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Oropharyngeal (p16-negative) cancer (staging)

Last revised by Dr David Matthews on 10 Feb 2022

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 published by the American Joint Committee on Cancer, published in 2017 1,2.

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.

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Cases and figures

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