TNM Staging for Cancers of the Lip and Oral Cavity

Description

Carcinomas of the lip and oral cavity are staged using the American Joint Committee on Cancer (AJCC) TNM system.

Tumor locations:

(1) lip

(2) buccal mucosa

(3) floor of mouth

(4) oral tongue

(5) hard palate

(6) gingiva

TNM Parameter	Finding	Designation
T	primary tumor cannot be assessed	TX
	no evidence of primary tumor	T0
	carcinoma in situ	Tis
	tumor <= 2 cm in maximum dimension	T1
	tumor > 2 cm and <= 4 cm in maximum dimension	T2
	tumor > 4 cm in maximum dimension	T3
	tumor invades into adjacent structures	T4
	(lip) tumor invades through cortical bone, inferior alveolar nerve, flood of mouth, skin of nose, skin of chin (oral cavity) tumor invades through cortical bone into deep/extrinsic muscles of tongue, maxillary sinus, or skin of face	T4a
	tumor invades masticator space, pterygoid plate, skull base, or encases carotid artery	T4b
N	regional lymph nodes cannot be assessed	NX
	no regional lymph node metastasis	N0
	metastasis to a single ipsilateral lymph node, <= 3 cm in maximum dimension	N1
	metastasis in a single ipsilateral, multiple ipsilateral, bilateral or contralateral lymph nodes, as listed below	N2
	metastasis in a single ipsilateral lymph node, > 3 cm and <= 6 cm in maximum dimension	N2a
	metastasis in multiple ipsilateral lymph nodes, all <= 6 cm in maximum dimension	N2b
	metastasis in bilateral or contralateral lymph nodes, all <= 6 cm in maximum dimension	N2c
	metastasis to a lymph node > 6 cm in diameter	N3
M	presence of metastases cannot be assessed	MX
	no distant metastasis	M0
	distant metastasis present	M1

where:

• Tumor invasion into adjacent structures for tumors of the lip: through cortical bone, tongue, skin of neck.

• Tumor invasion into adjacent structures for tumors of the oral cavity: through cortical bone, into deep (extrinsic) muscle of tongue, maxillary sinus, skin.

• Deep/extrinsic muscles of tongue include the genioglossus, hypoglossus, palatoglossus and styloglossus muscles.

• Superficial erosion of bone or tooth socket by a gingival tumor is not sufficient to classify the tumor as T4.

• Regional lymph nodes include the internal jugular, parotic, submandibular, submental and cervical lymph nodes.

• Midline nodes are considered ipsilateral nodes.

TNM Groups	Stage
Tis, N0, M0	0
T1, N0, M0	I
T2, N0, M0	II
T3, N0, M0 T1 or T2 or T3, N1, M0	III
T4a, N0, M0 T4a, N1, M0 T1, N2, M0 T2, N2, M0 T3, N2, M0 T4a, N2, M0	IVA
any T, N3, M0 T4b, any N, M0	IVB
any T, any N, M1	IVC

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TNM Staging for Cancers of the Lip and Oral Cavity

Description

Specialty