Stages of Hypopharyngeal Cancer
After hypopharyngeal cancer is diagnosed, tests are done to determine the extent or stage of the cancer. The stage of cancer describes how much cancer is in the body. It helps you and your doctor understand the severity of cancer, how best to treat it, and the chance of survival.
Doctors mainly depend on the TNM system created by the American Joint Committee on Cancer (AJCC) for hypopharyngeal cancer. The TNM system is based on three key pieces of information:
How big the main tumor (T) is
If the cancer has spread to nearby lymph nodes (N)
The spread (metastasis) to distant parts of the body (M)
The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer and communicating it, so doctors can work together to plan the best treatments. Numbers or letters after T, N, and M provide more details about each of these factors. Lower numbers mean that the cancer is in an early stage. Higher numbers mean the cancer is more advanced.
Tumor (T)
Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Tumor size is measured in centimeters (cm).
Tumors of the Hypopharynx
TX: The primary tumor cannot be evaluated.
Tis: This is a stage called carcinoma (cancer) in situ. It is a very early cancer where cancer cells are found in only one layer of tissue.
T1: The tumor is 2 cm or smaller and is limited to a single place in the lower throat.
T2: The tumor involves more than one site in the lower throat, or the tumor measures between 2 cm and 4 cm but does not touch the voice box.
T3: The tumor is larger than 4 cm or has spread to the larynx or esophagus.
T4a: The tumor has spread into nearby structures, such as the thyroid gland, the arteries that carry blood to the brain, or the esophagus.
T4b: The tumor has spread to the prevertebral fascia (space in front of the spinal cord), encases the arteries, or involves the chest area.
Node (N)
The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Regional lymph nodes are located near the head and neck, while distant lymph nodes are located in other parts of the body.
When cancer has spread through a lymph node and into the tissues directly surrounding it, this is called extranodal extension (ENE). Knowing whether ENE is present plays an important role in the evaluation of lymph nodes in hypopharyngeal cancer.
The evaluation of nodes can be clinical or pathological. Clinical evaluation is based on the results of tests done before surgery. Pathological evaluation is based on what is found during surgery plus other testing results.
Clinical N
NX: The regional lymph nodes cannot be evaluated.
N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.
N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller. There is no ENE.
N2a: Cancer has spread to a single lymph node on the same side as the primary tumor and is larger than 3 cm but not larger than 6 cm. There is no ENE.
N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measures larger than 6 cm. There is no ENE.
N2c: Cancer has spread to more than one lymph node on either side of the body, and none measures larger than 6 cm. There is no ENE.
N3a: The cancer is found in a lymph node larger than 6 cm. There is no ENE.
N3b: There is ENE in any lymph node.
Pathological N
NX: The regional lymph nodes cannot be evaluated.
N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.
N1: The cancer has spread to a single lymph node on the same side as the primary tumor, and the cancer found in the node is 3 cm or smaller. There is no ENE.
N2a: Cancer has spread to one lymph node and is 3 cm or smaller, but there is ENE. Or cancer has spread to a single lymph node on the same side as the primary tumor and is larger than 3 cm but not larger than 6 cm, and there is no ENE.
N2b: Cancer has spread to more than one lymph node on the same side as the primary tumor, and none measures larger than 6 cm. There is no ENE.
N2c: Cancer has spread to more than one lymph node on either side of the body, and none measures larger than 6 cm. There is no ENE.
N3a: The cancer is found in a lymph node and is larger than 6 cm. There is no ENE.
N3b: There is ENE in a single lymph node on the same side as the primary tumor, and it is larger than 3 cm. Or, cancer has spread to many lymph nodes, and at least 1 has ENE. Or, there is ENE in a single lymph node on the opposite side of the primary tumor that is 3 cm or smaller.
Metastasis (M)
The "M" in the TNM system describes whether the cancer has spread to other parts of the body, called metastasis.
M0: The cancer has not spread to other parts of the body.
M1: The cancer has spread to other parts of the body.
The Stages of Hypopharyngeal Cancer
The staging described below is only used for patients who have not had lymph nodes in the neck removed and checked for signs of cancer.
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the lining of the hypopharynx. These abnormal cells may become cancerous and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed in only one area of the hypopharynx and/or the tumor is 2 centimeters or smaller.
Stage II
In stage II, the tumor is:
found in more than one area of the hypopharynx or in a nearby area; or
larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx (voice box).
Stage III
In stage III, the tumor:
is larger than 4 centimeters or has spread to the larynx (voice box) or the esophagus's mucosa (inner lining). Cancer may have spread to one lymph node on the same side of the neck as the tumor. The affected lymph node is 3 centimeters or smaller or
- has spread to one lymph node on the same side of the neck as the tumor. The affected lymph node is 3 centimeters or smaller. Cancer is also found:
in only one area of the hypopharynx and/or the tumor is 2 centimeters or smaller; or
in more than one area of the hypopharynx or a nearby area, or the tumor is larger than 2 centimeters but not larger than 4 centimeters and has not spread to the larynx.
Stage IV
Stage IV is divided into stages IVA, IVB, and IVC as follows:
In stage IVA, the tumor:
- has spread to one of the following:
the thyroid cartilage
the bone above the thyroid cartilage
the thyroid gland
the cartilage around the trachea
the esophageal muscle
the nearby muscles and fatty tissue in the neck.
One lymph node on the same side of the neck as the tumor. The affected lymph node is 3 centimeters or smaller; or
- is found in the hypopharynx and may have spread to the thyroid cartilage, the bone above the thyroid cartilage, the thyroid gland, the cartilage around the trachea, the esophagus, or the nearby muscles and fatty tissue in the neck. Cancer has spread to one of the following:
one lymph node on the same side of the neck as the tumor. The affected lymph node is larger than 3 centimeters but not larger than 6 centimeters
more than one lymph node anywhere in the neck. The affected lymph nodes are 6 centimeters or smaller.
In stage IVB, the tumor or cancerous cells:
- The tumor may be any size and cancer may have spread to
The thyroid cartilage
The bone above the thyroid cartilage
The thyroid gland
The cartilage around the trachea
The esophagus
Nearby muscles and fatty tissue in the neck
Cancerous cells Have spread to a lymph node that is larger than 6 centimeters or have spread through the outside covering of a lymph node into nearby connective tissue; or
Cancerous cells have spread to the connective tissue covering the muscles that support the spinal column, the area around the carotid artery, or the area between the lungs. Cancer may have also spread to lymph nodes in the neck.
In stage IVC, cancer has spread to other parts of the body, such as the lung, liver, or bone.
Head and Neck Cancer Care Available in Brevard County
If you have been diagnosed with hypopharyngeal cancer or a different type of head and neck cancer, the Cancer Care Centers of Brevard are ready to help. We provide second opinions on diagnosis and create personalized treatment plans based on each patient. Our cancer centers are available throughout Brevard County, including Melbourne, Rockledge, Merritt Island, and Palm Bay, FL.