Nasal cavity, paranasal sinuses, nasopharynx
General
Staging-nasopharynx

Editor-in-Chief: Debra Zynger, M.D.
Bin Xu, M.D., Ph.D.

Topic Completed: 30 December 2019

Minor changes: 11 July 2020

Copyright: 2004-2020, PathologyOutlines.com, Inc.

PubMed Search: Staging[TI] nasopharynx[TIAB]

Bin Xu, M.D., Ph.D.
Page views in 2019: 692
Page views in 2020 to date: 1,258
Cite this page: Xu B. Staging-nasopharynx. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/nasalstagingnasopharynx.html. Accessed September 29th, 2020.
Definition / general
  • All primary carcinomas of the nasopharynx are covered by this staging system
  • These topics are not covered: metastasis, mucosal melanoma, lymphoma and sarcoma
Essential features
  • AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory
ICD coding
  • ICD-O: 8071/3 - keratinizing squamous cell carcinoma
  • ICD-O: 8072/3 - nonkeratinizing squamous cell carcinoma
  • ICD-O: 8083/3 - basaloid squamous cell carcinoma
  • ICD-O: 8260/3 - nasopharyngeal papillary adenocarcinoma
  • ICD-O: 8200/3 - salivary gland carcinoma
Primary tumor (pT)
  • pTX: cannot be assessed
  • 
pT0: no evidence of primary tumor, with proven EBV positive lymph node metastasis
  • pTis: carcinoma in situ
  • pT1: confined to nasopharynx or involvement to oropharynx or nasal cavity without parapharyngeal extension
  • 
pT2: parapharyngeal extension or involvement of adjacent soft tissue including medial pterygoid / lateral pterygoid / prevertebral muscles
  • pT3: bone invasion into skull base, cervical vertebra, pterygoid structures or paranasal sinuses
  • pT4: involvement of intracranial structures, cranial nerve, hypopharynx, orbit or parotid gland or invasion beyond the lateral surface of the lateral pterygoid muscle
Regional lymph nodes (pN)
  • pNX: cannot be assessed
  • 
pN0: no regional lymph node metastasis
  • pN1: metastasis to unilateral cervical lymph node(s) or unilateral / bilateral retropharyngeal lymph node(s), above the inferior border of cricoid cartilage, ≤ 6 cm in size
  • 
pN2: metastasis to bilateral cervical lymph nodes, above the inferior border of cricoid cartilage, ≤ 6 cm in size
  • 

pN3: metastasis > 6 cm in size or below the inferior border of cricoid cartilage
Distant metastasis (pM)
  • pM1: distant metastasis
Prefixes
  • y: preoperative radiotherapy or chemotherapy
  • r: recurrent tumor stage
AJCC prognostic stage groups
Stage group 0: Tis N0 M0
Stage group I: T1 N0 M0
Stage group II: T0 or T1 N1 M0
T2 N0 or N1 M0
Stage group III: T0, T1 or T2 N2 M0
T3 N0, N1 or N2 M0
Stage group IV: T4 any N any M
any T N3 any M
any T any N M1
Stage group IVA: T4 any N M0
any T N3 M0
Stage group IVB: any T any N M1
Registry data collection variables
  • Not applicable
Histologic grade (G)
  • Not applicable for nasopharyngeal carcinoma
Histopathologic type
  • Nasopharyngeal carcinoma
    • Keratinizing squamous cell carcinoma
    • Nonkeratinizing squamous cell carcinoma
    • Basaloid squamous cell carcinoma
  • Nasopharyngeal papillary adenocarcinoma
  • Salivary gland carcinoma
Board review style question #1
Which of the following statements about the AJCC staging (8th edition) for nasopharyngeal carcinoma is true?

  1. pN is determined using a combination of laterality and location of involved lymph node and size of the metastasis
  2. The presence of extranodal extension increases the pN category
  3. pT is determined by tumor size and site of involvement
  4. A cervical lymph node with EBV positive squamous cell carcinoma and no primary tumor detected after extensive sampling is pTX
Board review answer #1
A. pN is determined using a combination of laterality and location of involved lymph node and size of the metastasis

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Reference: Pathologic TNM staging of nasopharynx (AJCC 8th edition)
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