Number stages of nasopharyngeal cancer

The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need. It can also give some idea of your outlook (prognosis).

The number staging system uses the TNM system to divide cancers into stages. There are 5 stages of nasopharyngeal cancer numbered from 0 to 4.

TNM stages

The number stages for nasopharyngeal cancer are based on the TNM stages. The letters stand for tumour, node and metastasis:

• T describes the size of the tumour
• N describes whether there are any cancer cells in the lymph nodes
• M describes whether the cancer has spread to a different part of the body

Number stages of nasopharyngeal cancer

There are 5 main stages of nasopharyngeal cancer. Stage 0 is the earliest stage and stage 4 is the most advanced.

Stage 0 nasopharyngeal cancer

If you have stage 0 nasopharyngeal cancer, you have a very early stage cancer. There are cancer cells only in the top layer of cells that line the inside of the nasopharynx and it has not grown deeper. 

This is Tis, N0, M0 in the staging system.

Stage 1 nasopharyngeal cancer

The cancer is in the nasopharynx and may have started to grow into the nasal cavity or oropharynx (the area at the back of the mouth and top of the throat). The cancer has not spread to nearby tissues, lymph nodes or other parts of the body. This is the same as T1, N0, M0 in the TNM staging system.

Stage 2 nasopharyngeal cancer

Stage 2 nasopharyngeal cancer means one of the following:

• No cancer is seen in the nasopharynx but there are lymph nodes in the neck that test positive for the Epstein Barr virus (EBV). This means it is likely to be nasopharyngeal cancer (T0). Or the cancer is within the nasopharynx and may have grown into the nasal cavity or oropharynx. There is cancer in the lymph nodes on one side of the neck, or behind the throat on one or both sides of the neck. The lymph nodes are not more than 6cm across. This is the same as T0 or T1, N1, M0 in the TNM staging system.
• The cancer has spread into the areas next to the nasopharynx (parapharyngeal space) and might have spread into the lymph nodes on one side of the neck or behind the throat on one or both sides. The lymph nodes are not more than 6cm across. This is the same as T2, N0 or N1, M0 in the TNM staging system.

Stage 3 nasopharyngeal cancer

Stage 3 nasopharyngeal cancer means one of the following:

• The cancer has spread to nearby bones and air cavities (sinuses). It might also have spread to lymph nodes on one or both sides of the neck, or behind the throat, but not anywhere else. The affected lymph nodes are not more than 6 cm across. This is the same as T3, N0 or N1 or N2, M0 in the TNM staging system.
• No cancer is seen in the nasopharynx. But there are cancerous lymph nodes in the neck that are positive for Epstein Barr virus. Or the cancer is within the nasopharynx and may have grown into the oropharynx, nasal cavity or surrounding tissue (parapharyngeal space). The cancer has spread into the lymph nodes on both sides of the neck, but none of them are larger than 6cm. This is the same as T0, T1 or T2, N2, M0 in the TNM staging system.

Stage 4 nasopharyngeal cancer

Stage 4 means the cancer is advanced. It has 2 groups, 4A and 4B.

Stage 4A means one of the following:

• the cancer has grown into the skull, cranial (skull) nerves, eye or nearby tissues, main salivary gland, or the lower part of the throat. There might be cancer cells in the lymph nodes on one or both sides of the neck or behind the throat. These nodes are smaller than 6cm. The cancer has not spread anywhere else. This is the same as T4, N0, N1 or N2, M0 in the TNM staging system.
• the cancer might have grown into nearby tissues or bones. It has spread to at least one lymph node that is bigger than 6cm across, or is in the lower neck above the collarbone. The cancer has not spread anywhere else. This is the same as Any T, N3, M0 in the TNM staging system.

Stage 4B means the cancer has spread to other parts of the body, such as the lungs. This is the same as Any T, Any N, M1 in the TNM staging system.

Recurrent nasopharyngeal cancer

You might hear the term recurrent nasopharyngeal cancer. This means nasopharyngeal cancer that has come back (recurred) after treatment. The cancer might have come back in the nasopharynx (called local recurrence) or in another part of the body. This might be in the bones, liver, or lungs.

Treatment decisions

The stage of your cancer helps your doctor to decide which treatment you need. Your treatment also depends on:

• the type of cancer (the type of cells the cancer started in)
• where the cancer is
• other health conditions that you have

A team of doctors and healthcare professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).