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Head and neck cancer

Head and neck cancer stages

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 at Cancer Treatment Centers of America® (CTCA) will thoroughly review your medical history, family history and other factors to develop an individualized treatment plan for you. The stages of head and neck cancer are:

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 I (stage 1 head and neck cancer): The primary tumor is 2 cm across or smaller, and no cancer cells are present in nearby structures, lymph nodes or distant sites .

Stage II (stage 2 head and neck cancer): 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 III (stage 3 head and neck cancer): 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 IV (stage 4 head and neck cancer): This stage has several categories:

  • Stage IVA: 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 IVB: 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 IVC: 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.