lymph nodes are considered ipsilateral nodes.
• The supraclavicular fossa is a triangular region with apices (1) superior margin of the sternal end of the clavicle, (2) the superior margin of the lateral end of the clavicle, (3) the point where the neck meets the shoulder.
TNM Groups |
Stage |
Tis, N0, M0 |
0 |
T1, N0, M0 |
I |
T2a, N0, M0 |
IIA |
T1, N1, M0 T2a, N1, M0 T2b, N0, M0 T2b, N1, M0 |
IIB |
T1, N2, M0 T2a, N2, M0 T2b, N2, M0 T3, N0, M0 T3, N1, M0 T3, N2, M0 |
III |
T4, N0 , M0 T4, N1, M0 T4, N2, M0 |
IVA |
any T, N3, M0 |
IVB |
any T, any N, M1 |
IVC |
Specialty: Hematology Oncology, Surgery, general, Otolaryngology