Nasopharyngeal cancer (staging)

Last revised by Daniel J Bell on 19 Oct 2021

Nasopharyngeal cancer staging refers to TNM staging of malignant tumors of the nasopharynx. The vast majority of applicable tumors are nasopharyngeal carcinomas, but other epithelial malignancies of the nasopharynx are included, such as minor salivary gland tumors. The following article reflects the 8th edition published by the American Joint Committee on Cancer, which is used for staging starting 1 January 2018 1,2.

*Though it is not explicitly defined in the AJCC manual, "pterygoid structures" include medial/lateral pterygoid platespterygomaxillary fissure, and pterygopalatine fossa according to articles that formed the basis of the 8th edition criteria 4.

  • NX: nodes cannot be assessed
  • N0: no regional nodal metastasis
  • N1: metastasis above the caudal border of cricoid cartilage involving
    • unilateral cervical lymph node(s), and/or
    • unilateral or bilateral retropharyngeal lymph node(s) ≤6 cm in greatest dimension
  • N2: bilateral cervical lymph node metastasis ≤6 cm, above caudal border of cricoid cartilage
  • N3
    • unilateral or bilateral cervical lymph node metastasis >6 cm, and/or
    • lymph node metastasis extending below the caudal border of cricoid cartilage

NB: all nodal sizes in TNM are "greatest dimension" not short axis diameter

The terms pM0 and MX are no longer valid TNM categories. The following categories may be used, either in the clinical classification (c) for patients with cancer identified before treatment and/or in the pathological classification (p) for patients for whom surgery is the first definitive therapy:

  • cM0: no evidence of metastases
  • cM1: distant metastasis
  • pM1: distant metastasis, microscopically confirmed
  • Stage 0
    • Tis, N0, M0
  • Stage I
    • T1, N0, M0
  • Stage II
    • [T0, T1], N1, M0
    • T2, [N0, N1], M0
  • Stage III
    • [T0, 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

Compared to the 7th edition of the AJCC staging system, prevertebral muscle involvement was added as a T2 criterion in the 8th edition. Involvement of the infratemporal fossa/masticator space as a T4 criterion was changed to the lateral border of the lateral pterygoid muscle. Involvement of the supraclavicular fossa as a N3 criterion was changed to lower level (levels IV and Vb) as demarcated by the caudal border of the cricoid cartilage. Stage IVA and IVB were merged into stage IVA, while stage IVC was upgraded to stage IVB.

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