Quick Reference Guide to TNM Staging of Head and Neck Cancer and Neck Dissection Classification

N2b* Metastases in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension, ENE(−) N2c* Metastases in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension, and ENE (−) N3 Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−); or metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral or bilateral nodes any with ENE(+); or a single contralat- eral node of any size and ENE (+) N3a* Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−) N3b* Metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+); or multiple ipsilateral, contralateral or bilateral nodes any with ENE(+); or a single contralateral node of any size and ENE(+)** *Note: A designation of “U” or “L” may be used for any N stage to indicate metastasis above the lower border of the cricoid cartilage (U) or below the lower border of the cricoid cartilage (L). **ENE is pathologically classified as ENEmi (microscopic ENE ≤ 2mm) or ENEma (macroscopic ENE>2mm). Both ENEmi and ENEma qualify as ENE(+) for the purposes of pN Staging. NECK STAGING FOR HPV-MEDIATED OROPHARYNGEAL CANCER For HPV-mediated Oropharyngeal Cancer, there is a clinical and pathologic nodal staging system CLINICAL REGIONAL LYMPH NODE STAGING (CN), HPV-MEDIATED OROPHARYNGEAL CANCER cNX Regional lymph nodes cannot be assessed cN0 No regional nodes metastasis cN1* One or more ipsilateral lymph node metastases ≤ 6 cm

cN2* Contralateral or bilateral lymph node(s) ≤ 6cm cN3* Any neck lymph node metastasis larger than 6cm

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