p16 negative oropharyngeal squamous cell carcinoma (SCC) TNM

Clinical staging, p16 negative oropharyngeal tumours, TNM8^th Edition, UICC, 2017

 

Primary Tumour (T)

T1        Tumours 2cm or less in greatest dimension

T2        Tumours greater than 2cm but not greater than 4cm in greatest dimension

T3        Tumour more than 4cm in dimension or extension into lingual surface of epiglottis

T4a       Advanced local disease with tumour invasion of any of the following: larynx, deep/extrinsic muscles of the tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), medial pterygoid, hard palate or mandible

T4b       Advanced local disease with tumour invasion of any of the following: lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, skull base or encases carotid artery

NB       Mucosal extension to the lingual surface of the epiglottis from primary tumours of the base of tongue or vallecula does not constitute invasion of the larynx

 

Regional Lymph Nodes (N)

Nx       Regional lymph nodes cannot be assessed

N0       No regional lymph node metastasis

N1       Metastasis in a single ipsilateral lymph node, ≤3 cm and no extranodal extension (ENE)

N2a     Metastasis in a single ipsilateral lymph node, >3cm but ≤6cm, no ENE

N2b     Metastasis in multiple ipsilateral lymph nodes, all ≤6cm and no ENE

N2c     Metastasis in bilateral or contralateral lymph nodes, ≤6cm and no ENE

N3a     Metastasis in any lymph node >6cm with no ENE

N3b     Metastasis in any lymph node(s) with clinical ENE *

Notes: * The presence of skin involvement or soft tissue invasion with deep fixation/tethering to underlying muscle or adjacent structures or clinical signs of nerve involvement is classified as clinical extranodal extension. Midline nodes are considered ipsilateral nodes.

 

Distant Metastasis (M)

M0       No distant metastasis

M1       Distant metastasis

 

Pathological classification of Regional Lymph Nodes (pN)

Histological examination of a selective neck dissection specimen will ordinarily include 10 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 15 or more lymph nodes.

pNx     Regional lymph nodes cannot be assessed

pN0     No regional lymph node metastasis

pN1     Metastasis in a single ipsilateral lymph node, ≤3cm, no ENE

pN2a   Metastasis in a single ipsilateral lymph node, ≤3cm With ENE+; OR single lymph node >3cm but ≤6cm and no ENE

pN2b   Metastasis in multiple ipsilateral lymph nodes, ≤6cm, no ENE

pN2c    Metastasis in bilateral or contralateral lymph nodes, ≤6cm, no ENE

pN3a   Metastasis in any lymph node >6cm, no ENE

pN3b   Metastasis in a single ipsilateral lymph node >3cm with ENE+; OR single contralateral node, any size with ENE+; OR multiple nodes, any size with ENE+

Note:   Midline nodes are considered ipsilateral nodes.