Head and neck cancer staging

While staging head and neck cancer, the pathologist determines where exactly the disease formed, how extensive it is and whether and how much it has spread. The stage of head and neck cancer is one of the most important factors in determining treatment options that may be tailored to your needs.

Head and neck cancer stages are typically based on the results of physical exams, endoscopies, biopsies and imaging tests, such as CT scans, MRIs, chest X-rays and/or PET scans.

The American Joint Committee on Cancer developed the TNM cancer staging system to evaluate three primary factors when it comes to treating cancer:

T (tumor): This refers to the size of the primary tumor and to which, if any, tissues in the oral cavity and oropharynx the cancer has spread.

N (node): This describes the involvement of lymph nodes near the primary tumor. Lymph nodes are small, bean-shaped clusters of immune system cells that are key to fighting infections and are usually one of the first sites in the body to which cancer spreads.

M (metastasis): This indicates whether the cancer has spread (metastasized) to other areas of the body. With oral cancer, the most common site of metastases is the lungs, followed by the liver and bones.

During the head and neck cancer staging process, your doctor will assign T, N and M values to the disease based on its microscopic appearance. Your care team may also thoroughly review your medical history, family history and other factors to develop an individualized treatment plan for you.

Head and neck cancer stages

Stage 0

The tumor is only growing in the part of the head and neck where it started. No cancer cells are present in deeper layers of tissue, nearby structures, lymph nodes or distant sites (carcinoma in situ).

Stage 1 head and neck cancer

In stage 1, the primary tumor is 2 cm across or smaller, and no cancer cells are present in nearby structures, lymph nodes or distant sites .

Stage 2 head and neck cancer

In stage 2, the head and neck tumor measures 2-4 cm across, and no cancer cells are present in nearby structures, lymph nodes or distant sites.

Stage 3 head and neck cancer

In stage 3, the tumor fits one of the following criteria:

• It is larger than 4 cm across, and no cancer cells are present in nearby structures, lymph nodes or distant sites.
• It is any size but has not grown into nearby structures or distant sites. However, cancer cells are present in one lymph node, which is located on the same side of the head or neck as the primary tumor and is smaller than 3 cm across.

Stage 4 head and neck cancer

Stage 4 has several categories:

• Stage 4A: One of the following applies:
• The head and neck cancer tumor is any size and is growing into nearby structures. Cancer cells may not be present in the lymph nodes, or they may have spread to one lymph node, which is located on the same side of the head or neck as the primary tumor and is smaller than 3 cm across. Cancer has not spread to distant sites.
• The tumor is any size and may or may not have invaded nearby structures. It has not spread to distant sites, and one of the following is true:
  • Cancer cells are present in one lymph node, located on the same side of the head or neck as the primary tumor and measuring 3-6 cm across.
  • Cancer cells are present in one lymph node on the opposite side of the head or neck and measuring less than 6 cm across.
  • Cancer cells are present in two or more lymph nodes, all smaller than 6 cm across and located on either side of the head or neck.

• Stage 4B: One of the following applies:
• The tumor has invaded deeper areas and/or tissues. It may or may not have spread to lymph nodes and has not spread to distant sites.
• The tumor is any size and may or may not have grown into other structures. It has spread to one or more lymph nodes larger than 6 cm across, but has not spread to distant sites.

• Stage 4C: Cancer cells have spread to distant sites.
• The head and neck cancer tumor is any size and may or may not have spread to the lymph nodes.

Head and neck cancer survival rate

According to the American Cancer Society, approximately 4 percent of all cancer cases in the United States are head and neck cancers, and an estimated 71,100 Americans will be diagnosed with head and neck cancer in 2024, while 16,110 are expected to die from the disease.

Doctors often use five-year relative survival rates to help formulate a patient’s prognosis. These rates are calculated based on large datasets of past patients to estimate the likelihood someone with a specific cancer will survive for at least five years after their diagnosis, compared to those without cancer. It’s important to note, though, that survival rates only provide estimates based on averages.

Each type of head and neck cancers is linked to its own unique outcomes. As a result, limited survival data is available for head and neck cancers, and overall survival rates across all head and neck cancers are generally not available. Survival rates for specific types of head and neck cancer can be accessed via the National Cancer Institute Surveillance, Epidemiology, and End Results Program (SEER). Below are the overall five-year survival rates (including stages) for some types of head and neck cancer:

• Laryngeal cancer: 61 percent
• Oral cavity and pharynx cancer: 68 percent
• Lip cancer: 91.4 percent
• Tongue cancer: 68.8 percent

These rates vary substantially depending on the stage. For example, according to SEER, early-stage localized laryngeal cancer, which is confined to the larynx, has a five-year relative survival rate of 78.3 percent, while distant or metastatic laryngeal cancer has a survival rate of 33.9 percent.

Next topic: How is head and neck cancer diagnosed?