Nasopharyngeal Cancer: Stages and Grades

Approved by the Cancer.Net Editorial Board, 01/2019

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. Use the menu to see other pages.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor decide what kind of treatment to recommend and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer spread to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person.

There are 5 stages of NPC: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Recently, doctors have found that finding out whether there is Epstein-Barr virus (EBV; see Risk Factors and Diagnosis) present can be useful in staging.

Here are more details of each part of the TNM system for NPC.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Stage may also be divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

Tis: This describes a stage called carcinoma (cancer) in situ. This is a very early cancer where cancer cells are found only in 1 layer of tissue.

T0 (T plus zero): No evidence of a tumor is found, but there are lymph nodes in the neck that are positive for EBV.

T1: The tumor has not spread beyond the nasopharynx. Or the tumor has grown into the oropharynx and/or nasal cavity but does not involve the areas around the pharynx.

T2: The tumor extends into the soft tissue of the middle throat.

T3: The tumor extends into bony structure or into the area behind the nose.

T4: The tumor extends inside the head to an area of the brain or into the lower part of the throat.

Node (N)

The “N” in the TNM staging system is for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near where the cancer started are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

For people with NPC, doctors examine lymph nodes in a triangle-shaped area formed by 3 points: where the neck meets the shoulder, where the collarbone joins the tip of the shoulder, and where the front half of the collarbone meets the base of the neck.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): There is no evidence of cancer in the regional lymph nodes.

N1: Cancer has spread to lymph nodes above the triangular area described above. The lymph nodes are on the same side of the neck as the primary tumor. The cancer found in the lymph nodes is 6 centimeters (cm) or smaller. A centimeter is roughly equal to the width of a standard pen or pencil.

N2: Cancer has spread to lymph nodes on both sides of the neck, above the triangular area, but the cancer is 6 cm or smaller.

N3: Cancer found in lymph nodes is larger than 6 cm and/or is found in lymph nodes located in the triangle.

Metastasis (M)

The "M" in the TNM system describes whether the cancer has spread to other parts of the body, called distant metastasis.

M0 (M plus zero): Cancer has not spread to other parts of the body.

M1: Cancer has spread to other parts of the body.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage 0: A carcinoma in situ with no spread to lymph nodes and no distant metastasis (Tis, N0, M0).

Stage I: A small tumor with no spread to lymph nodes and no distant metastasis (T1, N0, M0).

Stage II: There is evidence of EBV in lymph nodes in the neck or a tumor found only in the nasopharynx that has spread to lymph nodes but no metastasis (T0 or T1, N1, M0). This stage may also describe a tumor that has extended beyond the nasopharynx but has not spread to lymph nodes or to distant parts of the body (T2, N0, M0). It may also describe a tumor that has spread to lymph nodes but has not spread elsewhere (T2, N1, M0).

Stage III: A noninvasive or invasive tumor that has spread to lymph nodes on both sides of the neck above the triangular area but has not metastasized (T0, T1, or T2; N2; M0). This stage may also describe a larger tumor with or without lymph node involvement and no metastasis (T3; N0, N1, or N2; M0).

Stage IVA: This describes any invasive tumor with either no lymph node involvement or spread to only a single same-sided lymph node but no metastasis (T4, N0 or N1, M0). It is also used for any invasive tumor with more significant lymph node involvement but no metastasis (T4, N2, M0). It also describes any tumor (any T) with extensive lymph node involvement but no metastasis (any T, N3, M0).

Stage IVB: This describes any tumor when there is evidence of distant spread (any T, any N, M1).

Recurrent: Recurrent cancer is cancer that has come back after treatment. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017), published by Springer International Publishing.

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.