TNM Staging Guide 5th Edition eBook

I. Neck Staging under the TNM Staging System for Head and Neck Tumors

This staging system excludes cancers of the nasopharynx and thyroid, as well as HPV-mediated oropharyngeal cancer. There is a clinical staging system (pre-operative staging or for patients undergoing non-surgical therapy) and a pathologic staging system (for individuals undergoing neck dissection as part of their management). CLINICAL STAGING SYSTEM OF REGIONAL LYMPH NODES (cN) NX Regional lymph nodes cannot be assessed N0 No regional nodes metastasis N1* Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension, ENE(−) N2a* Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension, ENE(−) N2b* Metastasis in multiple ipsilateral lymph nodes, none more that 6 cm in greatest dimension, ENE(−) N2c* Metastasis in bilateral or contralateral lymph node(s), none more than 6 cm in greatest dimension, ENE(−) N3a* Metastasis in a lymph node more than 6 cm in greatest dimension N3b* Metastasis in a lymph node with clinically overt 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). **Clinically overt ENE is defined as invasion of skin or dense tethering to adjacent structures or evidence of dysfunction of adjacent cranial nerves, brachial plexus, sympathetic chain, and/or phrenic nerves. PATHOLOGIC STAGING SYSTEM OF REGIONAL LYMPH NODES (pN) NX Regional lymph nodes cannot be assessed N0 No regional nodes metastasis N1* Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension, ENE(−) N2a* Metastasis in single ipsilateral node 3 cm or smaller in greatest dimension and ENE(+); or a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(−)

22 TNM Staging of Head and Neck Cancer and Neck Dissection Classification