Head and neck cancers are staged according to the TNM system. Accuracy of staging is especially critical, since a slight difference in the location and size of the tumor has a significant effect on the therapy chosen, the extent of surgery and the prognosis .
Accurate staging requires visual inspection, x-rays, appropriate biopsies, blood tests (such as complete blood counts and liver tests) and careful palpation and measurement of enlarged lymph nodes . The mobility of enlarged nodes should be determined since a lymph node that cannot be moved back and forth may contain cancer that has spread to adjacent tissues. Sometimes examination under anesthesia is needed to directly inspect inaccessible areas such as the larynx, nasopharynx and oropharynx, as well as to perform necessary biopsies.
TNM Stage Grouping
Stage I: T1, N0, M0
Stage II: T2, N0, M0
Stage III: T3, N0, M0
T1-3, N1, M0
Stage IV: T4, N0 or N1, M0
Any T, N2-3, M0
Any T, any N, M1
For most subsites there are also other TNM categories that define the tumor more precisely.
