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Cancer Staging Systems

Staging of lip and oral cancer

TNM definition

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• Tis: Carcinoma in situ
• T1: Tumor 2 cm or less in greatest dimension
• T2: Tumor more than 2 cm but not more than 4 cm in greatest dimension
• T3: Tumor more than 4 cm in greatest dimension
• T4: (lip) Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, i.e., chin or nose
  • T4a: (oral cavity) Tumor invades adjacent structures (e.g., through cortical bone, into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus, and styloglossus], maxillary sinus, skin of face)
  • T4b: Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery

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 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

• Any T, N3, M0
• T4b, any N, M0

Stage IVC

• Any T, any N, M1

References

1. Lip and oral cavity. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 23-32. 

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