TNM stages of nasopharyngeal cancer

The stage of a cancer tells you where it is, how big it is and whether it has spread. This helps your doctor decide which treatment you need.

Your doctor works out your stage from the tests and scans you have had.

What TNM means

Doctors use a staging system called TNM. The letters stand for tumour, node and metastasis:

  • T describes the size of the tumour
  • N describes whether there are any cancer cells in the lymph nodes Open a glossary item
  • M describes whether the cancer has spread to a different part of the body

T stages

T stages describe the size of your primary tumour. There are 5 T stages:

T0 means that no cancer is seen in the nasopharynx but there are cancer cells in one or more lymph nodes in the neck, which test positive for the Epstein Barr virus (EBV). This means it is very likely to be nasopharyngeal cancer.

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

Diagram showing stage T1 nasopharyngeal cancer

T2 means cancer cells have spread into areas next to the nasopharynx. But they have not spread into bone. You might hear this called parapharyngeal extension.

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 skull - you may hear this called intracranial extension
  • the cranial 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 main salivary gland (the parotid gland)
  • nearby soft tissues
Diagram showing stage T4 nasopharyngeal cancer

N stages

N stages describe whether the cancer has spread to any lymph nodes, and the size and position of any nodes affected. There are 4 N stages for nasopharyngeal cancer.

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

N3 means there are cancer cells in one or more lymph nodes on one or both sides of the neck. The affected nodes are more than 6cm across or are just above the collar bone

Diagram showing nasopharyngeal cancer that has spread to the lymph nodes

M stages

M stages describe whether the cancer has spread to another part of your body. There are just 2 M stages to describe spread of nasopharyngeal cancer:

  • M0 means the cancer has not spread to other parts of the body
  • M1 means the cancer has spread to other parts of the body, such as the lungs
Diagram showing nasopharyngeal cancer that has spread to the lungs

Number staging system

Together, the T, N and M stages give your doctor a complete description of the stage of your cancer.

For example, if your cancer has the stages T1, N0 and M0, you might have a tumour that has spread beyond the nasopharynx into the nasal cavity or oropharynx. But the cancer has not spread to your lymph nodes or to any other parts of your body.

The different combinations of T, N and M stages are then grouped together to give 4 main number stages.

Treatment decisions

The stage of your cancer helps your doctor to decide which treatment you need. Your treatment also depends on:

  • the type of cancer (the type of cells the cancer started in)
  • where the cancer is
  • other health conditions that you have

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

Last reviewed: 
09 Feb 2021
Next review due: 
09 Feb 2024
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer
    Springer, 2017

  • Nasopharyngeal carcinoma: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up
    P Bossi and others
    Annals of Oncology, 2021. Volume 32, Issue 4, Pages 452-465