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

    Staging systems are all clinical staging and are based on the best possible estimate of the extent of disease before treatment.[1,2] Assessment of the primary tumor is based on inspection and palpation, and fiberoptic endoscopic evaluation. The tumor must be confirmed histologically, and any other pathologic data obtained on biopsy may be included. Evaluation of the function of the cranial nerves is especially appropriate for tumors of the nasopharynx. The appropriate nodal drainage areas are examined by careful palpation and radiologic evaluation. The retropharyngeal lymph nodes are the first echelon of drainage.[3,4] Information from diagnostic imaging studies may be used in staging. Magnetic resonance imaging provides additional information to computed tomographic scanning in the evaluation of skull base invasion and intracranial spread.[5] Positron emission tomography scans combined with CT are helpful in radiation treatment planning for target delineation of the primary tumor, aids in detection of metastatic nodal involvement and metastatic spread such as lung or skeletal metastases in patients with advanced nasopharyngeal cancer.[6]

    If a patient has a relapse, a complete reassessment must be done to select the appropriate additional therapy.

    Definitions of TNM

    The American Joint Committee on Cancer (AJCC) has designated staging by TNM classification to define nasopharyngeal cancer.[7]

    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 Parapharyngeal extension denotes posterolateral infiltration of tumor.
    TX Primary tumor cannot be assessed.
    T0 No evidence of primary tumor.
    Tis Carcinoma in situ.
    T1 Tumor confined to the nasopharynx, or tumor extends to oropharynx and/or nasal cavity without parapharyngeal extension.b
    T2 Tumor with parapharyngeal extension.b
    T3 Tumor involves bony structures of skull base and/or paranasal sinuses.
    T4 Tumor with intracranial extension and/or involvement of cranial nerves, hypopharynx, orbit, or with extension to the infratemporal fossa/masticator space.
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