Oropharyngeal (p16-negative) cancer (staging)

Last revised by Francis Deng on 15 Jun 2023

Oropharyngeal (p16-) cancer staging refers to TNM staging of carcinomas originating in the oropharynx that are not human papillomavirus (HPV)-associated. This system most commonly pertains to squamous cell carcinomas that tested negative for p16, an immunohistochemical proxy for HPV infection, or were not tested. Also included are minor salivary cancers and neuroendocrine carcinomas, in which p16 assessment is not required or contributory. The following article reflects the 8th edition of the classification by the American Joint Committee on Cancer (AJCC) and Union for International Cancer Control (UICC), published in 2017 1-4.

*Note: According to the AJCC, involvement of the palatoglossus muscle within the oropharynx does not change the T category and this criterion mainly denotes invasion "anteriorly to the extrinsic muscles of the tongue in the floor of the mouth" 1. According to the UICC, this criterion is defined as "deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus)" 4. The application of this criterion is controversial because only the genioglossus is deep among the extrinsic tongue muscles 5.

Regional nodal status is defined the same as for most other cancers of the head and neck. See the main article, cervical lymph node (staging).

The terms pM0 and MX are not valid TNM categories. The following categories may be used:

  • cM0: no evidence of metastases

  • cM1: distant metastasis

  • pM1: distant metastasis, microscopically confirmed

The prognostic stage groups are defined the same as for most other cancers of the head and neck:

  • 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

    • T4a, [N0, N1], M0

    • [T1, T2, T3, T4a], N2, M0

  • stage IVB

    • [Any T], N3, M0

    • T4b, [Any N], M0

  • stage IVC

    • [Any T], [Any N], M1

The 8th edition staging system separated HPV-associated and non-HPV-associated oropharyngeal cancers 3. Otherwise, the T category definitions did not change from the 7th edition staging system. Nodal staging was changed, as with other head and neck sites, to emphasize extranodal extension.

ADVERTISEMENT: Supporters see fewer/no ads

Cases and figures

  • Case 1: large B cell lymphoma
    Drag here to reorder.
  • Updating… Please wait.

     Unable to process the form. Check for errors and try again.

     Thank you for updating your details.