Larynx and hypopharynx
Miscellaneous
TNM staging - hypopharynx

Author: Nat Pernick, M.D. (see Authors page)

Revised: 27 March 2018, last major update December 2013

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Staging [title] hypopharynx [title]

Cite this page: Pernick, N. TNM staging - hypopharynx. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/larynxstaginghypopharynx.html. Accessed August 16th, 2018.

Pathologic TNM staging of hypopharynx, AJCC 7th edition
Primary tumor (T)
  • TX: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • Tis: carcinoma in situ
  • T1: tumor limited to one subsite of hypopharynx or 2 cm or less in greatest dimension
  • T2: tumor invades more than one subsite of hypopharynx or an adjacent site, or measures more than 2 cm but not more than 4 cm in greatest dimension without fixation of hemilarynx
  • T3: tumor more than 4 cm in greatest dimension or with fixation of hemilarynx or extension to esophagus
  • T4a: moderately advanced local disease - tumor invades thyroid / cricoid cartilage, hyoid bone, thyroid gland or central compartment soft tissue (prelarynageal strap muscles and subcutaneous fat)
  • T4b: very advanced local disease - tumor invades prevertebral fascia, encases carotid artery or involves mediastinal structures

  • Notes: hypopharynx subsites are pyriform sinuses (left and right), lateral and posterior hypopharyngeal walls and postcricoid region
Regional lymph nodes (N)
  • NX: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
  • N2: metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
  • N2a: metastasis in a single ipsilateral lymph node more than 3 cm but not more than 6 cm in greatest dimension
  • N2b: metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
  • N2c: metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
  • N3: metastasis in a lymph node more than 6 cm in greatest dimension

  • Notes:
    • Mediastinal lymph nodes are considered distant metastases
    • Midline nodes are considered ipsilateral
    • Metastases at level VII are considered regional lymph node metastases
    • A designation of U or L may be used to indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L)
    • Selective neck dissection ordinarily includes 6+ lymph nodes; radical / modified radical neck dissection ordinarily includes 10+ lymph nodes
    • Survival is significantly worse when metastases involve lymph nodes beyond the first echelon of lymphatic drainage, particularly lymph nodes in levels IV and V; thus, the region of nodal involvement should also be reported

  • Level I: submental, submandibular; contains the submental and submandibular triangles bounded by the anterior and posterior bellies of the digastric muscle, and by the hyoid bone inferiorly, and the body of the mandible superiorly
  • Level II: upper jugular; contains the upper jugular lymph nodes and extends from the level of the skull base superiorly to the hyoid bone inferiorly
  • Level III: mid jugular; contains the middle jugular lymph nodes from the hyoid bone superiorly to the level of the lower border of the cricoid cartilage inferiorly
  • Level IV: lower jugular; contains the lower jugular lymph nodes from the level of the cricoid cartilage superiorly to the clavicle inferiorly
  • Level V: posterior triangle; contains the lymph nodes in the posterior triangle bounded by the anterior border of the trapezius muscle posteriorly, the posterior border of the sternocleidomastoid muscle anteriorly, and the clavicle inferiorly; for description purposes, Level V may be further subdivided into upper, middle and lower levels corresponding to the superior and inferior planes that define Levels II, III and IV
  • Level VI: prelaryngeal, pretracheal, paratracheal; contains the lymph nodes of the anterior central compartment from the hyoid bone superiorly to the suprasternal notch inferiorly; on each side, the lateral boundary is formed by the medial border of the carotid sheath
  • Level VII: upper mediastinal; contains the lymph nodes inferior to the suprasternal notch in the superior mediastinum
Distant metastasis (M)
  • M0: no distant metastasis
  • M1: distant metastasis
Anatomic stage / prognostic groups
0:TisN0M0
I:T1N0M0
II:T2N0M0
III:T3N0M0orT1-3N1M0
IVA:T4aN0-1M0orT1-4aN2M0
IVB:T4bany NM0orany TN3M0
IVC:any Tany NM1