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Pharynx (ICD10 C01, C05.1-2, C09, C10.0, C10.2-3, C11-13)

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Introduction

This is the data sheet for TNM 8th edition staging of the pharynx (ICD10 C01, C05.1-2, C09, C10.0, C10.2-3, C11-13).

For more detailed information regarding TNM staging, please see pages 6, 8 & 22-30 of the UICC TNM 8 book or visit the Wiley and UICC website.

Stage groupings

Oropharynx – P16 negative & hypopharynx

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

Oropharynx – P16 positive (clinical)

Stage Group

T stage

N stage

M stage

Stage 0

Tis

N0

M0

Stage I

T1, T2

N0, N1

M0

Stage II

T1, T2

N2

M0
 

T3

N0, N1, N2

M0

Stage III

T1, T2, T3

N3

M0
 

T4

Any N

M0

Stage IV

Any T

Any N

M1

Oropharynx – P16 positive (pathological)

Stage Group

T stage

N stage

M stage

Stage 0

Tis

N0

M0

Stage I

T1, T2

N0, N1

M0

Stage II

T1, T2

N2

M0
 

T3, T4

N0, N1,

M0

Stage III

T3, T4

N2

M0

Stage IV

Any T

Any N

M1

Nasopharynx

Stage Group

T stage

N stage

M stage

Stage 0

Tis

N0

M0

Stage I

T1

N0

M0

Stage II

T1

N1

M0
 

T2

N0, N1

M0

Stage III

T1, T2

N2

M0
 

T3

N0, N1, N2

M0

Stage IVA

T4

N0, N1, N2

M0
 

Any T

N3

M0

Stage IVB

Any T

Any N

M1

TNM clinical classification

T - primary tumour

T value Description

TX

Primary tumour cannot be assessed

T0

No evidence of primary tumour

Tis

Carcinoma in situ

Oropharynx – p16‐negative cancers of the oropharynx or oropharyngeal cancers without a p16 immunohistochemistry performed

T value

Description

T1

Tumour 2 cm or less in greatest dimension

T2

Tumour more than 2 cm but not more than 4 cm in greatest dimension

T3

Tumour more than 4 cm in greatest dimension or extension to lingual surface of epiglottis

T4a

Tumour invades any of the following: larynx*, deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), medial pterygoid, hard palate, or mandible*

T4b

Tumour invades any of the following: lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, skull base; or encases carotid artery

Note:

*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.

Oropharynx – p16‐Positive Tumours

T value

Description

T1

Tumour 2 cm or less in greatest dimension

T2

Tumour more than 2 cm but not more than 4 cm in greatest dimension

T3

Tumour more than 4 cm in greatest dimension or extension to lingual surface of epiglottis

T4

Tumour invades any of the following: larynx*, deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), medial pterygoid, hard palate, mandible*, lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, skull base; or encases carotid artery

Nasopharynx

T value

Description

T1

Tumour confined to nasopharynx, or extends to oropharynx and/or nasal cavity without parapharyngeal involvement

T2

Tumour with extension to parapharyngeal space and/or infiltration of the medial pterygoid, lateral pterygoid, and/or prevertebral muscles

T3

Tumour invades bony structures of skull base cervical vertebra, pterygoid structures, and/or paranasal sinuses

T4

Tumour with intracranial extension and/or involvement of cranial nerves, hypopharynx, orbit, parotid gland and/or infiltration beyond the lateral surface of the lateral pterygoid muscle

Hypopharynx

T value

Description

T1

Tumour limited to one subsite of hypopharynx (see page 23) and/or 2 cm or less in greatest dimension

T2

Tumour invades more than one subsite of hypopharynx or an adjacent site, or measures more than 2 cm but not more than 4 cm in greatest dimension, without fixation of hemilarynx

T3

Tumour more than 4 cm in greatest dimension, or with fixation of hemilarynx or extension to oesophageal mucosa

T4a

Tumour invades any of the following: thyroid/cricoid cartilage, hyoid bone, thyroid gland, oesophagus, central compartment soft tissue*

T4b

Tumour invades prevertebral fascia, encases carotid artery, or invades mediastinal structures

 

Note:

* Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat.

N - regional lymph nodes

Oropharynx –p16 Negative and Hypopharynx

N value Description

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 without extranodal extension

N2

Metastasis described as:

 

N2a - Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension without extranodal extension

 

N2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension without extranodal extension
 

N2c - Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension, without extranodal extension

N3

N3a - Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension

N3b - Metastasis in a single or multiple lymph nodes with clinical extranodal extension*

Notes:

*The presence of skin involvement or soft tissue invasion with deep fixation/tethering to underlying muscle or adjacent structures or clinical signs of nerve involvement is classified as clinical extranodal extension. Midline nodes are considered ipsilateral nodes.

Oropharynx –p16 Positive

N value Description

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Unilateral metastasis, in lymph node(s), all 6 cm or less in greatest dimension

N2

Contralateral or bilateral metastasis in lymph node(s), all 6 cm or less in greatest dimension

N3

Metastasis in lymph node(s) greater than 6 cm in dimension

Notes:

* Midline nodes are considered ipsilateral nodes.

Nasopharynx 

N value

Description

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Unilateral metastasis, in cervical lymph node(s), and/or unilateral or bilateral metastasis in retropharyngeal lymph nodes, 6 cm or less in greatest dimension, above the caudal border of cricoid cartilage

N2

Bilateral metastasis in cervical lymph node(s), 6 cm or less in greatest dimension, above the caudal border of cricoid cartilage

N3

Metastasis in cervical lymph node(s) greater than 6 cm in dimension and/or extension below the caudal border of cricoid cartilage

Notes:

* Midline nodes are considered ipsilateral nodes.

M - distant metastasis

M value Description

M0

No distant metastasis

M1

Distant Metastasis

Note:

The MX category is considered to be inappropriate as clinical assessment of metastasis can be based on physical examination alone. (The use of MX may result in exclusion from staging.)

TNM pathological classification

pT - primary tumour

The pT categories correspond to the T categories as per above.

pN - regional lymph nodes

Histological examination of a selective neck dissection specimen will ordinarily include 10 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 15 or more lymph nodes.

Oropharynx –p16 Negative 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 extranodal extension

pN2

Metastasis described as:

 

pN2a - Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension with extranodal extension or more than 3 cm but not more than 6 cm in greatest dimension without extranodal extension

 

pN2b - Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, without extranodal extension

 

pN2c - Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension, without extranodal extension

pN3

pN3a - Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension

pN3b - Metastasis in a lymph node more than 3 cm in greatest dimension with extranodal extension or, multiple ipsilateral, or any contralateral or bilateral node(s) with extranodal extension *

Oropharynx – p16 Positive (pathological)

N value Description

pNX

Regional lymph nodes cannot be assessed

pN0

No regional lymph node metastasis

pN1

Metastasis in 1 to 4 lymph node(s)

pN2

Metastasis in 5 or more lymph node(s)

Nasopharynx 

The pN categories correspond to the N categories

M - distant metastasis*

M value Description

pM1

Distant metastasis microscopically confirmed

Note:

*pM0 and pMX are not valid categories

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Last edited: 4 January 2024 8:40 am

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Malignant melanoma of upper aerodigestive tract

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Major salivary glands
  1. Cancer staging guidance sheets
  2. Lip and oral cavity (ICD10 C00, C02-C06)
  3. Malignant melanoma of upper aerodigestive tract (ICD10 C00-06, C10-14, C30-32)
  4. Pharynx (ICD10 C01, C05.1-2, C09, C10.0, C10.2-3, C11-13)
  5. Major salivary glands (ICD10 C07, C08)
  6. Oesophagus including oesophagastric junction (ICD10 C15 & C16.0)
  7. Stomach (ICD10 C16 except C16.0)
  8. Small intestine (ICD10 C17)
  9. Appendix (ICD10 C18.1)
  10. Colon and rectum (ICD10 C18-C20)
  11. Anal canal and perianal skin data (ICD10 C21, C44.5)
  12. Liver (ICD10 C22.0)
  13. Intrahepatic bile ducts (ICD10 C22.1)
  14. Gallbladder (ICD10 C23, C24.0)
  15. Distal extrahepatic bile duct (ICD10 C24.0)
  16. Perihilar bile ducts (ICD10 C24.0)
  17. Ampulla of vater (ICD10 C24.1)
  18. Pancreas (ICD10 C25)
  19. Nasal cavity and paranasal sinuses (ICD10 C30.0, C31.0, C31.1)
  20. Larynx (ICD10 C32.0 C32.1, C32.2, C10.1)
  21. Lung (ICD10 C34)
  22. Thymic tumours (ICD10 C37)
  23. Soft tissues (ICD10 C38.1-2, C47-C49)
  24. Bone (ICD10 C40 & C41)
  25. Malignant melanoma of skin (ICD10 C43, C51.0, C60.9, C63.2)
  26. Merkel cell carcinoma of skin (ICD10 C44 & C63.2)
  27. Skin carcinoma of the head and neck (ICD10 C44.0, C44.2-4)
  28. Carcinoma of skin of the eyelid (ICD10 C44.1)
  29. Carcinoma of skin (excluding eyelid, head and neck, perianal, vulva and penis) (ICD10 C44.5-7, C63.2)
  30. Pleural mesothelioma (ICD10 C45)
  31. Breast tumours (ICD10 C50)
  32. Vulva (ICD10 C51)
  33. Cervix uteri (ICD10 C53)
  34. Uterine sarcomas
  35. Uterus - endometrium (ICD10 C54.1, C55)
  36. Ovarian, fallopian tube and primary peritoneal carcinoma (ICD10 C56, C57, C48.1, C48.2)
  37. Gestational trophoblastic neoplasms (ICD10 C58)
  38. Penis tumours (ICD10 C60)
  39. Prostate tumours (ICD10 C61)
  40. Testis tumours (ICD10 C62)
  41. Kidney tumours (ICD10 C64)
  42. Renal pelvis and ureter tumours (ICD10 C65 & C66)
  43. Urinary bladder tumours (ICD10 C67)
  44. Urethra tumours (ICD10 C68.0)
  45. Carcinoma of conjuctiva (ICD10 C69.0)
  46. Malignant melanoma of conjuctiva (ICD10 C69.0)
  47. Retinoblastoma (ICD10 C69.2)
  48. Malignant melanoma of uvea (ICD10 C69.3, C69.4)
  49. Carcinoma of lacrimal gland (ICD10 C69.5)
  50. Sarcoma of orbit (ICD10 C69.6)
  51. Thyroid gland (ICD10 C73)
  52. Adrenal cortex (ICD10 C74.0)
  53. Chronic lymphocytic leukaemia
  54. Hepatoblastoma (CTYA)
  55. Hodgkins and non-hodgkins lymphoma (ICD10 C81-88)
  56. Medulloblastoma
  57. Multiple myeloma
  58. Neuroblastoma
  59. Neuroendocrine tumours of the foregut
  60. Neuroendocrine tumours of the midgut and hindgut
  61. Non-hodgkin lymphoma (children)
  62. Rhabdomyosarcoma and other soft tissue sarcomas (CTYA)
  63. Wilms tumour of the kidney