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Nasopharyngeal carcinoma staging

Nasopharyngeal carcinoma is staged using the TNM staging system with derived stage groupings. 

TNM staging
Primary tumour (T)
  • Tx: primary tumour cannot be assessed
  • T0: no evidence of primary tumour
  • Tis: carcinoma in situ
  • T1: tumour is confined to the nasopharynx
  • T2: tumour extends to soft tissues of the oropharynx and/or nasal fossa
    • T2a: without extension to the parapharyngeal region
    • T2b: with extension to the parapharyngeal region
  • T3: invasion of adjacent bony structures and/or paranasal sinuses
  • T4: invasion of any one or more of the following
Nodal status (N)
  • Nx: nodes cannot be assessed
  • N0: no evidence of nodal involvement
  • N1: unilateral nodal involvement <6cm maximal diameter above supracalvicular fossa
  • N2: bilateral nodal involvement <6cm maximal diameter above supracalvicular fossa
  • N3
    • N3a: >6 cm maximal diameter (unilateral or bilateral)
    • N3b: involvement of the supracalvicular fossa
Metastases (M)
  • Mx: presence of metastases cannot be assessed
  • M0: no evidence of metastases
  • M1: distant metastases present

Stage groupings

  • Stage 0:  Tis, N0, M0
  • Stage 1:  T1, N0, M0
  • Stage 2a:  T2a, N0, M0  
  • Stage 2b:  T2b, N0, M0 or T0-T2, N1, M0
  • Stage 3: T3, N0-2, M0 or T0-T2, N2, M0
  • Stage 4a: T4, N0-2, M0
  • Stage 4b: any T, N3, M0
  • Stage 4c: any T, any N, M1

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