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Understanding Your Stage of Head and Neck Cancer

Stage defines how far the cancer has spread. Stages range from I to IV. Doctors need to know the stage of your head and neck cancer to decide what treatment to recommend. The stage is based on these things:

  • Size and extent of your tumor

  • Number of lymph nodes involved

  • How far the cancer has spread (metastasized)

Your doctor gets this information from the tests conducted to make the diagnosis.

Different head and neck cancers are staged in different ways. Below is a list of staging for each kind of head and neck cancer.

Cancer of the hypopharynx (bottom of the throat)

Here's an overview of the stages for cancer of the hypopharynx:

  • Stage I. Cancer is only in one part of the hypopharynx and is smaller than two centimeters. It has not spread to lymph nodes nearby.

  • Stage II. Cancer is in more than one part of the hypopharynx, or it is between two and four centimeters, or it has spread to nearby tissues. It has not grown into the larynx (voice box) or to nearby lymph nodes.

  • Stage III. Cancer is larger than four centimeters or it is affecting the vocal cords. Or the cancer has spread to one lymph node on the same side of the neck.

  • Stage IV. Cancer is growing into cartilage, bone, or other nearby structures. Or the cancer has spread to more than one lymph node, to a lymph node that is more than three centimeters, or to a lymph node that is on the other side of the neck. Or the cancer has spread to distant lymph nodes or organs in other parts of the body.

  • Recurrent. Recurrent cancer means that cancer has come back after it has been treated.

Cancer of the nasopharynx (upper portion of the throat)

Here's an overview of the stages for cancer of the nasopharynx:

  • Stage I. Cancer is only in one part of the nasopharynx and has not spread to nearby lymph nodes.

  • Stage II. Cancer has spread to soft tissues of the nasal cavity or oropharynx (the part of the throat behind the mouth) and may have spread to the left or right sides of the throat. It may have spread to one or more lymph nodes (not larger than six centimeters) on one side of the neck, or to lymph nodes on either side of  tissues behind the throat.

  • Stage III. Cancer has spread to the sinuses or the bones near the nasopharynx. It may or may not have spread to nearby lymph nodes (not larger than six centimeters and on one side of the neck). Or the cancer has spread nearby lymph nodes on both sides of the neck, and none is larger than six centimeters across.

  • Stage IV. Cancer may have spread to bones or nerves in the head, or to the eye or nearby structures. Or the cancer has spread to lymph nodes that are larger than six centimeters across and/or are above the collarbone area. Or the cancer has spread to distant lymph nodes or organs in other parts of the body.

  • Recurrent. Recurrent cancer means that cancer has come back after it has been treated.

Cancer of the oropharynx (middle part of the throat)

Here's an overview of the stages for cancer of the oropharynx:

  • Stage I. Cancer is not larger than two centimeters and has not spread to nearby lymph nodes.

  • Stage II. Cancer is between two and four centimeters and has not spread to nearby lymph nodes.

  • Stage III. Cancer is more than four centimeters or the cancer is any size but has spread to a lymph node (smaller than three centimeters) on the same side of the neck as the tumor.

  • Stage IV. Cancer has spread into nearby tissues. Or the cancer has spread to more than one lymph node, to a lymph node that is more than three centimeters, or to a lymph node that is on the other side of the neck. Or the cancer has spread to distant lymph nodes or organs in other parts of the body.

  • Recurrent. Recurrent cancer means that cancer has come back after it has been treated.

Cancer of the paranasal ethmoid sinus and nasal cavity

Here's an overview of the stages for cancer of the paranasal ethmoid sinuses and nasal cavity:

  • Stage I. Cancer is in the sinus or nasal cavity only; for ethmoid sinus cancers, the cancer may have invaded the sinus bones. Cancer has not spread to nearby lymph nodes.

  • Stage II. Cancer has spread to other sinus cavities.

  • Stage III. Cancer has not spread further than the bones of the sinus or nasal cavity and is found in only one lymph node (not larger than three centimeters) on the same side of the neck as the tumor. Or the cancer has grown into the bone of the eye socket, the roof of the mouth (palate), the cribriform plate (the bone that separates the nose from the brain), and/or the maxillary sinus, with or without spreading to a lymph node on the same side of the neck.

  • Stage IV. Cancer has spread to other structures such as the eye, the brain, the skin of the nose or cheek, or some parts of the skull. Or the cancer is the same as in Stage III but has spread to more than one lymph node, to a lymph node that is more than three centimeters, or to a lymph node that is on the other side of the neck. Or the cancer has spread to distant lymph nodes or organs in other parts of the body.

  • Recurrent. Recurrent cancer means that cancer has come back after it has been treated.

Cancer of the salivary gland

Here's an overview of the stages for cancer of the salivary gland:

  • Stage I. Cancer is not larger than two centimeters and has not spread into nearby lymph nodes or nearby tissue.

  • Stage II. Cancer is between two and four centimeters and has not spread into nearby lymph nodes or nearby tissue.

  • Stage III. Cancer is larger than four centimeters and/or is growing into nearby soft tissues. Or the cancer is found in only one lymph node (not larger than three centimeters) on the same side of the neck as the tumor.

  • Stage IV. Cancer invades nearby structures such as the jaw bone, skin, ear canal, and/or facial nerve. Or the cancer has spread to more than one lymph node, to a lymph node that is more than three centimeters (or greater than six centimeters for Stage IVB), or to a lymph node that is on the other side of the neck. Or the cancer has spread to distant lymph nodes or organs in other parts of the body.

  • Recurrent. Recurrent cancer means that cancer has come back after it has been treated.

Salivary gland cancers are also classified by grade. The grade tells how fast the cancer cells grow, based on how the cells look under a microscope. Low-grade cancers grow more slowly than high-grade cancers.

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