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Head and Neck Cancer: Stages

What does stage of cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. He or she can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer. 

Different head and neck cancers are staged in different ways. Below is a list of stages for some of the more common types of head and neck cancer.

Cancer of the bottom of the throat (hypopharynx)

The stages for cancer of the hypopharynx are:

Stage 0 (carcinoma in situ). The cancer is only in the tissue where it started. It has not spread.

Stage I. Cancer is only in 1 part of the hypopharynx and is smaller than 2 centimeters (cm). It has not spread to nearby lymph nodes.

Stage II.  Cancer has not grown into the voice box (larynx) or to nearby lymph nodes. In addition, 1 of the following is also true:

  • Cancer is in more than 1 part of the hypopharynx

  • Cancer is between 2 cm and 4 cm

  • Cancer has spread to nearby tissues

Stage III. One of the following is true:

  • The cancer is larger than 4 cm or it is affecting the vocal cords.

  • The cancer is smaller than 4 cm and has spread to 1 lymph node on the same side of the neck.

Stage IV. One of the following is true:

  • Cancer is growing into cartilage, bone, or other nearby structures.

  • Cancer has spread to more than 1 lymph node, to a lymph node that is more than 3 cm, or to a lymph node on the other side of the neck.

  • Cancer has spread to distant lymph nodes or organs in other parts of the body.

Recurrent. The cancer has come back after it has been treated.

Cancer of the upper portion of the throat (nasopharynx)

Stage 0 (carcinoma in situ). The cancer is only in the tissue it started in. It has not spread.

Stage I. Cancer is only in the nasopharynx. It has not spread to nearby lymph nodes.

Stage II. Cancer has spread to soft tissues of the nasal cavity or the part of the throat behind the mouth (the oropharynx), and may have spread to the left or right sides of the throat. It may have spread to 1 or more lymph nodes (which are not larger than 6 cm) on 1 side of the neck. Or it may have spread to lymph nodes on either side of tissues behind the throat.

Stage III. One of the following is true:

  • Cancer has spread to the sinuses or the bones near the nasopharynx. It may also have spread to nearby lymph nodes (which are not larger than 6 cm and on 1 side of the neck).

  • Cancer has spread to nearby lymph nodes on both sides of the neck. None of the lymph nodes is larger than 6 cm across.

Stage IV. One of the following is true:

  • Cancer may have spread to bones or nerves in the head, or to the eye, or nearby structures.

  • Cancer has spread to lymph nodes that are larger than 6 cm across or are above the collarbone area.

  • Cancer has spread to distant lymph nodes or organs in other parts of the body.

Recurrent. The cancer has come back after it has been treated.

Cancer of the middle part of the throat (oropharynx)

Stage 0 (carcinoma in situ). The cancer is only in the tissue it started in. It has not spread.

Stage I.  The cancer is not larger than 2 cm and has not spread to nearby lymph nodes.

Stage II. The cancer is between 2 cm and 4 cm and has not spread to nearby lymph nodes.

Stage III. One of the following is true:

  • The cancer is more than 4 cm.

  • The cancer is any size, but has spread to a lymph node (smaller than 3 cm) on the same side of the neck as the tumor.

Stage IV. One of the following is true:

  • Cancer has spread into nearby tissues.

  • Cancer has spread to more than 1 lymph node, or to a lymph node that is more than 3 cm, or to a lymph node on the other side of the neck.

  • Cancer has spread to distant lymph nodes or organs in other parts of the body.

Recurrent. The cancer has come back after it has been treated.

Cancer of the paranasal ethmoid sinus and nasal cavity

Stage 0 (carcinoma in situ). Cancer is only in the tissue it started in. It has not spread.

Stage I. Cancer is in the sinus or nasal cavity only. Cancer has not spread to nearby lymph nodes.

Stage II. Cancer has spread to other sinus cavities.

Stage III. One of the following is true:

  • Cancer has not spread further than the bones of the sinus or nasal cavity. It is found in only 1 lymph node (not larger than 3 cm) on the same side of the neck as the tumor.

  • Cancer has grown into the bone of the eye socket or the maxillary sinus. It may or may not have spread to a lymph node on the same side of the neck.

Stage IV. One of the following is true:

  • 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.

  • Cancer is the same as in Stage III but has spread to more than 1 lymph node. Or it has spread to a lymph node on the same side of the neck that is between 3 cm and 6 cm, or to a lymph node that is larger than 6 cm, or to a lymph node on the other side of the neck.

  • Cancer has spread to distant lymph nodes or organs in other parts of the body.

Recurrent. The cancer has come back after it has been treated.

Cancer of the salivary gland

Stage I. Cancer is not larger than 2 cm and has not spread into nearby lymph nodes or nearby tissue.

Stage II. Cancer is between 4 cm and 6 cm and has spread beyond the salivary glands. But it does not affect the facial nerve and has not spread into nearby lymph nodes. 

Stage III. Cancer is smaller than 4 cm and has spread into nearby lymph nodes. 

Stage IV. One of the following is true:

  • Cancer has invaded nearby structures, such as the skull, arteries, jaw bone, skin, ear canal, or facial nerve.

  • Cancer has spread to more than 1 lymph node, to a lymph node that is more than 3 cm, or to a lymph node on the other side of the neck.

  • Cancer has spread to distant lymph nodes or organs in other parts of the body.

Recurrent. The 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.

Talking with your healthcare provider

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask any questions or talk about your concerns.

Online Medical Reviewer: Gersten, Todd, MD
Online Medical Reviewer: Stump-Sutliff, Kim, RN, MSN, AOCNS
Date Last Reviewed: 10/1/2016
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