Oral cavity
Miscellaneous
TNM staging - lip and oral cavity

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

Revised: 25 May 2018, last major update November 2013 - UPDATE IN PROGRESS

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

PubMed Search: TNM staging lip and oral cavity

Cite this page: Pernick, N. TNM staging - lip and oral cavity. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/oralcavitytnm.html. Accessed October 16th, 2018.
Pathologic TNM staging of cancer of the Lip and Oral Cavity, AJCC 8th edition
Definition / general
  • Includes epithelial and minor salivary gland cancers
  • Excludes nonepithelial tumors (lymphoma, soft tissue, bone, cartilage, mucosal melanoma, cutaneous squamous cell carcinoma of the vermilion lip)
  • See separate sections for oropharynx / hypopharynx and mucosal melanoma
Essential features
  • AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the 8th edition is mandatory
Primary tumor (T)
  • TX: primary tumor cannot be assessed
  • Tis: carcinoma in situ
  • T1: tumor ≤ 2 cm; ≤ 5 mm depth of invasion (DOI); DOI is depth of invasion and not tumor thickness
  • T2: tumor more than 2 cm but not more than 4 cm in greatest dimension
  • T3: tumor more than 4 cm in greatest dimension
  • T4a: moderately advanced local disease
    • (lip): tumor invades through cortical bone, inferior alveolar nerve, floor of mouth or skin of face; i.e. chin or nose
    • (oral cavity): tumor invades adjacent structures only (e.g. though cortical bone [mandible or maxilla], into deep [extrinsic] muscle of tongue [genioglossus, hyoglossus, palatoglossus and styloglossus], maxillary sinus, skin of face)
  • T4b: very advanced local disease - tumor invades masticator space, pterygoid plates or skull base or encases internal carotid artery

  • Note: superficial erosion alone of bone / tooth socket by gingival primary is not sufficient to classify a tumor as T4
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
  • 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:T3N0 - 1M0orT1 - 3N1M0
IVA:T4aN0 - 1M0orT1 - 4aN2M0
IVB:any TN3M0orT4bany NM0
IVC:any Tany NM1