Metastasis in any node(s) and clinically overt ENE(+)Īs said above, p staging obviously applicable only to patients who undergo surgery. Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(–) or In bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(–) Metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(–) or Metastasis in a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(–) or Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(–)Ĭontralateral or bilateral lymph nodes, none larger than 6 cm One or more ipsilateral lymph nodes, none larger than 6 cm ENE is not considered as a prognostic factor in these cases.
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Clinical nodal staging is established after clinical examination and basic investigations like imaging, needle aspiration, etc.Nodal stages are divided into clinical nodal (cN) staging and pathological (pN) nodal staging. Tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base or encases carotid artery. Tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible or beyond.* Tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible or beyond Tumor larger than 4 cm in greatest dimension or extension to the lingual surface of epiglottis Tumor larger than 2 cm but not larger than 4 cm in greatest dimension Tumor 2 cm or smaller in greatest dimension T4a / T4b distinction eliminated as prognostically there is no difference – means survival curves of T4a and T4b are indistinguishable.Carcinoma in situ (Tis) stage of AJCC 7 removed due to the absence of a distinct basement membrane in the epithelium of Waldeyer’s ring and also due to the indolent nature of p16 + oropharyngeal cancer.So there is no rationale to support retaining the T0 designation outside of the virally associated cancers of the oropharynx. This is because, in a p16 negative cancer, if no primary lesion can be identified, then the lymph node may have emanated from any mucosal site. The following are changes made in T classifications of oropharyngeal cancers. In TNM staging of cancer, T describes the size of the original (primary) tumor and whether it has invaded nearby tissue. Based on the expression of p16, oropharyngeal cancers are divided into p16 positive(HPV positive) and p16 negative (HPV negative). P16 is a surrogate molecular marker for detecting HPV infection. This was the whole rationale behind creating a separate staging algorithm for high-risk human papillomavirus-associated oropharyngeal cancer. Large primary, small or large nodal diseaseįrom the table, it’s clear that HPV positive oropharyngeal cancers are associated with a good prognosis and less chance of recurrence.
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Younger, healthy patients – median age 57 years Some of these characteristics are tabulated below. These studies have shown a significant difference in the clinical spectrum between HPV +ve and HPV -ve oropharyngeal cancers. When analyzing the data on oropharyngeal cancers, it was found that 60-80% of oropharyngeal cancer cases are HPV positive.