Head and Neck Cancer Staging

Laryngeal cancer is staged as follows:

• Stage 0 (carcinoma in situ): Abnormal cells are detected in the larynx lining. These cells have the potential to become cancerous.
• Stage I: Cancer cells are detected in the supraglottis, glottis or subglottis. The vocal cords still function normally.
• Stage II: Cancer cells are detected in the supraglottis (vocal cords work normally), glottis (vocal cords don’t work normally) or subglottis (vocal cords may not work normally).
• Stage III: Cancer cells are detected in the supraglottis, glottis or subglottis.
  • Stage III cancer of the supraglottis:
    • Cancer is only found in the larynx, the vocal cords don’t work properly and cancer has spread to the thyroid cartilage and possibly a nearby lymph node. The affected lymph node is 3 centimeters or less; or
    • Cancer cells are found in only one area of the supraglottis and the vocal cords function normally. Cancer has spread to a nearby lymph node and the lymph node is 3 centimeters or less; or
    • Cancer cells are found in multiple areas of the supraglottis or have spread to the tissues around the vocal cords or the base of the tongue. The vocal cords still function normally. Cancer has spread to a nearby lymph node, which is 3 centimeters or less.

• Stage III cancer of the glottis:
  • Cancer is only located in the larynx, the vocal cords don’t work and cancer has spread near or into the thyroid cartilage. Cancer cells may have spread to a nearby lymph node, which is 3 centimeters or less; or
  • Cancer is found in one or both vocal cords, which still function normally. It has spread to a nearby lymph node, which is 3 centimeters or less; or
  • Cancer has spread to the subglottis, supraglottis or both. The vocal cords don’t function properly. Cancer cells have also spread to a nearby lymph node, which is 3 centimeters or less.
  • Stage III cancer of the subglottis:
    • Cancer is found only in the larynx, the vocal cords don’t function properly and/or the cancerous cells have spread to the inner portion of the thyroid cartilage. Cancer cells may have spread to a nearby lymph node, which is 3 centimeters or less; or
    • Cancer is found in the subglottis only. Cancer cells have also spread to the nearby lymph node, which is 3 centimeters or less; or
    • Cancer has spread to one or both vocal cords, which may not function properly. Cancer cells have also spread to the nearby lymph node, which is 3 centimeters or less.
• Stage IV:
  • Stage IVA:
    • Cancer has spread beyond the larynx to areas like the thyroid, thyroid cartilage, esophagus, neck or trachea. Cancer cells have also spread to a nearby lymph node, which is 3 centimeters or less; or
    • Cancer has spread beyond the larynx to areas like the thyroid, thyroid cartilage, esophagus, neck or trachea. The vocal cords may not function properly. Cancer has spread:
      • To a lymph node on the same side of the neck as the primary tumor, which is 3 centimeters or less. Cancer cells have spread through the outer covering of the lymph node; or
      • To a lymph node on the same side of the neck as the primary tumor, which is between 3 and 6 centimeters. It hasn’t spread through the outer covering of the lymph node; or
      • To more than one lymph node on the same side of the neck as the primary tumor. The lymph nodes are less than 6 centimeters. Cancer hasn’t spread through the outside covering of the lymph nodes; or
      • To lymph nodes on both sides of the neck or the side of the neck opposite the tumor. Lymph nodes are 6 centimeters or less. Cancer has not spread through the outside covering of the lymph nodes.
    • Stage IVB: Cancer may have spread to the areas surrounding the carotid artery, between the lungs or in front of the spine. The vocal cords may not function properly. It has also spread:
      • To a lymph node that’s greater than 6 centimeters, but hasn’t spread through the outer covering of the lymph node; or
      • To a lymph node on the same side of the neck as the primary tumor and the lymph node is greater than 3 centimeters. Cancer cells have spread through the outer covering of the lymph node; or
      • To multiple lymph nodes in the neck and through the outer covering of the lymph nodes; or
      • To one lymph node in the neck on the opposite side of the tumor. Cancer cells have spread through the outer covering of the lymph nodes; or
      • To the areas surrounding the carotid artery, between the lungs or in front of the spine. The cancer cells may have spread to one or more lymph nodes in the neck. The lymph nodes can be any size.
    • Stage IVC: The cancer cells have spread to other parts of the body, such as the liver, lungs or bones.

Lip and oral cavity cancer is staged as follows:

• Stage 0 (carcinoma in situ): Abnormal cells detected in the lining of the oral cavity and lips. These abnormal cells can become cancerous.
• Stage I: The tumor is 2 centimeters or less and the deepest point of tumor invasion is 5 millimeters or fewer.
• Stage II: The tumor is:
  • 2 centimeters or less and the deepest point of tumor invasion is more than 5 millimeters; or
  • Between 2 and 4 centimeters and the deepest point of tumor invasion is 10 millimeters or fewer.
• Stage III: The tumor:
  • Is between 2 and 4 centimeters. The deepest point of tumor invasion is more than 10 millimeters; or
  • Is greater than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or less; or
  • Has spread to a single lymph node that’s 3 centimeters or less on the same side of the neck as the primary tumor.
• Stage IV:
  • Stage IVA: The tumor:
    • Is greater than 4 centimeters and the deepest point of tumor invasion is 10 millimeters or more, or the cells have spread to the outer surface of the jawbones, to the facial skin or to the maxillary sinus. It may have spread to a single lymph node that’s less than 3 centimeters on the same side of the neck as the original tumor; or
    • Is any size and has spread to the facial skin, maxillary sinus and upper or lower jawbone. Cancer has spread:
      • To a single lymph node that’s 3 centimeters or less near on the same side of the neck as the primary tumor and through the outer covering of the lymph node; or
      • To a single lymph node that’s between 3 and 6 centimeters on the same side as the primary tumor; or
      • To multiple lymph nodes that are smaller than 6 centimeters and on the same side of the neck as the original tumor or on the opposite side of the neck.
    • Stage IVB: Cancer has spread:
      • Further into the bones or muscles used for chewing or to the sphenoid bone near the upper jaw and/or near the carotid artery at the base of the skull. Cancer cells may be detected in one or more lymph nodes in the neck; or
      • To a lymph node on the opposite side of the neck as the primary tumor and through the outer covering of the lymph node to the nearby connective tissue; or
      • To multiple lymph nodes in the neck and through the outer covering of the lymph node to the nearby connective tissue; or
      • To one lymph node that’s more than 3 centimeters and near the primary tumor. It has spread through the outer covering of the lymph node to nearby connective tissue; or
      • To a single lymph node that’s greater than 6 centimeters.
    • Stage IVC: Cancer has spread to other parts of the body, such as the liver, lungs or bones.

There isn’t a staging system for metastatic squamous neck cancer with occult primary. If you’ve been diagnosed with this type of cancer, your physician will run tests to determine if cancer has spread elsewhere in the body.

Nasopharyngeal cancer is staged as follows:

• Stage 0: Abnormal cells are detected in the nasopharynx lining. These cells have the potential to become cancerous.
• Stage I: Cancer cells are found in the nasopharynx only or have also spread to the nasal cavity and/or the oropharynx.
• Stage II:
  • Cancer cells are found in one or more lymph nodes on one side of the neck or in the lymph nodes in the back of the throat. The lymph nodes are 6 centimeters or less. Cancer cells are also detected:
    • In the nasopharynx only or in the nasopharynx, oropharynx and/or nasal cavity; or
    • Only in the neck lymph nodes. These cancer cells are positive for the Epstein-Barr virus.
  • Cancer cells have spread to the surrounding muscles and/or the parapharyngeal space. Cancer may be present in one or multiple lymph nodes on one side of the neck or in the back of the throat. The lymph nodes are 6 centimeters or less.
• Stage III:
  • Cancer cells have spread to one or more lymph nodes on both sides of the neck. Lymph nodes are 6 centimeters or less. Cancer cells are also present in the:
    • Nasopharynx only or in the nasopharynx, oropharynx and/or nasal cavity; or
    • Neck lymph nodes only. These cancer cells are positive for the Epstein-Barr virus.
  • Cancer cells have spread to nearby muscles and/or the parapharyngeal space. They have also spread to at least one lymph node on both sides of the neck. The affected lymph nodes are 6 centimeters or less.
  • Cancer cells have spread to the sinuses around the eyes and nose, jaw muscles, bones in the neck and/or bones at the base of the skull. The affected lymph nodes are 6 centimeters or less.
• Stage IV:
  • Stage IVA:
    • Cancer cells have spread to the brain, soft tissues of the jaw, salivary gland in front of the ear, cranial nerves, hypopharynx and/or bone around the eye. Cancer may also be present in one or more lymph nodes on either or both sides of the neck or in the back of the throat. The affected lymph nodes are 6 centimeters or less.
    • Cancer has spread to at least one lymph node on one or both sides of the neck. The lymph nodes are greater than 6 centimeters and/or located in the lower part of the neck.
  • Stage IVB: Cancer cells have spread to distant lymph nodes (such as those in the groin, armpit, between the lungs or beneath the collarbone) or distant parts of the body, such as the liver, lungs or bones.

HPV-positive oropharyngeal cancer is staged as follows: 

• Stage I:
  • Cancer is found in one or more lymph nodes. The primary tumor (where the cancer began) is unknown. The affected lymph nodes as 6 centimeters or less on one side of the neck; or
  • Cancer cells are found in the throat (oropharynx) and the tumor is 4 centimeters or less. Cancer may have spread to one or more lymph nodes. The affected lymph nodes are 6 centimeters or smaller and located on the same side of the neck as the primary tumor.
• Stage II:
  • Cancer cells are found in one or more lymph nodes, which are 6 centimeters or less on one or both sides of the neck; or
  • The tumor is 4 centimeters or less. Cancer cells are detected in the lymph nodes, which are 6 centimeters or smaller, and located on the opposite side of the neck as the primary tumor or on both sides of the neck; or
  • The tumor is greater than 4 centimeters or cancer cells have spread to the epiglottis (a flap that covers the trachea when you swallow). Cancer cells may have spread to one or more lymph nodes anywhere in the neck. The affected lymph nodes are 6 centimeters or smaller.
• Stage III:
  • Cancer cells have spread to the voice box (larynx), lower jaw, muscles that move the tongue, front of the roof of the mouth, or other areas of the neck and head. Cancer may also be present in the lymph nodes in the neck; or
  • The tumor is any size and may have spread to the voice box (larynx), lower jaw, front of the roof of the mouth, muscles that move the tongue or other parts of the head and neck. Cancer cells may be present in one or more lymph nodes anywhere in the neck. The affected lymph nodes are greater than 6 centimeters.
• Stage IV: Cancer cells have spread to distant parts of the body, such as the bones or lungs. 

HPV-negative oropharyngeal cancer is staged as follows: 

• Stage 0 (carcinoma in situ): Abnormal cells are detected in the oropharynx (throat) lining. These cells have the potential to become cancerous.
• Stage I: Cancer cells are present in the oropharynx and the tumor is 2 centimeters or less.
• Stage II: The tumor is between 2 and 4 centimeters.
• Stage III: The tumor is:
  • Any size and has spread to a lymph node that’s 3 centimeters or smaller on the same side of the neck as the original tumor; or
  • Greater than 4 centimeters or has spread to the epiglottis (the flap that covers the trachea when you swallow).
• Stage IV:
• Stage IVA: Cancer:
  • Has spread to the voice box (larynx), muscles that move the tongue, lower jaw and front part of the roof of the mouth. Cancer cells may be present in a lymph node on the same side of the neck as the primary tumor. The affected lymph node is 3 centimeters or less.
  • Is any size and may have spread to the voice box (larynx), front part of the roof of the mouth, top of the epiglottis, muscles that move the tongue or lower jaw. It may have spread to:
    • A lymph node on the same side of the neck as the primary tumor. The affected lymph node is between 3 and 6 centimeters; or
    • Multiple lymph nodes anywhere in the neck that are 6 centimeters or less.
• Stage IVB: Cancer:
• Has spread to the area around the carotid artery or behind the nose, the lower jaw, the base of the skull or the bone attached to the muscle that moves the jaw. It may have spread to the lymph nodes in the neck; or
• May be any size and spread to other areas of the neck and head. It may be found in lymph nodes that are greater than 6 centimeters or have spread to the outer covering of the lymph node into the connective tissue.
• Stage IVC: Cancer has spread to distant parts of the body, such as the liver, lungs or bones.

There’s currently no standard staging system for cancer of the frontal sinuses and sphenoid.

Maxillary sinus cancer is staged as follows:

• Stage 0 (carcinoma in situ): Abnormal cells are detected in the mucus membranes that line the maxillary sinus. These cells have the potential to become cancerous.
• Stage I: Cancer is detected in the mucus membranes of the maxillary sinus.
• Stage II: Cancer is detected in the bone surrounding the maxillary sinus (including the nose and the roof of the mouth), but not in the portion of the sphenoid bone behind the upper jaw or in the bone at the back of the maxillary sinus.
• Stage III:
  • Cancer cells have spread to:
    • The tissues beneath the skin.
    • The bone at the back of the maxillary sinus.
    • The ethmoid sinus.
    • The area behind the cheekbone.
    • The bottom of the eye socket or the portion of the eye socket near the nose.
  • Cancer is present in the maxillary sinus and may have spread to:
    • The tissues beneath the skin.
    • The ethmoid sinus.
    • The bottom of the eye socket or the portion of the eye socket near the nose.
    • The area behind the cheekbone.
    • The roof of the mouth and nose.
  • Cancer is also present in one lymph node on the same side of the neck as the primary tumor. The affected lymph node is 3 centimeters or less.
• Stage IV:
  • Stage IVA:
    • Cancer cells have spread to any of the following:
      • Sphenoid or frontal sinuses
      • The bone between the eyes
      • The area behind the upper jaw
      • The eye
      • The skin on the cheek
      • The bone behind the upper jaw
    • Cancer cells are present in the maxillary sinus and may have spread to any of the following areas:
      • The ethmoid, frontal or sphenoid sinuses.
      • The area behind the cheekbone.
      • The area behind the upper jaw.
      • The bone behind the upper jaw.
      • The eye or eye socket (near the nose or on the bottom of the socket).
      • The tissues beneath the skin.
      • The bone between the eyes.
      • The bones in the nose and roof of the mouth.
    • Cancer has also spread to:
      • One lymph node on the same side of the neck as the primary tumor. The affected lymph node is between 3 and 6 centimeters; or
      • Multiple lymph nodes on the same side of the neck as the primary tumor. The lymph nodes are 6 centimeters or less; or
      • The lymph nodes on the opposite side of the neck as the primary tumor or on both sides of the neck. The affected lymph nodes are 6 centimeters or less.
    • Stage IVB:
      • Cancer has spread to any of the following:
        • The brain.
        • The cranial nerves.
        • The area behind the eye.
        • The base of the skull.
        • The upper portion of the throat near the nose.
        • The middle portions of the skull.
      • Cancer may be present in one or more lymph nodes of any size in any part of the neck.
      • Cancer may be found in or near the maxillary sinus. It has spread to a lymph node that is greater than 6 centimeters or has spread to the outer covering of the lymph node into the connective tissue.
    • Stage IVC: Cancer has spread to distant organs, such as the liver, lungs or bones.

 Nasal cavity and ethmoid sinus cancer is staged as follows: 

• Stage 0 (carcinoma in situ): Abnormal cells are detected in the mucus membranes that line the ethmoid sinus or nasal cavity. These cells have the potential to become cancerous.
• Stage I: Cancer cells are detected in one area in either the ethmoid sinus or the nasal cavity. It may have spread to the bone.
• Stage II: Cancer is detected in two nearby areas of the ethmoid sinus or nasal cavity, or the cancer cells have spread to an area near the sinuses. It may have spread to the bone.
• Stage III:
  • Cancer may have spread to any of the following:
    • The maxillary sinus
    • The roof of the mouth
    • The bone between the eyes
    • The portion of the eye socket near the nose or the bottom of the eye socket; or
  • Cancer is detected in the ethmoid sinus or nasal cavity and may have spread to any of the following:
    • The maxillary sinus
    • The portion of the eye socket near the nose or the bottom of the eye socket
    • The bone between the eyes
    • The roof of the mouth
  • Cancer has spread to a lymph node on the same side of the neck as the primary tumor. The lymph node is 3 centimeters or less.
• Stage IV:
  • Stage IVA:
    • The cancer cells have spread to any of the following:
      • The frontal or sphenoid sinuses
      • The front portions of the skull
      • The eye
      • The skin on the cheek or nose
      • The portion of the sphenoid bone behind the upper jaw
    • The cancer cells may have spread to a lymph node on the same side of the neck as the primary tumor. The affected lymph node is 3 centimeters or less; or
    • Cancer cells are detected in the ethmoid sinus or nasal cavity and may have spread to any of the following:
      • The front portions of the skull
      • The frontal or sphenoid sinuses
      • The portion of the sphenoid bone behind the upper jaw
      • The eye, the part of the eye socket near the nose or the bottom of the eye socket
      • The skin on the cheek or nose
    • Cancer cells have also spread to:
      • A lymph node on the same side of the neck as the primary tumor. The lymph node is between 3 and 6 centimeters; or
      • Multiple lymph nodes on the same side of the neck as the primary tumor. The affected lymph nodes are 6 centimeters or less; or
      • The lymph nodes on the opposite side of the neck as the primary tumor or on both sides of the neck. The affected lymph nodes are 6 centimeters or less.
  • Stage IVB:
  • Cancer cells have spread to any of the following:
    • The brain
    • The base of the skull
    • The cranial nerves
    • The upper portion of the throat behind the nose
    • The area behind the eye
    • The middle portions of the skull
  • Cancer may also be present in one or more lymph nodes anywhere in the neck; or
  • Cancer may be present in or near the ethmoid sinus or nasal cavity. Cancer cells have spread to a lymph node. The affected lymph node is greater than 6 centimeters. Cancer cells have spread through the outer covering of the lymph node into the connective tissue.
  • Stage IVC: Cancer has spread to distant parts of the body, such as the lungs, liver or bones.

Salivary gland cancer that affects the sublingual, submandibular and parotid glands is staged as follows: 

• Stage 0 (carcinoma in situ): Abnormal cells are detected in the salivary duct lining or the small sacs in the salivary gland. These abnormal cells have the potential to become cancerous.
• Stage I: A tumor of 2 centimeters or less is present in the salivary gland.
• Stage II: The tumor is only present in the salivary gland and is between 2 and 4 centimeters.
• Stage III:
  • The tumor is greater than 4 centimeters and/or has spread to the soft tissue surrounding the salivary gland; or
  • The tumor is any size and may have spread to the soft tissue surrounding the salivary gland. Cancer cells are present in one lymph node on the same side of the head or neck as the primary tumor. The lymph node is 3 centimeters or less and the cancer cells are contained to the lymph node.
• Stage IV:
  • Stage IVA:
    • Cancer cells have spread to the facial nerve, jawbone, skin and/or ear canal. Cancer may be present in one lymph node on the same side of the head or neck as the primary tumor. The lymph node is 3 centimeters or less and the cancer cells are contained to the lymph node; or
    • The tumor is any size and may have spread to the skin, ear canal, facial nerve, jawbone or soft tissue near the salivary gland. Cancer has also spread to:
      • A lymph node on the same side of the head or neck as the primary tumor. The lymph node is 3 centimeters or less. Cancer cells have grown outside the lymph node; or
      • A lymph node on the same side of the head or neck as the primary tumor. The lymph node is between 3 and 6 centimeters. Cancer has not spread outside the lymph node; or
      • Multiple lymph nodes on the same side of the head or neck as the primary tumor. The lymph nodes are 6 centimeters or less. Cancer cells have not spread outside the lymph nodes; or
      • Lymph nodes on both sides of the neck or head or on the opposite side as the primary tumor. The lymph nodes are 6 centimeters or less. Cancer cells have not spread beyond the lymph nodes.
  • Stage IVB:
  • The tumor is any size and cancer may have spread to the ear canal, facial nerve, jawbone, skin or soft tissue near the salivary gland. Cancer has spread to:
    • A single lymph node greater than 6 centimeters. Cancer has not spread beyond the lymph node; or
    • One lymph node on the same side of the neck or head as the primary tumor. The lymph node is greater than 3 centimeters. Cancer cells have spread beyond the lymph node; or
    • Multiple lymph nodes on the same side of the neck or head as the primary tumor, on both sides of the head or neck, or on the opposite side of the head or neck as the primary tumor. The cancer cells have spread outside of the lymph nodes; or
    • A single lymph node of any size on the opposite side of the head or neck as the primary tumor. The cancer cells have spread beyond the lymph node.
  • Cancer cells have spread to the base of the skull or around the carotid artery. Cancer may have spread to one or more lymph nodes anywhere on the head or neck and grown beyond the lymph nodes.
  • Stage IVC: Cancer has spread to distant parts of the body, such as the lungs, liver or bones.