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Cancer Staging Systems

Staging of hypopharyngeal cancer

TNM definition

TNM definitions

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• Tis: Carcinoma in situ
• T1: Tumor limited to 1 subsite* of the hypopharynx and 2 cm or less in greatest dimension
• T2: Tumor invades more than 1 subsite* of the hypopharynx or an adjacent site, or measures more than 2 cm but not more than 4 cm in greatest diameter without fixation of hemilarynx
• T3: Tumor measures more than 4 cm in greatest dimension or with fixation of hemilarynx
• T4a: Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, esophagus, or central compartment soft tissue (including prelaryngeal strap muscles and subcutaneous fat)
• T4b: Tumor invades prevertebral fascia, encases carotid artery, or involves mediastinal structures

  *Subsites of the hypopharynx are as follows:

  • Pharyngoesophageal junction (postcricoid area), extending from the level of the arytenoid cartilages and connecting folds to the inferior border of the cricoid cartilage.
  • Pyriform sinus, extending from the pharyngoepiglottic fold to the upper end of the esophagus, bounded laterally by the thyroid cartilage and medially by the surface of the aryepiglottic fold and the arytenoid and cricoid cartilages.
  • Posterior pharyngeal wall, extending from the level of the floor of the vallecula to the level of the cricoarytenoid joints.

Regional lymph nodes (N)

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
• N2: Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
  • N2a: Metastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension
  • N2b: Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
  • N2c: Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
• N3: Metastasis in a lymph node more than 6 cm in greatest dimension

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

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Stage grouping

Stage 0

• Tis, N0, M0

Stage I

• T1, N0, M0

Stage II

• T2, N0, M0

Stage III

• T3, N0, M0
• T1, N1, M0
• T2, N1, M0
• T3, N1, M0

Stage IVA

• T4a, N0, M0
• T4a, N1, M0
• T1, N2, M0
• T2, N2, M0
• T3, N2, M0
• T4a, N2, M0

Stage IVB

• T4b, any N, M0
• Any T, N3, M0

Stage IVC

• Any T, any N, M1

References

1. Pharynx (including base of tongue, soft palate and uvula). In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 31-46. 

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