TNM Staging for Cancers of the Hypopharynx

A cancer of the hypopharynx can be staged using the TNM staging criteria of the American Joint Committee on Cancer (AJCC).

Anatomic extent of the hypopharynx:

(1) pharyngo-esophageal junction

(2) pyriform sinus

(3) posterior pharyngeal wall

NOTE: This staging scheme does not include tumors of soft, hematopoietic or lymphoid tissues.

TNM Parameter	Finding	Designation
T	primary tumor cannot be assessed	TX
	no evidence of primary tumor	T0
	carcinoma in situ	Tis
	tumor limited to one subsite of the hypopharynx and is <= 2 cm in diameter	T1
	tumor invades more than 1 subsite of the hypopharynx, or invades into an adjacent site, or measures from 2.01 to 4 cm in diameter, without fixation of the hemilarynx	T2
	tumor measures > 4 cm in diameter, or there is fixation of the hemilarynx	T3
	tumor invades into the thyroid or cricoid cartilage, hyoid bone, thyroid gland, esophagus or central compartment soft tissue	T4a
	tumor invades the prevertebral fascia, encases the carotid artery or involves mediastinal structures	T4b
N	regional lymph nodes cannot be assessed	NX
	no regional lymph node metastasis	N0
	metastasis in a single ipsilateral lymph node <= 3 cm in greatest dimension	N1
	metastasis in a single ipsilateral lymph node > 3 cm but <= 6 cm in greatest dimension	N2a
	metastasis in multiple ipsilateral lymph nodes, all <= 6 cm in diameter	N2b
	metastasis in bilateral or contralateral lymph nodes, all <= 6 cm in diameter	N2c
	metastasis in lymph node > 6 cm in diameter	N3
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.

• Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat.

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