TNM Staging for Cancers of the Oropharynx

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

Anatomic extent of the oropharynx:

(1) anterior wall: base of tongue, vallecula

(2) lateral wall: tonsil, tonsillar fossa, tonsillar pillars, glossotonsillar sulci

(3) posterior wall

(4) superior wall: inferior surface of the soft palate, uvula

TNM	Finding	Designation
T	primary tumor cannot be assessed	TX
	no evidence of primary tumor	T0
	carcinoma in situ	Tis
	tumor <=2 cm in diameter	T1
	tumor > 2 cm and <= 4 cm in diameter	T2
	tumor > 4 cm in diameter	T3
	tumor invades the larynx, deep or extrinsic muscles of the tongue, medial pterygoid, hard palate or mandible	T4a
	tumor invades the lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, skull base or encases the carotid artery	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.

• Midline lymph nodes are considered ipsilateral nodes

• Muscles of the tongue include the genioglossus, hypoglossus, palatoglossus, and styloglossus.

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