STAGES OF NPC

Understand the different stages of nasopharyngeal cancer

STAGES OF NPC

Staging of NPC is based on clinical and radiologic examination findings. Unfortunately, over 70% of NPC patients are already in advanced stages of the disease when first examined by the physician (Stage III or IV). This is because NPC is hidden deep behind the nose in the skull base, making it exceedingly difficult to detect.

STAGE O

IN SITU CANCER BEFORE TUMOR GROWTH:

Naspopharyngeal Cancer Stage 0

STAGE I

SMALL TUMOR CONFINED TO NASOPHARYNX:

Naspopharyngeal Cancer Stage 1

STAGE II

TUMOR EXTENDING IN THE LOCAL AREA OR EVIDENCE OF LIMITED NECK (NODAL) DISEASE:

Naspopharyngeal Cancer Stage 2

STAGE III

A LARGE TUMOR WITH OR WITHOUT NECK DISEASE, OR A TUMOR WITH BILATERAL NECK DISEASE:

Naspopharyngeal Cancer Stage 3

STAGE IV

INTRACRANIAL OR INFRATEMPORAL INVOLVEMENT OF TUMOR, EXTENSIVE NECK DISEASE, OR ANY DISTANT METASTASIS:

Naspopharyngeal Cancer Stage 4
Naspopharyngeal Cancer Stage 4C

DESCRIBING THE SPREAD OF NPC

A staging system is a standard way for the cancer care team to sum up the extent of a cancer’s spread.

The most common system used to describe the spread of NPC is the TNM system created by the American Joint Committee on Cancer (AJCC). 

This system contains 3 key pieces of information:

T

Describes whether the main (primary) tumor has invaded other organs or tissues near the nasopharynx.

N

Describes whether the cancer has spread to nearby (regional) lymph nodes (bean-sized collections of immune system cells throughout the body).

M

Indicates whether the cancer has metastasized (spread) to other parts of the body. (The most common sites of distant NPC spread are the lungs, liver, and bones.)

TNM STAGE GROUPING

Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping.

The stage is expressed as the number 0 (zero) or the Roman numerals I to IV (1-4). Some stages are subdivided with letters.

Stage 0:

Tis, N0, M0: The cancer is “in situ.” Cancer cells are only on the surface layer of the nasopharynx and have not yet grown into deeper layers (Tis). The cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage I:

T1, N0, M0: The tumor is in the nasopharynx and may have spread to soft tissues of the nasal cavity and/or the oropharynx (T1). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II:

T2, N0, M0: The tumor has grown into the tissues of the left or right sides of the upper part of the throat (T2). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

OR

T1 or T2, N1, M0: The tumor may still be confined to the nasopharynx, or it may have extended to the soft tissues of the nasal cavity or the oropharynx (T1), or the left or right sides of the upper part of the throat (T2). It has spread to one or more nearby lymph nodes, none of which is larger than 6 cm (about 2½ inches) across. These lymph nodes are either neck lymph nodes on one side or lymph nodes behind the throat (retropharyngeal lymph nodes) on either side (N1). The cancer has not spread to distant sites (M0).

Stage III:

T3, N0 to N2, M0: The tumor has spread to the sinuses or the bones near the nasopharynx (T3). It may or may not have spread to lymph nodes in the neck or behind the throat, but none of these lymph nodes is larger than 6 cm across (N0 to N2). It has not spread to distant sites (M0).

OR

T1 or T2, N2, M0: The tumor may still be confined to the nasopharynx, or it may have grown into the soft tissues of the nasal cavity or the oropharynx (T1), or the left or right sides of the upper part of the throat (T2). The tumor has spread into nearby neck lymph nodes on both sides, but none of the lymph nodes is larger than 6 cm across (N2). The cancer has not spread to distant sites. (M0).

Stage IVA:

T4, N0 to N2, M0: The tumor has grown into the skull and/or cranial nerves, the hypopharynx (lower part of the throat), the eye, or its nearby tissues (T4). It may or may not have spread to nearby lymph nodes in the neck, none of which is larger than 6 cm across (N0 to N2). It has not spread to distant sites (M0).

Stage IVB:

Any T, N3, M0: The tumor may or may not have extended into nearby soft tissues or bones (any T). It has spread to lymph nodes that are larger than 6 cm across and/or is in the shoulder area above the collarbone (N3). The cancer has not spread to distant sites (M0).

Stage IVC:

Any T, any N, M1: The tumor may or may not have extended into nearby soft tissues or bones (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant sites (M1).