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Tumor Staging for Cancers of the Head and Neck

By categorizing tumors, medical professionals can decide how severe a case is, which treatment plan to follow and how the prognosis will be. This is an international way of regulating tumor size, lymph node involvement and size and metastatic presentation.

Prevalence and Etiology

Alcohol consumption and smoking or chewing tobacco can play a major role in the manifestation of orofacial tumors, whose prevalence is steadily on the rise. Depending on the country, head and neck tumors are the eighth most frequent malignancy worldwide. In order to eliminate the risk of development of these particular tumors, several measures must be put in place, that limit a patient's exposure to both major and minor risk factors :

  • avoid alcohol and tobacco
  • maintain a healthy diet combined with exercise
  • high risk patients with systemic diseases and long term medications should be regularly screened
  • patients with a history of cancer or familial cancer should be regularly screened

Signs and Symptoms




These vary according to the type of cancer. Some can become quite advanced before they are diagnosed, as pain or swelling usually isn’t seen in the early stages. The most common early symptoms that need to be checked by a doctor include:

  • soreness in the mouth
  • the development of a lump or thickened tissue (in the maxilla or mandible or the soft tissues of the oral cavity: bucca, soft palate, hard palate, floor of the mouth, tongue, lips, gingiva)
  • erythroplakia or leukoplakia (a non-removable red or white patch or plaque, usually found on the bucca)
  • a chronic ulcer (aptha on the soft tissues of the oral cavity, especially the bucca and the lower lip)


More advanced symptoms include:

  • difficulty in speech and swallowing (due to paralysis or obstruction by the swelling)
  • weight loss
  • trismus (difficult in opening the jaws)
  • ulcer infection (chronic aphthae which are infiltrated and colonized by oral bacteria)
  • auricular pain (referred)
  • sensory disturbances (local neural destruction)
  • swellings or lumps in the neck (lymph node involvement, metastasis)

Tumor Staging

The TNM classification, stages the tumors according to:

  • T - Primary Tumor Size
  • N - Lymph Node Involvement
  • M - Distant Metastasis

Primary Tumor Size

  • Tx - Inaccessible
  • T0 - Inevident
  • T1 - ≤2 cm
  • T2 - 2-4 cm
  • T3 - ≥4 cm
  • T4 - Invasion of Adjacent Structures

Lymph Node Involvement

  • Nx - Inaccessible
  • N0 - Nonpalpable
  • N1 - Single Ipsilateral Node ≤3 cm
  • N2a - Single Ipsilateral Node 3-6 cm
  • N2b - Multiple Ipsilateral Nodes ≤6 cm
  • N2c - Bilateral or Contralateral Nodes ≤6 cm
  • N3 - Any Node that is ≥6 cm

Distant Metastasis

  • M0 - None
  • M1 - Distant Metastasis

If you have been suffering from any of the previously mentioned symptoms for more than a week please consult your doctor immediately!

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Show references


  • David Wray, David Stenhouse, David Lee, Andrew J. E. Clark, Textbook of general and Oral Surgery, 1st edition, Churchill Livingstone, 2003, Chapter 17


  • Dr. Alexandra Sieroslawska


  • Hardin MD Image Collections
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