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The Sidney Kimmel Comprehensive Cancer Center

In This Section      

Tumor Staging for Head and Neck Cancer

The place where a cancer starts is called the PRIMARY site. From the primary site the cancer can spread (metastasize) to other parts of the body.  Regardless of where a cancer may spread, it is always named for the place it began. For instance, breast cancer that spreads to the liver is still called breast cancer.

Different types of cancer can behave very differently.  They can grow at different rates and respond to different kinds of treatments.  That is why people with cancer need treatment aimed at their particular type of cancer.


The most common type of cancer. These tumors arise from the cells that cover external and internal body surfaces.  The most frequent cancers of this type are lung, breast, colon and prostate cancer.


These cancers arise from cells found in the supporting tissues of the body such as bone, cartilage, fat, connective tissue and muscle.


Cancers that arise in the lymph nodes and tissues of the body's immune system.


Cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream.

Tumor Staging

The most common tumor staging system is the American Joint Commission on Cancer system of TNM.

 T representing tumor,  N representing the nodes and M representing the presence of distant metastases.   Accurate tumor staging usually requires an imaging study which can help the surgeon see how far the cancer has spread and what structures are involved.

The staging system below applies to most tumors of the head and neck involving the upper aero-digestive tract (sinus, nasal cavity, oropharynx, larynx, hypopharynx).   
Nasopharynx, thyroid and esophageal cancer have their own staging systems.

T 0

The primary tumor cannot be found (unknown primary)

T 1

Tumor is less than 2 cm ( 1”) in size

T 2

Tumor is greater than 2 cm but less than 4 cm (2 “)

T 3

Tumor is greater the 4 cm (2 “) OR tumor involves a vocal cord causing paralysis OR has limited spread beyond the larynx OR  involves the bone of the sinuses

T 4

Tumor has spread beyond the site of origin to involve nearby structures such as bone or muscle

N 0

No obvious lymph node involvement

N 1

A single enlarged lymph node, less than 3 cm , on the same side as the primary tumor

N 2

A single enlarged lymph node, greater than 3 cm but less than 6 cm OR more than one lymph node involved that is less than 6 cm in size

N2a – Single lymph node ,between 3 cm to 6 cm, on the same side as the tumor

N2b – More than one lymph node, less than 6 cm, on the same side as the tumor

N2c -  Lymph nodes involved on both sides of the neck OR the opposite side of the neck from the

tumor, less than 6 cm in size

N 3

An enlarged lymph node that is 6 cm or larger in size


M 0

No distant metastasis found

M 1

Distant metastases found