Your doctor might be able to see a tumor in your pharynx without special equipment but may need special mirrors or fiberoptic telescopes. Your doctor may also need to feel the back of your throat with a gloved finger. A biopsy will confirm the diagnosis. Biopsies are usually performed with the patient under general anesthesia.

Tumor staging

T stages for orophaynx cancer

T1: Tumor is no more than 2 cm (about 3/4 inch) across

T2: Tumor is between 2 and 4 cm across (3/4 inch to 1 1/2 inch)

T3: Tumor is more than 4 cm (about 1 1/2 inch) across

T4a: Tumor is growing into nearby structures, such as the larynx (voicebox), the tongue muscle, or bones, such as the medial pterygoid, hard palate, or jaw

T4b: Tumor has grown through nearby structures and into deeper areas or tissues. This is known as very advanced local disease.

T stages of hypopharyngeal cancer

The spread of cancer within the hypopharynx is described according to the size of the tumor and how many areas (subsites) are involved. The hypopharynx consists of three subsites:

• Pharyngo-esophageal junction
• Pyriform sinus
• Posterior pharyngeal wall

T1: The tumor is growing only in one subsite of the hypopharynx and is less than 2 cm (about 3/4 of an inch) across.

T2: The tumor in growing in two or more subsites of the hypopharynx or

• The tumor is growing in one subsite plus an area nearby or
• The tumor is 2 to 4 cm in size (3/4 inch to 1 1/2 inch), with normal movement of the vocal cords.

T3: Either the tumor is more than 4 cm (about 1 1/2 inches) across or the tumor is affecting vocal cord movement.

T4a: The tumor is growing into the cricoid or thyroid cartilage, hyoid bone, thyroid gland, esophagus, or the strap muscles in front of the larynx. This is known as moderately advanced local disease.

T4b: The tumor is growing into the space in front of the spine in the neck, is growing around a carotid artery, or is growing down into the front of the chest cavity. T4b tumors are known as very advanced local disease.

N categories:

N0: No spread to nearby lymph nodes

N1: The cancer has spread to one lymph node on the same side of the head or neck as the primary tumor. The lymph node is less than 3 cm (about 1 1/4 inch) across

N2: Includes three subgroups:

• N2a: The cancer has spread to one lymph node on the same side as the primary tumor. The lymph node more than 3 cm across but smaller than 6 cm (about 2 1/2 inches)
• N2b: The cancer has spread to 2 or more lymph nodes on the same side as the primary tumor, but none are more than 6 cm across
• N2c: The cancer has spread to one or more lymph nodes on both sides of the neck or on the side opposite the primary tumor, but none are more than 6 cm across

N3: The cancer has spread to a lymph node that is more than 6 cm across

M categories:

M0: No distant spread

M1: The cancer has spread to distant sites outside the head and neck region, for example, the lungs

Stage grouping

Once the T, N, and M categories are assigned, this information is combined by a process called stage grouping to assign an overall stage of 0, I, II, III, or IV. Stage IV is further divided into A, B, and C.

Stage 0: Tis, N0, M0: Carcinoma in situ. The cancer is only growing in the epithelium, the outer layer of oral or oropharyngeal tissue (Tis). It has not yet grown into a deeper layer or spread to nearby structures, lymph nodes (N0), or distant sites (M0).

Stage I: T1, N0, M0: The tumor is 2 cm (about 3/4 inch) across or less (T1) and has not spread to nearby structures, lymph nodes (N0), or distant sites (M0).

Stage II: T2, N0, M0: The tumor is more than 2 cm across but smaller than 4 cm (T2) and has not spread to nearby structures, lymph nodes (N0), or distant sites (M0).

Stage III: One of the following applies:

T3, N0, M0: The tumor is more than 4 cm across, but it hasn't grown into nearby structures or spread to the lymph nodes (N0) or distant sites (M0).

OR

T1 to T3, N1, M0: The tumor is any size and hasn't grown into nearby structures (T1 to T3). It has spread to one lymph node on the same side of the head or neck, with the lymph node being less than 3 cm across (N1). The cancer hasn't spread to distant sites (M0).

Stage IVA: One of the following applies:

T4a, N0 or N1, M0: The tumor is growing into nearby structures (T4a). It can be any size. It has either not spread to the lymph nodes (N0) or has spread to one lymph node, on the same side of the head or neck, with the lymph node being less than 3 cm across (N1). The cancer hasn't spread to distant sites (M0).

OR

T1 to T4a, N2, M0: The tumor is any size and may or may not invade nearby structures. It has not spread to distant sites (M0). It has spread to one of the following:

• One lymph node, on the same side of the head and neck, that is between 3 and 6 cm across (N2a)
• One lymph node, on the opposite side of the head and neck, that is less than 6 cm across (N2b)
• Two or more lymph nodes, each of which is smaller than 6 cm across. The lymph nodes can be on any side of the neck (N2c)

Stage IVB: One of the following applies:

T4b, any N, M0: The tumor is growing into deeper areas and/or tissues (very advanced local disease - T4b). It may (or may not) have spread to lymph nodes (any N). It has not spread to distant sites (M0).

OR

Any T, N3, M0: The tumor is any size and it may or may not have grown into other structures (any T). It has spread to one or more lymph nodes , each being more than 6 cm across (N3), but the tumor hasn't spread to distant sites (M0).

Stage IVC: Any T, Any N, M1. The tumor is any size and may or may not have spread to the lymph nodes. It has spread to distant sites, most commonly the lungs.