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The stages of nasopharyngeal cancer

Men and women discussing nasopharyngeal cancer

This page has information on nasopharyngeal cancer staging and grading. You can find the following information

 

A quick guide to what's on this page

The stages of nasopharyngeal cancer

The stage of a cancer tells the doctor how far a cancer has grown or spread. The staging information helps your doctor decide on the best treatment. The two main ways are the TNM system and number system.

TNM stages of nasopharyngeal cancer

TNM stands for Tumour, Node and Metastasis. The system describes

  • The size of a primary tumour (T)
  • Whether the cancer has spread to the lymph nodes (N)
  • Whether the cancer has spread to a different part of the body (M)

Number stages of nasopharyngeal cancer

There are 4 main stages in this system – stages 1 to 4. A very early stage cancer is sometimes referred to as stage 0 or carcinoma in situ. Further down this page, there are detailed descriptions of the different stages of nasopharyngeal cancer.

Grade

The grade of a cancer tells you how much the cancer cells look like normal cells. If you have a low grade cancer, the cancer cells look very much like normal nasopharyngeal cells. High grade means they look very abnormal and very unlike normal nasopharyngeal cells. High grade cancers are likely to be faster growing and are more likely to spread. But in nasopharyngeal cancer, high grade cancers can respond particularly well to treatment with radiotherapy and chemotherapy.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating nasopharyngeal cancer section.

 

 

What staging is

The stage of a cancer tells your doctor how far a cancer has grown or spread. It is important because the stage helps your doctor to decide on the best treatment for you. The tests and scans that your doctor does when diagnosing your cancer, give some information about the stage.

 

Different staging systems

There are different ways of staging cancers. The two main ways are the TNM system and number system. They are used together to give your doctor a description of your cancer. You may not be familiar with these terms so the stage of your cancer may sound a bit confusing. If you don't understand what stage your cancer is, your doctor or clinical nurse specialist will be able to explain it to you.

Understanding your staging may help you understand why your doctors have chosen a particular treatment for you. At the end of this section there is a list of questions for your doctor that may help you. There is more about staging cancers in the about cancer section.

 

TNM staging of nasopharyngeal cancer

TNM stands for Tumour, Node and Metastasis. The system describes

The size of your primary tumour (T)

T0 means that there is no evidence of a tumour. TIS (tumour in situ) are cancer cells only in the surface layer of the nasopharynx. Doctors also call this carcinoma in situ (CIS), which is a very early stage cancer. 

There are 4 main T stages of nasopharyngeal cancer

  • T1 means the cancer is contained within the nasopharynx or has spread into the oropharynx (the area at the back of the mouth and top of the throat) or nasal cavity

    Diagram showing stage T1 nasopharyngeal cancer
  • T2 means cancer cells have spread into areas next to the nasopharynx – you may hear this called parapharyngeal extension, but it has not spread into bone

    Diagram showing stage T2 nasopharyngeal cancer
  • T3 means the tumour has spread into the sinuses or the bones near the nasopharynx

    Diagram showing stage T3 nasopharyngeal cancer
  • T4 means the tumour has spread into one or more of the following areas
    • The cranial (skull) nerves (these nerves are close to the nasopharynx and control our eye movement, sight and sense of smell)
    • The lower part of the throat (hypopharynx)
    • The eye or the surrounding tissue
    • The bony spaces near the cheek and teeth

      Diagram showing stage T4 nasopharyngeal cancer

Whether the cancer has spread to the lymph nodes (N)

There are 4 main lymph node stages of cancer of the nasopharynx. The stages describe whether there is cancer in any of the lymph nodes and the size and position of the nodes affected

  • N0 means there are no lymph nodes containing cancer cells
  • N1 means there are cancer cells in one or more lymph nodes on one side of the neck or there are cancer cells in the lymph nodes behind the throat, on one or both sides of the neck – but in either case, the nodes are not more than 6cm across
  • N2 means there are cancer cells in lymph nodes on both sides of the neck. The nodes are not more than 6cm across and are above the collarbone
  • N3 is divided into 3a and 3b
    • N3a  – means there are cancer cells in one or more lymph nodes – one node is more than 6cm across
    • N3b  – means there are cancer cells in the dip above the collarbone called the supraclavicular fossa

      DIagram showing nasopharyngeal cancer that has spread to the lymph nodes

Whether the cancer has spread to another part of your body (M)

There are two stages to describe spread of cancer of the nasopharynx

  • M0 means there is no cancer spread to other parts of the body
  • M1 means the cancer has spread to other parts of the body

    Diagram showing nasopharyngeal cancer that has spread to the lungs

Together, the T, N and M stages give your doctor a complete description of the stage of your cancer. For example, if you have a T1, N0, M0 cancer, you may have a tumour that has spread beyond the nasopharynx, to the nasal cavity or oropharynx. Your lymph nodes do not contain any cancer and there is no cancer spread to other parts of the body.

The different groups of TNM stages are put together to give 4 main number stages.

 

Number staging of nasopharyngeal cancer

There are 4 main stages in this system – stages 1 to 4. You may also hear the term stage 0 used.

Stage 0 or carcinoma in situ (CIS)

If you have CIS or stage 0 cancer of the nasopharynx, you have a very early stage cancer. Some doctors prefer to call this pre cancer. You may also see this stage written as TIS (tumour in situ). Insitu means that the cancer cells are only in the surface layer of the lining of the nasopharynx. The cells haven't spread to nearby tissue, lymph nodes or anywhere else in your body. Although the cells have not yet spread, if they are not treated, there is a high chance of them developing into an invasive cancer.

Stage 1

The cancer is in the nasopharynx and may have started to grow into the nasal cavity or oropharynx (the area at the back of the mouth and top of the throat). The cancer has not spread to nearby tissues, lymph nodes or other organs. This is the same as T1, N0, M0 in the TNM staging system.

Stage 2

Stage 2 nasopharyngeal cancer means one of the following

  • The cancer may have spread into the oropharynx or nasal cavity, and there is cancer in the lymph nodes on one side of the neck or behind the throat. The lymph nodes are not more than 6cm across. This is the same as T1, N1, M0 in the TNM staging system
  • The cancer has spread into the areas next to the nasopharynx (parapharyngeal space) and may have spread into the lymph nodes on one side of the neck or behind the throat. This is the same as T2, N0 or N1, M0

Stage 3

If you have stage 3 nasopharyngeal cancer, it means one of the following

  • The cancer has spread to nearby bones and air cavities (sinuses). It may also have spread to lymph nodes on one or both sides of the neck, or behind the throat, but not anywhere else. The affected lymph nodes are not more than 6 cm across. This is the same as T3, N0 or N1 or N2, M0 in the TNM staging system
  • The cancer may have spread into the oropharynx, nasal cavity or surrounding area (parapharyngeal space) and has spread into the lymph nodes on both sides of the neck. None of the lymph nodes are larger than 6cm. This is the same as T1 or T2, N2, M0

Stage 4

This means the cancer is advanced. Stage 4 has 3 groups

  • 4A means the cancer has grown within the skull. It may be in the cranial (skull) nerves, eye or nearby tissues, or the lower part of the throat. There may be cancer cells in the lymph nodes on one or both sides of the neck. These nodes are smaller than 6cm and above the collarbone area. The cancer has not spread anywhere else. This is the same as T4, N0 or N1 or N2, M0 in the TNM staging system
  • 4B means the cancer may have grown into nearby tissues or bones. It has spread to at least one lymph node that is bigger than 6cm across, or is in the collarbone area, or both. The cancer has not spread anywhere else. This is the same as Any T, N3, M0
  • 4C means the cancer has spread to other parts of the body, for example the lungs. This is the same as Any T, Any N, M1
 

Recurrent nasopharyngeal cancer

This means nasopharyngeal cancer that has come back (recurred) after treatment. The cancer may come back in the nasopharynx (local recurrence) or in another part of the body.

 

The different grades of nasopharyngeal cancer

The grade of a cancer tells you how much the cancer cells look like normal cells. There are 3 grades of nasopharyngeal cancer

  • Grade 1 means low grade – the cancer cells look very much like normal nasopharyngeal cells
  • Grade 2 means intermediate grade – the cancer cells look slightly like normal nasopharyngeal cells
  • Grade 3 means high grade – the cancer cells look very abnormal and are very unlike normal nasopharyngeal cells

You may hear your doctor use the word differentiation. Differentiation means how developed or mature a cell is. So grade 1 cancer cells are well differentiated and look very like normal cells. Grade 2 cancer cells are moderately differentiated. Grade 3 cancer cells are poorly differentiated and look very abnormal.

The grade of the cancer gives your specialist a guide as to how the cancer may behave. Low grade cancers are usually slower to grow and less likely to spread. High grade cancers are likely to be faster growing and are more likely to spread. But in nasopharyngeal cancer high grade cancers can respond particularly well to treatment with radiotherapy and chemotherapy. 

Please remember that this is only a guide. Your specialist will consider all your test results when deciding which treatment is best for you.

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Updated: 22 January 2013