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Hypopharyngeal Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Hypopharyngeal Cancer

The staging systems are all clinical staging and are based on the best possible estimate of the extent of disease before treatment. The assessment of the primary tumor is based on inspection and palpation, when possible, and by both indirect mirror examination and direct endoscopy. The tumor must be confirmed histologically, and any other pathologic data obtained from a biopsy may be included. Additional radiographic studies may be included. As an adjunct to clinical examination, computed tomography and/or magnetic resonance imaging are needed for an accurate staging of laryngeal and hypopharyngeal carcinomas because both cross-sectional imaging modalities are known to reliably evaluate deep tumor infiltration.[1,2,3] The appropriate nodal drainage areas are examined by careful palpation. If a patient relapses, complete restaging must be done to select the appropriate additional therapy.

Definitions of TNM

The American Joint Committee on Cancer has designated staging by TNM classification to define hypopharyngeal cancer.[4]

Table 1. Primary Tumor (T)a

a Reprinted with permission from AJCC: Pharynx. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 41-56.
b Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinomain situ.
Hypopharynx
T1Tumor limited to 1 subsite of hypopharynx and/or ≤2 cm in greatest dimension.
T2Tumor invades >1 subsite of hypopharynx or an adjacent site, or measures >2 cm but not >4 cm in greatest dimension without fixation of hemilarynx.
T3Tumor >4 cm in greatest dimension or with fixation of hemilarynx or extension to esophagus.
T4aModerately advanced local disease.
Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, or central compartment soft tissue.b
T4bVery advanced local disease.
Tumor invades prevertebral fascia, encases carotid artery, or involves mediastinal structures.
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