Tnm classification in otolaryngology head &neck surgery

1. TNM classification in Otolaryngology-
Head &Ncek Surgery
The TNM system describes a cancerous tumour involvement at primary site (T), as well as spread to
the regional lymph nodes(N) &distantmetastasis(M).
Aims of the TNM Staging:to describe cancer in a uniform fashion.
To better understanding of prognosis & accurate patient counselling.
To develop treatment protocol.
The American joint committee on cancer was formed in 1959,unifying previous classification
systems.Since then the AJCC has continued to update a stage classification system for all anatomic
sites & subsites.The recent revision was published in 2002.
T describes the extent of the primary tumour.there are 7 categories:TX(primary tumour cannt be
assessed),T0 (no evidence of primary tumour), Tis (tumour is situ),T1,T2,T3 &T4.
N decribes spread of the cancer to regional lynph node.NX(regional lymph node cannot be assessed)
NO( no palpable lymph node) N1,N2,&N3 described by the size of the lymph node.
M describes the presence of distant metastasis.A patient with a metastasis beyond the regional
lymph node has M1.Mx designates that a metastatic workup has not been completed.M0 (no
evidence of metastasis.)
T of Lips & mouth cavity(oral tongue ,buccal mucosa, hard palate, alveolar
ridge, retromolar trigone, floor of mouth, lips)
T1 <2cm
T2 >2cm but <4cm
T3 >4cm
T4 invades adjacent structure(bone, soft tissue, deep tongue muscle, skin)
Nasopharynx
T1 confined to nasopharynx
T2 extent to oropharynx,nasal cavity, or parapharyngeal extension.
T3 invades bony structures or paranasal sinus.
T4 invades adjacent structures(skull, cranial nerve, infratemporal fossa, hypopharynx,orbit,
masticator space.)

2. Oropharynx(base of the tongue,soft palate,tonsils, pharyngeal wall)
T1 <2cm
T2 >2cm <4cm
T3 >4cm
T4 invades adjacent structures (larynx,deep tongue muscle,pterygoid muscle, bone)
Hypopharynx(piriform sinus, postcricoid area, posterior pharyngeal wall)
T1 <2cm & limited to one subsite.
T2 >2cm <4cm or invades adjacent subsite of hypopharynx.
T3 >4cm or hemilarynx fixed.
T4 invades adjacent structures (cartilage, bone, thyroid gland, eosphagus ,prevertebral fascia.
Supraglottis larynx(lingual surface & laryngeal surface &infrahyoid
epiglottis, false cords,arytenoids,aryepiglottic fold)
T1 limited to one subsite
T2 spread to adjacent subsite within supraglottic larynx or outside of supraglottic larynx.
T3 Vocal cord fixation or invades adjacent structures (postcricoid area, preepiglottic
tissue,paraglottic tissue,inner cortex of thyroid cartilage.)
T4 invades adjacent structures or extends beyond larynx.
Glottic larynx
T1 limited to vocal cord(s)
T2 extends to supraor subglottic area and/or impaired mobility.
T3 limited to larynx with vocal cord fixation.
T4 invades thyroid cartilage or extend beyond larynx.
Subglottic larynx
T1 limited to subglottis.
T2 extends to vocal cords with normal or impaired mobility.
T3 Extends to vocal cords with fixation
T4 Invades cricoids or thyroid cartilage or extend beyond larynx.

3. Nasal cavity & ethmoid sinus
T1 limited to one subsite, with or without bony invasion
T2 invades two subsites in a single region or extends to adjacent region.
T3 extends to medial wall, floor of orbit, maxillary sinus ,palate or cribriform plate.
T4 invades orbit,skin, skull base, cranial nerve,sphenoid sinus,frontal sinus.pterygoid,
nasopharynx.
Maxillary sinus
T1 limited to mucosa
T2 invades infrastructure
T3 invades subcutaneous tissue, posterior wall,orbital floor, ethmoids
T4 invades orbit ,skin skull base cranial nerva other than v2, sphenoid or frontal
sinus,pterygoid,nasopharynx.
Major salivary glands(parotid,submandibular ,sublingual)
T1 <2cm
T2 >2cm<4cm
T3 >4cm or extraparenchymal extension.
T4 invades skin, bone,cartilage,facial nerve skull base.
Thyroid
T1 <1cm
T2 >1cm <4cm
T3 >4cm or minimal extrathyroid extension(sternothyroid)
T4 invades adjacent structures or any anaplastic carcinoma.

4. N staging for regional lymph nodes
N0 no lymph nodes
N1 Ipsilateral <3cm
N2aIpsilateral single >3cm &< 6cm
N2bIpsilateral multiple <6cm
N2cbilateral or contralateral <6cm
N3 >6cm
Stage grouping
stageI T1 N0 M0
StageII T2 N0 M0
stageIII T3
T1-3
N0
N1
M0
M0
StageIV T4
AnyT
AnyT
AnyT
N0
N2
N3
Any N
M0
M0
M0
M1