Chapter 084. Head and Neck Cancer (Part 4)

Table 84-2 Definition of TNM–NasopharynxPrimary Tumor (T)Stage GroupingTXCannot assessedbe 0StageTisN0M0T0No evidence IStageT1N0M0TisCarcinoma in situ IIAStageT2aN0M0T1Tumorconfined IIBStageT1N1M0to the nasopharynxT2Tumor extends to soft tissuesT2N1M0T2a extends toTumor theT2aN1M0oropharynx and/or nasal cavity parapharyngeal extension w/oT2b Any tumor with extension parapharyngealT2bN1M0T3TumorinvolvesT2bN1M0bony structures and/or paranasal sinusesT4Tumor intracranialwith extension IIIStageT1N2M0and/or involvement of cranial infratemporal nerves, fossa, T2a N2 M0hypopharynx, orbit, or masticator spaceRegional (N)LymphNodesT2bN2M0The distribution and the prognostic lymph impact node of spread regional fromT3 ...
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Chapter 084. Head and Neck Cancer (Part 4) Chapter 084. Head and Neck Cancer (Part 4)Table 84-2 Definition of TNM–NasopharynxPrimary Tumor (T) Stage GroupingTX Cannot be Stage Tis N0 M0 assessed 0T0 No evidence Stage T1 N0 M0 ITis Carcinoma in situ Stage T2a N0 M0 IIAT1 Tumor confined Stage T1 N1 M0 to the nasopharynx IIBT2 Tumor extends to T2 N1 M0 soft tissues T2a Tumor T2a N1 M0 extends to the oropharynx and/or nasal cavity w/o parapharyngeal extension T2b Any tumor T2b N1 M0 with parapharyngeal extensionT3 Tumor involves T2b N1 M0 bony structures and/or paranasal sinuses T4 Tumor with Stage T1 N2 M0 intracranial extension III and/or involvement of cranial nerves, T2a N2 M0 infratemporal fossa, hypopharynx, orbit, or masticator space Regional Lymph Nodes T2b N2 M0(N) The distribution and the T3 N0 M0prognostic impact of regionallymph node spread fromnasopharynx cancer, particularly ofthe undifferentiated type, aredifferent from those of other headand neck mucosal cancers andjustify the use of a different Nclassification scheme. NX Regional lymph nodes T3 N1 M0cannot be assessed N0 No regional lymph node T3 N2 M0metastasis N1 Unilateral metastasis in T4 N0 M0lymph node(s), ≤6 cm in greatestdimension, above thesupraclavicular fossa N2 Bilateral metastasis in T4 N1 M0lymph node(s), ≤6 cm in greatestdimension, above thesupraclavicular fossa N3 Metastasis in lymph T4 N2 M0node(s), >6 cm and/or tosupraclavicular fossa N3a Greater than 6 cm in Any N3 M0dimension T N3b Extension to the Any Any M1supraclavicular fossa T N In patients with lymph node involvement and no visible primary, thediagnosis should be made by lymph node excision. If the results indicatesquamous cell carcinoma, a panendoscopy should be performed, with biopsy of allsuspicious-appearing areas and directed biopsies of common primary sites, such asthe nasopharynx, tonsil, tongue base, and pyriform sinus.