Upper Aerodigestive Tract (Including Salivary Glands) Protocol applies to all invasive carcinomas of the upper aerodigestive tract including the oral cavity (including lip and tongue), pharynx



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Primary Tumor (T): Hypopharynx


T1 Tumor limited to 1 subsite of hypopharynx (ie, pyriform sinus, post-cricoid region, or posterior wall) and 2 cm or less in greatest dimension

T2 Tumor invades more than 1 subsite of hypopharynx or an adjacent site, or measures more than 2 cm but not more than 4 cm in greatest dimension, without fixation of hemilarynx#

T3 Tumor measures more than 4 cm in greatest dimension, or with fixation of hemilarynx#

T4a Tumor invades adjacent structures, eg, thyroid/cricoid cartilage, hyoid bone, thyroid gland, esophagus, or central compartment soft tissue##

T4b Tumor invades prevertebral fascia, encases carotid artery, or invades mediastinal structures
# May only be determined clinically.

## Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat.

Regional Lymph Nodes (N): Lip and Oral Cavity, Oropharynx, and Hypopharynx


NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension

N2 Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension

N2a Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension

N2b Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension

N2c Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension

N3 Metastasis in a lymph node more than 6 cm in greatest dimension


Note: Midline nodes are considered ipsilateral nodes.

Regional Lymph Nodes (N): Nasopharynx


NX Regional lymph nodes cannot be assessed

N0 No regional lymph node metastasis

N1 Unilateral metastasis in lymph node(s),# 6 cm or less in greatest dimension, above supraclavicular fossa

N2 Bilateral metastasis in lymph node(s), 6 cm or less in greatest dimension, above supraclavicular fossa

N3 Metastasis in lymph node(s) more than 6 cm in greatest dimension and/or to supraclavicular fossa

N3a Metastasis in lymph node(s) more than 6 cm in dimension

N3b Metastasis in lymph node(s) residing wholly or in part in the supraclavicular fossa
# Midline nodes are considered ipsilateral nodes.

Distant Metastasis (M): Lip and Oral Cavity, Oropharynx, Nasopharynx, and Hypopharynx


MX Distant metastasis cannot be assessed

M0 No distant metastasis

M1 Distant metastasis

Stage Groupings: Lip and Oral Cavity, Oropharynx, and Hypopharynx


Stage 0 Tis N0 M0

Stage I T1 N0 M0

Stage II T2 N0 M0

Stage III T1,T2 N1 M0

T3 N0,N1 M0

Stage IVA T1,T2,T3 N2 M0

T4a N0,N1,N2 M0

Stage IVB Any T N3 M0

T4b Any N M0

Stage IVC Any T Any N M1



Stage Groupings: Nasopharynx


Stage 0 Tis N0 M0

Stage I T1 N0 M0

Stage IIA T2a N0 M0

Stage IIB T1 N1 M0

T2a N1 M0

T2b N0,N1 M0

Stage III T1 N2 M0

T2a,T2b N2 M0

T3 N0,N1,N2 M0

Stage IVA T4 N0,N1,N2 M0

Stage IVB Any T N3 M0

Stage IVC Any T Any N M1



Larynx




Anatomical Sites and Subsites for Larynx

Supraglottis


Epilarynx, including marginal zone

Suprahyoid epiglottis, including tip, lingual (anterior) and laryngeal surfaces

Aryepiglottic fold, laryngeal aspect

Arytenoid

Supraglottis, excluding epilarynx

Infrahyoid epiglottis

Ventricular bands (false cords)

Glottis


Vocal cords

Anterior commissure

Posterior commissure

Subglottis




Primary Tumor (T): Supraglottis


TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Tumor limited to 1 subsite of supraglottis (with normal vocal cord mobility)#

T2 Tumor invades mucosa of more than 1 adjacent subsite of supraglottis or glottis or region outside the supraglottis (eg, mucosa of base of tongue, vallecula, medial wall of pyriform sinus) (without fixation of the larynx) #

T3 Tumor limited to larynx (with vocal cord fixation) # and/or invades any of the following: postcricoid area, pre-epiglottic tissues paraglottic space, and/or minor thyroid cartilage erosion (eg, inner cortex)

T4a Tumor invades through the thyroid cartilage, and/or invades tissues beyond the larynx, eg, trachea, soft tissues of neck including deep/ extrinsic muscle of the tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid and esophagus

T4b Tumor invades prevertebral space, mediastinal structures, or encases carotid artery


# May only be determined clinically.

Primary Tumor (T): Glottis


TX Primary tumor cannot be assessed

T0 No evidence of primary tumor

Tis Carcinoma in situ

T1 Tumor limited to vocal cord(s) (may involve anterior or posterior commissure) (with normal mobility)#

T1a Tumor limited to 1 vocal cord

T1b Tumor involves both vocal cords

T2 Tumor extends to supraglottis and/or subglottis (and/or with impaired vocal cord mobility#)

T3 Tumor limited to larynx (with vocal cord fixation)# and/or invades paraglottic space, and/or minor thyroid cartilage erosion (eg, inner cortex)

T4a Tumor invades through the thyroid cartilage, and/or invades tissues beyond the larynx, eg, trachea, soft tissues of neck including deep/extrinsic muscle of the tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid and esophagus

T4b Tumor invades prevertebral space, mediastinal structures, or encases carotid artery


# May only be determined clinically.




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