New TNM staging of oral cancer
Clinical TNM classification staging is helpful to assist in the formulation of treatment plans and estimation of prognosis. Currently, the standards of TNM classification are not fully unified internationally. The new TNM classification of oral cancer (UICC 2002) is introduced.
I. Lip and oral cavity
This classification applies to carcinoma of the red lip and oral mucosa as well as minor salivary gland carcinoma, which needs to be confirmed by pathology. Physical examination and imaging examination can be used to determine TNM classification and grading.
Anatomical partition
1.Lip: ①lip, red surface of lip; ②lower lip, red surface of lip; ③corner of mouth.
2, Oral cavity
(1) Buccal mucosa: ① upper and lower lip, medial mucosal surface; ② buccal mucosal surface; ③ posterior molar area; ④ upper and lower gingival buccal sulcus.
(2) Upper alveolar gingiva.
(3) Lower alveolar gingiva.
(4) Hard palate.
(5) Tongue: (i) dorsal and lateral margins of the tongue in front of the contoured papillae (anterior 2/3 of the tongue); (ii) abdomen of the tongue.
(6) Floor of the mouth.
Clinical classification of TNM
T: primary tumor.
Tx: primary tumor cannot be assessed.
T0: no evidence of primary tumor.
Tis: carcinoma in situ.
T1: Tumor maximum diameter ≤50px.
T2: Tumor maximum diameter >50px, ≤100px.
T3: Tumor maximal diameter >100px.
T4a: (Lip) Tumor invades through the bone cortex and invades the inferior alveolar nerve, floor of the mouth, facial skin (chin or nose).
T4a: (Oral) tumor invades through bone cortex, invades deep non-intrinsic lingual muscles (chin and lingual muscles, hyoid lingual muscles, palatal lingual muscles, stem lingual muscles), maxillary sinus or facial skin.
T4b: (lip and oral cavity) tumor invading the masticatory muscle space, pterygoid plate or skull base and/or internal carotid artery.
N: regional lymph nodes (in the neck).
Nx: The presence or absence of regional lymph node metastasis cannot be assessed.
N0: no regional lymph node metastasis.
N1: ipsilateral single lymph node metastasis ≤75px in diameter.
N2: ipsilateral single lymph node metastasis with a diameter >75px but ≤150px; or ipsilateral multiple lymph node metastasis but the largest diameter of which is <150px, or bilateral or contralateral lymph node metastasis of which the largest diameter is ≤150px.
N2a: ipsilateral single lymph node metastasis with a diameter >75px but ≤150px.
N2b: multiple ipsilateral lymph node metastases, of which the largest diameter is ≤150px.
N2c: bilateral or contralateral lymph node metastasis, of which the largest diameter ≤150px.
N3: metastatic lymph nodes with a maximum diameter >150px.
Note: Midline lymph node enlargement was considered as ipsilateral metastasis.
M: systemic metastasis.
Mx: the presence or absence of distant metastases could not be assessed.
M0: No distant metastasis.
M1: with distant metastasis (site of metastasis should be indicated at the same time).
(Note: The N and M classifications of head and neck tumors are the same unless otherwise noted. pTNM pathological classifications pT, pN, and pM classifications are consistent with T, N, and M classifications accordingly. )
Clinical staging
Stage 0:TisN0M0
Stage Ⅰ:T1N0M0
Stage II:T2N0M0
Stage III:T3N0M0
T1N1M0
T2N1M0
T3N1M0
Stage IVA:T4aN0M0
T4aN1M0
T1N2M0
T2N2M0
T3N2M0
T4aN2M0
Phase IVB:any TN3M0
T4bany NM0
Phase IVC:any T any NM1