Staging

Question 1

Oropharynx P16 NEGATIVE T Staging

Answer 1

T1: <2cm
T2: 2-4cm
T3: >4cm, extension to lingual epiglottis
T4a: Larynx, deep/extrinsic muscle of tongue, medial pterygoid, hard palate, mandible
T4b: Lateral pterygoids, pterygoid plates, lateral nasopharynx, skull base, carotid

Question 2

Oral Cavity T staging

Answer 2

Tis: Carcinoma in situ
T1: <2cm with DOI <5mm
T2: <2cm with DOI >5mm OR 2-4cm with DOI <10
T3 : Tumor > 4 cm OR ANY size with DOI > 10
T4a: >4cm with DOI >10 PLUS invades adjacent structure (cortical mandible/maxilla, maxillary sinus, skin)
T4b: Invades masticator space, pterygoid plates, skull base, or encases Carotid

Quick tip: T stage is most predictive of occult neck node mets in lip cancer

Question 3

Oropharyngeal P16 NEGATIVE N staging

Answer 3

N1: single, ipsilateral node, <3cm (1 = alone)
N2a: single, ipsilateral node 3-6cm
N2b: multiple ipsilateral LN <6cm (2b = a BUNCH of LN)
N2c: bilateral or contralateral LN, <6cm, (C for contralateral)
N3a: LN >6 cm
N3b: ENE positive (N3beeee! ENEEEEEE!)

Question 4

Oropharyngeal P16+ T + N Staging

Answer 4

T1: <2cm
T2: 2-4cm
T3: >4cm, extension to lingual epiglottis
T4: Larynx, deep/extrinsic muscle of tongue, medial pterygoid, hard palate, mandible
*Same as P16 negative except no T4a/b

N1: 1+ ipsilateral LN <6cm
N2: Contralateral or bilateral LNs <6cm
N3: Any LN >6cm
*Pathologic n takes into account number of lymph nodes:
pN0 = no LN
pN1 = 4 or less LN
pN2 = > 4 LN

Question 5

Larynx - Supraglottic T staging

Answer 5

T1: one subsite, normal VF mobility
T2: >1 subsite, normal VF mobility (NO fixation)
T3: VF fixation, or invasion of postcricoid, pre-epiglottic tissue, paraglottic space, inner cortex of thyroid
T4a: Through thyroid cartilage, invades trachea, soft tissue, muscles of tongue, strap muscles, thyroid, esophagus
T4b: prevertebral space, carotid, mediastinum

Question 6

Glottis T staging (Laryngeal ventricles to 1 cm below true vocal cords)

Answer 6

T1a: limited to one VF, normal VF mobility
T1b: limited to both VF, normal mobility
T2: supraglottic, subglottic ext, with impaired VF mobility
T3: limited to larynx, VF fixation or invasion of paraglottic space or inner cortex thyroid cartilage
T4a: outer cortex thyroid, trachea, soft tissues, muscles
T4b: prevertebral space, carotid, mediastinum

Question 7

Subglottis T staging

Answer 7

T1: limited to subglottis
T2: extends to VC normal to impaired mobility
T3: extends to VC with fixation, inner cortex of thyroid
T4a: Invades cricoid, thyroid cartilage, soft tissues
T4b: Prevertebral space, carotid encasement, mediastinum

Question 8

Hypopharynx T staging

Answer 8

T1: 1 subsite, <2 cm
T2: >1 subsite or adjacent site, or 2-4 cm, no fixation of hemilarynx
T3: >4 cm or fixation of ipsilateral cord, extension to esophagus
T4a: invades cricoid, thyroid, hyoid, thyroid gland, esophagus, soft tissue
T4b: prevertebral space, carotid, mediastinum

Question 9

N staging for supraglottis, glottis, subglottis, hypopharynx

Answer 9

N1: single, ipsilateral node, <3cm
N2a: single, ipsilateral node 3-6cm
N2b: multiple ipsilateral LN <6cm
N2c: bilateral or contralateral LN, <6cm, C for contralateral
N3a: LN >6 cm
N3b: ENE positive

*SAME N staging as for oropharyngeal

Question 10

Nasopharynx T, N + M staging

Answer 10

T0 - No tumor, EBV + node
Tis - Carcinoma in situ
T1 - Nasopharynx +/- oropharynx and nasal cavity
T2 - Extension to parapharyngeal space + medial/lateral pterygoids, prevertebral muscles
T3 - Bony infiltration at skull base, vertebra, pterygoid plates and fossa, paranasal sinuses
T4 - Involvement of CN, hypopharynx, orbit, parotid

N1: LN above cricoid cartilage (unilateral cervical or unilateral/bilateral retropharyngeal LN < 6 cm)
N2: Bilateral cervical LN < 6 cm, above cricoid cartilage
N3: Unilateral or bilateral cervical LN > 6 cm and/or LN BELOW cricoid cartilage

M0 - No mets
M1 - Yes distant mets

Question 11

Paranasal sinuses (Maxillary but basically the same for all)

Answer 11

T1: limited to maxillary sinus, no erosion of bone
T2: erosion of bone, extends to hard palate, middle meatus
T3: posterior wall of maxillary sinus, subcutaneous tissues, medial wall of orbit, pterygoid fossa or ethmoid sinuses
T4a: anterior orbital invasion, skin of cheek, pterygoid plates, infratemporal fossa, cribiform, sphenoid or frontal sinuses
T4b: orbital apex, dura, brain, middle CF, CN other than V2, nasopharynx, clivus

Question 12

MUCOSAL Melanoma T staging

Answer 12

STARTS at T3
T3 - Mucosal
T4a - Involves cartilage, skin, bone
T4b - All the above + dura, brain, carotid encasement

Question 13

Melanoma Group Staging

Answer 13

Any T with N1 or more = automatic stage III
Any T, Any N with M1 = automatic stage IV

Question 14

Parotid Staging (Includes all glands)

Answer 14

T1 <2cm
T2 2-4cm
T3 >4cm, extraparenchymal spread
T4a skin, mandible, ear canal, facial nerve
T4b skull base, pterygoid plates, carotid

Question 15

Non melanoma skin T staging

Answer 15

T1 <2cm
T2 2-4cm
T3 >4cm or bone./perineural invasion
T4a gross cortical bone invasion
T4b skull base, or foramen invasion

Question 16

Thyroid T staging

Answer 16

T1a <1cm, limited to thyroid
T1b 1-2cm, limited to thyroid
T2 2-4cm, limited to thyroid
T3a >4cm, limited to thyroid
T3b invasion of strap muscles
T4a soft tissue, larynx, trachea, esophagus, RLN
T4b prevertebral space, carotid, mediastinal vessels

Question 17

U Pitt T bone T staging

Answer 17

T1 Tumor limited to EAC, no bony erosion or evidence of soft tissue extension
T2 Limited EAC bony erosion (not full thickness) or limited soft tissue extension (<0.5cm)
T3 Full thickness erosion of osseus EAC with limited soft tissue invovlement (<0.5cm), tumor involving middle ear or mastoid
T4 Tumor involving cochlea, petrous apex, medial wall of middle ear, caroitd canal, jugular foramen or dura, with extensive (>0.5cm) soft tissue invovlement, or with facial paresis/paralysis