Nasal cavity, paranasal sinuses, nasopharynx
TNM staging - nasopharynx

Topic Completed: 1 November 2004

Revised: 19 February 2019

Copyright: 2004-2018,, Inc.

PubMed Search: TNM staging nasopharynx[TI]

Nat Pernick, M.D.
Page views in 2018: 201
Page views in 2019 to date: 517
Cite this page: Pernick N. TNM staging - nasopharynx. website. Accessed October 21st, 2019.
Primary tumor (T) - nasopharynx
  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
  • T1: Tumor extends to the nasopharynx or tumor extends to oropharynx or nasal cavity without parapharyngeal extension (denotes posterolateral infiltration of tumor)
  • T2: Tumor with parapharyngeal extension
  • T3: Tumor involves bony structures of skull base or paranasal sinuses
  • T4: Tumor with intracranial extension or involvement of cranial nerves, hypopharynx, orbit or with extension to the infratemporal fossa / masticator space
Regional lymph nodes (N) - nasopharynx
  • Distribution and prognostic impact of regional lymph node spread from nasopharynx cancer, particularly of the undifferentiated type, are different from those of other head and neck mucosal cancers and justify the use of a different N classification scheme

  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Unilateral metastasis in cervical lymph node(s), 6 cm or less in greatest dimension, above the supraclavicular fossa or unilateral or bilateral retropharyngeal lymph nodes, 6 cm or less in greatest dimension
  • N2: Bilateral metastasis in cervical lymph node(s), 6 cm or less in greatest dimension, above the supraclavicular fossa
  • N3: Metastasis in a lymph node(s), greater than 6 cm in greatest dimension or to supraclavicular fossa
  • N3a: Greater than 6 cm in dimension
  • N3b: Extension to the supraclavicular fossa

  • Midline nodes are considered ipsilateral
  • Supraclavicular zone or fossa is relevant to the staging of nasopharyngeal carcinoma and is the triangular region originally described by Ho; it is defined by three points:
    1. Superior margin of the sternal end of the clavicle
    2. Superior margin of the lateral end of the clavicle
    3. Point where the neck meets the shoulder; note that this would include caudal portions of levels IV and VB; all cases with lymph nodes (whole or part) containing tumor in the fossa are considered N3b
Distant metastasis (M) - nasopharynx
  • M0: No distant metastasis
  • M1: Distant metastasis
Anatomic stage / prognostic groups - nasopharynx
  • 0: Tis N0 M0
  • I: T1 N0 M0
  • II: T1 N1 M0 or T2 N0 - 1 M0
  • III: T1 - 2 N2 M0 or T3 N0 - 2 M0
  • IVA: T4 N0 - 2 M0
  • IVB: Any T N3 M0
  • IVC: Any T any N M1
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