TNM stages of nasopharyngeal cancer

The stage of a cancer tells you how big it is and how far it has spread. It helps your doctor work out the best treatment for you.

TNM system stands for Tumour, Node and Metastasis. Doctors use the TNM system to stage nasopharyngeal cancer. 

Doctors may also use a number staging system. Staging for nasopharyngeal cancer is very complex. Different factors are considered before doctors can confirm your final stage.

Speak to your doctor or specialist nurse if you have any questions about your staging.

Tumour (T)

Tumour describes the size of the tumour (area of cancer).

T0 means that no cancer is seen in the nasopharynx but there are cancer cells in one or more lymph nodes in the neck, which test positive for the Epstein Barr virus (EBV). This means it is very likely to be nasopharyngeal cancer.

Tis (carcinoma in situ) means the cancer is in the top layer of cells that line the inside of the nasopharynx and has not grown deeper.

T1 means the cancer is contained within the nasopharynx, or it has spread into the area at the back of the mouth and top of the throat (oropharynx) or the nasal cavity.

T2 means cancer cells have spread into areas next to the nasopharynx. But they have not spread into the bone. You might hear this called parapharyngeal extension.

T3 means the tumour has spread into the sinuses or the bones near the nasopharynx.

T4 means the tumour has spread into one or more of the following areas:

• the skull - you may hear this called intracranial extension
• the cranial nerves (these nerves are close to the nasopharynx and control our eye movement, sight and sense of smell)
• the lower part of the throat (hypopharynx)
• the eye or the surrounding tissue
• the main salivary gland (the parotid gland)
• nearby soft tissues

Node (N)

N stages describe whether the cancer has spread to any lymph nodes and the size and position of any nodes affected. 

N0 means there are no lymph nodes containing cancer cells.

N1 means there are cancer cells in one or more lymph nodes on one side of the neck, or there are cancer cells in the lymph nodes behind the throat on one or both sides of the neck. But in either case, the nodes are not more than 6cm across.

N2 means there are cancer cells in lymph nodes on both sides of the neck. The nodes are not more than 6cm across.

N3 means there are cancer cells in one or more lymph nodes on one or both sides of the neck. The affected nodes are more than 6cm across or are just above the collarbone.

Metastasis (M)

M stages describe whether the cancer has spread to another part of your body. There are 2 M stages to describe the spread of nasopharyngeal cancer:

• M0 means the cancer has not spread to other parts of the body
• M1 means the cancer has spread to other parts of the body, such as the lungs

Number staging system

Together, the T, N and M stages give your doctor a complete description of the stage of your cancer.

For example, if your cancer has the stages T1, N0 and M0, you might have a tumour that has spread beyond the nasopharynx into the nasal cavity or oropharynx. But the cancer has not spread to your lymph nodes or to any other parts of your body.

The different combinations of T, N and M stages are then grouped together to give 4 main number stages.

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Your treatment also depends on:

• the type of cancer (the type of cells the cancer started in)
• where the cancer is
• other health conditions that you have

Treatment may include:

• radiotherapy
• chemotherapy
• surgery 

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT). Your doctor will discuss the treatment options with you.