Part of Cancer staging guidance sheets
Pharynx (ICD10 C01, C02.4, C05.1-2, C09, C10.0, C10.2-3, C10.9, C11-13)
Introduction
This is the data sheet for TNM 9th edition staging of the pharynx (ICD10 C01, C02.4, C05.1-2, C09, C10.0, C10.2-3, C10.9, C11-13)
For more detailed information regarding TNM staging, please see pages 23-33 of the UICC TNM 9 book.
Stage groupings
Nasopharynx
|
Stage Group |
T stage |
N stage |
M stage |
|---|---|---|---|
|
Stage 0 |
Tis |
N0 |
M0 |
|
Stage IA |
T1, T2 |
N0 |
M0 |
|
Stage IB |
T0, T1, T2 |
N1 |
M0 |
|
Stage II |
T0, T1, T2 |
N2 |
M0 |
|
|
T3 |
N0, N1, N2 |
M0 |
|
Stage III |
T4 |
Any N |
M0 |
|
|
Any T |
N3 |
M0 |
|
Stage IVA |
Any T |
Any N |
M1a |
|
Stage IVB |
Any T |
Any N |
M1b |
Oropharynx - HPV associated
Clinical
|
Stage Group |
T stage |
N stage |
M stage |
|---|---|---|---|
|
Stage I |
T0 |
N1 |
M0 |
|
|
T1, T2 |
N0, N1 |
M0 |
|
Stage II |
T0, T1, T2 |
N2 |
M0 |
|
|
T3 |
N0, N1, N2 |
M0 |
|
Stage III |
Any T |
N3 |
M0 |
|
|
T4 |
Any N |
M0 |
|
Stage IV |
Any T |
Any N |
M1 |
Pathological
|
Stage Group |
T stage |
N stage |
M stage |
|---|---|---|---|
|
Stage I |
T0 |
N1 |
M0 |
|
|
T1, T2 |
N0, N1a, N1b |
M0 |
|
Stage II |
T0, T1, T2 |
N2, N3 |
M0 |
|
|
T3 |
N0, N1a, N1b, N2 |
M0 |
|
Stage III |
T3 |
N3 |
M0 |
|
|
T4 |
Any N |
M0 |
|
Stage IV |
Any T |
Any N |
M1 |
HPV - Independent Oropharynx and Hypoharynx
|
Stage Group |
T stage |
N stage |
M stage |
|---|---|---|---|
|
Stage 0 |
Tis |
N0 |
M0 |
|
Stage I |
T1 |
N0 |
M0 |
|
Stage II |
T2 |
N0 |
M0 |
|
Stage III |
T3 |
N0 |
M0 |
|
|
T1, T2, T3 |
N1 |
M0 |
|
Stage IVA |
T1, T2, T3 |
N2 |
M0 |
|
|
T4a |
N0, N1, N2 |
M0 |
|
Stage IVB |
T4b |
Any N |
M0 |
|
|
Any T |
N3 |
M0 |
|
Stage IVC |
Any T |
Any N |
M1 |
TNM clinical classification
Nasopharynx
T - primary tumour
|
T value |
Description |
|---|---|
|
cTX |
Primary tumour cannot be assessed |
|
cT0 |
No evidence of primary tumour, but EBV-positive (EBV-associated) cervical node(s) metastasis present |
|
cTis |
Carcinoma in situ |
|
cT1 |
Tumour confined to nasopharynx, or tumour extends to oropharynx and/or nasal cavity without parapharyngeal involvement |
|
cT2 |
Tumour with extension to parapharyngeal space or tumour infiltration of the medical pterygoid, lateral pterygoid, and/or prevertebral muscles |
|
cT3 |
Tumour invades bony structures of skull base, cervical vertebrae, pterygoid structures and/or paranasal sinuses |
|
cT4 |
Tumour with any of the following:
|
N - regional lymph nodes
|
N value |
Description |
|---|---|
|
cNX |
Regional lymph nodes cannot be assessed |
|
cN0 |
No regional lymph node metastasis |
|
cN1 |
Unilateral metastasis in cervical lymph node(s) and/or bilateral metastasis in retropharyngeal lymph nodes, and 6 cm or less in greatest dimension, and above the caudal border of cricoid cartilage, and without advanced clinical/radiological extranodal extension* |
|
cN2 |
Bilateral metastasis in cervical lymph nodes, and 6 cm or less in greatest dimension, and above the caudal border of cricoid cartilage and without advanced clinical/radiological extranodal extension* |
|
cN3 |
Metastasis in cervical lymph node(s) greater than 6 cm in greatest dimension or extension below the caudal border of cricoid cartilage or advanced clinical/radiological extranodal extension* |
Note:
*Advanced radiological and/or clinical extranodal extension is unequivocal evidence of tumour invasion into adjacent structures (i.e. skin, muscle, salivary gland and/or neurovascular bundles) identified by appropriate morphological imaging or clinical examination. Midline nodes are considered ipsilateral nodes.
M - distant metastasis
|
M value |
Description |
|---|---|
|
cM0 |
No distant metastasis |
|
cM1 |
Distant Metastasis cM1a - Distant metastasis. Three or fewer lesion(s) in one or more organs cM1b - Distant metastasis of more than three lesions in one or more organs |
Oropharynx - HPV associated
T - primary tumour
|
T value |
Description |
|---|---|
|
cT0 |
No evidence of primary tumour, but p16 positive (HPV-associated) cervical node(s) metastasis present |
|
cT1 |
Tumour 2 cm or less in greatest dimension* |
|
cT2 |
Tumour more than 2 cm but not more than 4 cm in greatest dimension |
|
cT3 |
Tumour more than 4 cm in greatest dimension or extension to lingual surface of epiglottis |
|
cT4 |
Tumour invades any of the following: larynx**, deep/extrinsic muscle of tongue (genioglussus, hyoglossus, palatoglossus and styloglossus), medial or lateral pterygoid muscle, hard palate, mandible, pterygoid plates (medial and/or lateral) nasopharynx, skull base, encases carotid artery |
Notes:
*The anatomical structure of the tonsillar crypts and lingual tonsil means that the basement membrane is incomplete and no carcinoma in situ is recognised.
**Mucosal extension to lingual surface of epiglottis from primary tumours of the base of the tongue and vallecula does not constitute invasion of the larynx.
N - regional lymph nodes
|
T value |
Description |
|---|---|
|
cNX |
Regional lymph nodes cannot be assessed |
|
cN0 |
No regional lymph node metastasis |
|
cN1 |
Metastasis in ipsilateral lymph node(s), all 6 cm or less in greatest dimension, without unequivocal imaging-detected and/or clinical extranodal extension |
|
cN2 |
Metastasis in ipsilateral lymph node(s), all 6 cm or less in greatest dimension, without unequivocal imaging-detected and/or clinical extranodal extension* OR contralateral or bilateral metastasis in lymph node(s), all 6 cm or less in greatest dimension, without unequivocal imaging-detected and/or clinical extranodal extension |
|
cN3 |
Metastasis in lymph node(s), greater than 6 cm in greatest dimension OR contralateral or bilateral metastasis in lymph node(s), with unequivocal imaging-detected and/or clinical extranodal extension* |
Note:
Imaging-detected extranodal extension (iENE) on appropriate morphological imaging refers to unequivocal radiologic signs of tumour invasion through the capsule of a lymph node into either perinodal fat or adjacent tissues (e.g. skin, muscle or neurovascular structures) or a coalescent nodal mass, which comprises ≥2 adjacent lymph nodes with loss of their intervening tissue planes and capsules to merge into a single indivisible structure. Clinical extranodal extension is defined as per Oral Cavity and Mucosal Lip. Midline nodes are considered ipsilateral nodes
M - distant metastasis
|
M value |
Description |
|---|---|
|
cM0 |
No distant metastasis |
|
cM1 |
Distant metastasis |
TNM pathological classification
The pT categories correspond to the cT categories
pN - regional lymph nodes
Oropharynx - HPV associated
|
N value |
Description |
|---|---|
|
pNX |
Regional lymph nodes cannot be assessed |
|
pN0 |
No regional lymph node metastasis |
|
pN1 |
Metastasis in 1-4 lymph nodes without definitive pathologic extranodal extension pN1a – Metastasis in 1 lymph node without definitive pathological extranodal extension pN1b - Metastasis in 2-4 lymph nodes without definitive pathological extranodal extension |
|
pN2 |
1-4 lymph nodes with definitive pathologic extranodal extension OR metastasis in >4 lymph nodes without definitive pathological extranodal extension |
|
pN3 |
Metastasis in >4 lymph nodes with definitive pathological extranodal extension |
Note
Pathological extranodal extension (pENE) should only be diagnosed when tumour that is present within the confines of a lymph node definitively transgresses through the entire thickness of the lymph node capsule into the surrounding connective tissue, with or without stromal reaction. A soft tissue deposit should be considered as at least one lymph node with extranodal extension if it occurs at a site where a regional lymph node would be expected.
TNM clinical classification
Oropharynx - HPV independent
T - Primary tumour
|
T value |
Description |
|---|---|
|
cTX |
Primary tumour cannot be assessed |
|
cT0 |
No evidence of primary tumour |
|
cTis |
Carcinoma in situ |
|
cT1 |
Tumour 2cm or less in greatest dimension |
|
cT2 |
Tumour more than 2cm but not more than 4cm in greatest dimension |
|
cT3 |
Tumour more than 4cm in greatest dimension or extension to lingual surface of epiglottis |
|
cT4a |
Tumour invades any of the following: larynx, * deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and Styloglossus), medial pterygoid, hard palate, mandible |
|
cT4b |
Tumour invades any of the following: lateral pterygoid muscle, pterygoid plates, nasopharynx, skull base; or encases carotid artery. |
Note
*Mucosal extension to the lingual surface or epiglottis from primary tumours of the base of the tongue and vallecula does not constitute invasion of the larynx.
Hypopharynx
T - Primary tumour
|
T value |
Description |
|---|---|
|
cTX |
Primary tumour cannot be assessed |
|
cT0 |
No evidence of primary tumour |
|
cTis |
Carcinoma in situ |
|
cT1 |
Tumour limited to one subsite of hypopharynx** and 2cm or less in greatest dimension |
|
cT2 |
Tumour invades more than one subsite of hypopharynx or an adjacent site OR tumour measures more than 2cm but not more than 4cm in greatest dimension, without fixation of hemilarynx |
|
cT3 |
Tumour more than 4cm in greatest dimension OR tumour with fixation of hemilarynx OR tumour with extension to oesophageal mucosa |
|
cT4a |
Tumour invades any of the following: thyroid/cricoid cartilage, hyoid bone, thyroid gland, oesophagus beyond the mucosa, central compartment soft tissue* |
|
cT4b |
Tumour invades prevertebral fascia, encases carotid artery or invades mediastinal structures |
Note
*Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat. Midline nodes are considered ipsilateral nodes.
** Hypopharynx subsites
1) Piriform sinus (C12.9): extends from the pharyngoepiglottic fold to the upper end of the oesophagus. It is bounded laterally by the thyroid cartilage and medially by the hypopharyngeal surface of the aryepiglottic fold (C13.1) and the arytenoid and cricoid cartilages.
2) Pharyngo-oesophageal junction (postcricoid area) (C13.0): extends from the level of the arytenoid cartilages and connecting folds to the inferior border of the cricoid cartilage, thus forming the anterior wall of the hypopharynx.
3) Posterior pharyngeal wall (C13.2): extends from the superior level of the hyoid bone (or floor of the vallecula) to the level of the inferior border of the cricoid cartilage and from the apex of one piriform sinus to the other.
Oropharynx - HPV independent and Hypopharynx
N - Regional lymph nodes
|
N value |
Description |
|---|---|
|
cNX |
Regional lymph nodes cannot be assessed |
|
cN0 |
No regional lymph node metastasis |
|
cN1 |
Metastasis in a single ipsilateral lymph node, 3cm or less in greatest dimension without clinical extranodal extension |
|
cN2 |
Metastasis described as: cN2a - Metastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension without clinical extranodal extension cN2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, without clinical extranodal extension cN2c - Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension, without clinical extranodal extension |
|
cN3a |
Metastasis in a lymph node more than 6 cm in greatest dimension without clinical extranodal extension |
|
cN3b |
Metastasis in a single or multiple lymph node with clinical extranodal extension* |
Note
* Clinical extranodal extension is defined as the presence of skin involvement or soft tissue invasion with deep fixation to underlying muscle or adjacent anatomical structures or clinical signs of nerve involvement. Imaging is becoming a standard method of detecting unequivocal extranodal extension. Midline nodes are considered ipsilateral nodes.
M - Distant metastasis
|
cM0 |
No distant metastasis |
|---|---|
|
cM1 |
Distant metastasis |
TNM pathological classification
The pT categories correspond to the T categories as per above.
Histological examination of a selective neck dissection specimen will ordinarily include six or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen should ordinarily include 15 or more lymph nodes.
pN - regional lymph nodes
Oropharynx –HPV independent and Hypopharynx
|
N value |
Description |
|---|---|
|
pNX |
Regional lymph nodes cannot be assessed |
|
pN0 |
No regional lymph node metastasis |
|
pN1 |
Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension without pathological extranodal extension |
|
pN2 |
Metastasis described as: |
|
|
pN2a - metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension with pathological extranodal extension* OR metastasis in a single ipsilateral lymph node, more than 3 cm but no more than 6 cm in greatest dimension without pathological extrandoal extension |
|
|
pN2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, without pathological extranodal extension |
|
|
pN2c - Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension, without pathological extranodal extension |
|
pN3 |
pN3a - Metastasis in a lymph node more than 6 cm in greatest dimension without pathological extranodal extension pN3b - Metastasis in a lymph node more than 3 cm in greatest dimension with pathological extranodal extension* OR metastasis in multiple ipsilateral, or any contralateral or bilateral node(s) with pathological extension* |
Note:
Pathological extranodal extension (pENE) should only be diagnosed when tumour that is present within the confines of a lymph node definitively transgresses through the entire thickness of the lymph node capsule into the surrounding connective tissue, with or without stromal reaction.
A soft tissue deposit should be considered as at least one lymph node with extranodal extension if it occurs where a regional lymph node would be expected.
Last edited: 20 January 2026 1:35 pm
