TNM stage grouping

Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping. The stage is expressed as the number 0 (zero) or the Roman numerals I to IV (1-4). Some stages are subdivided with letters.

Stage 0: Tis, N0, M0: The cancer is “in situ.” Cancer cells are only in the surface layer of the nasopharynx but have not yet grown into deeper layers (Tis). The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage I: T1, N0, M0: The tumor is in the nasopharynx and may have spread to soft tissues of the nasal cavity and/or the oropharynx (T1). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II: Either:

T2, N0, M0: The tumor has grown into the tissues of the left or right sides of the upper part of the throat (T2). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

OR

T1 or T2, N1, M0: The tumor may still be confined to the nasopharynx, or it may have extended to the soft tissues of the nasal cavity or the oropharynx (T1), or the left or right sides of the upper part of the throat (T2). It has spread to one or more nearby lymph nodes, none of which is larger than 6 cm (about 2½ inches) across. These lymph nodes are either neck lymph nodes on one side or lymph nodes behind the throat (retropharyngeal lymph nodes) on either side (N1). The cancer has not spread to distant sites (M0).

Stage III: Either:

T3, N0 to N2, M0: The tumor has spread to the sinuses or the bones near the nasopharynx (T3). It may or may not have spread to lymph nodes in the neck or behind the throat, but none of these lymph nodes is larger than 6 cm across (N0 to N2). It has not spread to distant sites (M0).

OR

T1 or T2, N2, M0: The tumor may still be confined to the nasopharynx, or it may have grown into the soft tissues of the nasal cavity or the oropharynx (T1), or the left or right sides of the upper part of the throat (T2). The tumor has spread into nearby neck lymph nodes on both sides, but none of the lymph nodes is larger than 6 cm across (N2). The cancer has not spread to distant sites. (M0).
Stage IVA: T4, N0 to N2, M0: The tumor has grown into the skull and/or cranial nerves, the hypopharynx (lower part of the throat), the eye, or its nearby tissues (T4). It may or may not have spread to nearby lymph nodes in the neck, none of which is larger than 6 cm across (N0 to N2). It has not spread to distant sites (M0).

Stage IVB: Any T, N3, M0: The tumor may or may not have extended into nearby soft tissues or bones (any T). It has spread to lymph nodes that are larger than 6 cm across and/or are located in the shoulder area above the collarbone (N3). The cancer has not spread to distant sites (M0).

Stage IVC: Any T, any N, M1: The tumor may or may not have extended into nearby soft tissues or bones (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant sites (M1).

American Cancer Society

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