Stage III
- is found in the nasopharynx only or has spread from the nasopharynx to the oropharynx and/or to the nasal cavity. Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller; or
- is found in the parapharyngeal space. Cancer has spread to one or more lymph nodes on both sides of the neck. The affected lymph nodes are 6 centimeters or smaller; or
- has spread to nearby bones or sinuses. Cancer may have spread to one or more lymph nodes on one or both sides of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller.
Stage IV-A
Cancer has spread beyond the nasopharynx and may have spread to the cranial nerves, the hypopharynx (bottom part of the throat), areas in and around the side of the skull or jawbone, and/or the bone around the eye. Cancer may also have spread to one or more lymph nodes on one or both sides of the neck and/or to lymph nodes behind the pharynx. The affected lymph nodes are 6 centimeters or smaller.
Stage IV-B
Cancer has spread to lymph nodes between the collarbone and the top of the shoulder and/or the affected lymph nodes are larger than 6 centimeters.
Stage IV-C
Cancer has spread beyond nearby lymph nodes to other parts of the body.
Opharyngeal Cancer
Stage 0
Abnormal cells are found in the lining of the oropharynx and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)
Stage I
Cancer has formed and is 2 centimeters or smaller and is found in the oropharynx only.
Stage II
The cancer is larger than 2 centimeters but not larger than 4 centimeters and is found in the oropharynx only.
Stage III
The cancer is either:
- 4 centimeters or smaller; cancer has spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller; or
- larger than 4 centimeters or has spread to the epiglottis (the flap that covers the trachea during swallowing). *may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller.
Stage IV-A
- has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is 3 centimeters or smaller; or
- has spread to one lymph node on the same side of the neck as the tumor (the lymph node is larger than 3 centimeters but not larger than 6 centimeters) or to more than one lymph node anywhere in the neck (the lymph nodes are 6 centimeters or smaller), and one of the following is true:
- tumor in the oropharynx is any size and may have spread to the epiglottis (the flap that covers the trachea during swallowing); or
- tumor has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing.
Stage IV-B
- surrounds the carotid artery or has spread to the muscle that opens the jaw, the bone attached to the muscles that move the jaw, nasopharynx, or base of the skull. Cancer may have spread to one or more lymph nodes which can be any size; or
- may be any size and has spread to one or more lymph nodes that are larger than 6 centimeters.
Stage IV-C
The tumor may be any size and has spread beyond the oropharynx to other parts of the body, such as the lung, bone, or liver.
Paranasal Sinus and Nasal Cavity Cancer
There is no standard staging system for cancer of the sphenoid and frontal sinuses.
Maxillary Sinus
Stage 0
Abnormal cells are found in the innermost lining of the maxillary sinus and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)
Stage I
Cancer has formed in the mucous membranes of the maxillary sinus.
Stage II
Cancer has spread to bone around the maxillary sinus, including the roof of the mouth and the nose, but not to bone at the back of the maxillary sinus or the base of the skull.
Stage III
Cancer has spread to any of the following:
- Bone at the back of the maxillary sinus.
- Tissues under the skin.
- The eye socket.
- The base of the skull.
- The ethmoid sinuses.
Or cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:
- The lining of the maxillary sinus.
- Bones around the maxillary sinus, including the roof of the mouth and the nose.
- Tissues under the skin.
- The eye socket.
- The base of the skull.
- The ethmoid sinuses.
Stage IV-A
- to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
- to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or
- to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.
- The lining of the maxillary sinus.
- Bones around the maxillary sinus, including the roof of the mouth and the nose.
- Tissues under the skin.
- The eye socket.
- The base of the skull.
- The ethmoid sinuses.
Or cancer has spread to any of the following:
- The front of the eye.
- The skin of the cheek.
- The base of the skull.
- Behind the jaw.
- The bone between the eyes.
- The sphenoid or frontal sinuses.
Cancer may also have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.
Stage IV-B
Cancer has spread to any of the following:
- The back of the eye.
- The brain.
- The middle parts of the skull.
- The nerves in the head that go to the brain.
- The upper part of the throat behind the nose.
- The base of the skull
Cancer may be found in one or more lymph nodes of any size, anywhere in the neck. Or cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the maxillary sinus.
Stage IV-C
Cancer may be anywhere in or near the maxillary sinus, may have spread to lymph nodes, and has spread to organs far away from the maxillary sinus, such as the lungs.
Nasal Cavity and Ethmoid Cancer
Stage 0
Abnormal cells are found in the innermost lining of the nasal cavity or ethmoid sinus and may become cancer and spread into nearby normal tissue. (also called carcinoma in situ)
Stage I
Cancer has formed and is found in only one area (of either the nasal cavity or the ethmoid sinus) and may have spread into bone.
Stage II
Cancer is found in two areas (of either the nasal cavity or the ethmoid sinus) that are near each other or has spread to an area next to the sinuses. Cancer may also have spread into bone.
Stage III
Cancer has spread to any of the following:
- The eye socket.
- The maxillary sinus.
- The roof of the mouth.
- The bone between the eyes.
Or cancer has spread to one lymph node on the same side of the neck as the cancer and the lymph node is 3 centimeters or smaller. Cancer has also spread to any of the following:
- The nasal cavity.
- The ethmoid sinus.
- The eye socket.
- The maxillary sinus.
- The roof of the mouth.
- The bone between the eyes.
Stage IVA
Cancer has spread:
- to one lymph node on the same side of the neck as the cancer and the lymph node is larger than 3 centimeters but not larger than 6 centimeters; or
- to more than one lymph node on the same side of the neck as the original tumor and the lymph nodes are not larger than 6 centimeters; or
- to lymph nodes on the opposite side of the neck as the original tumor or on both sides of the neck, and the lymph nodes are not larger than 6 centimeters.
- The nasal cavity.
- The ethmoid sinus.
- The eye socket.
- The maxillary sinus.
- The roof of the mouth.
- The bone between the eyes.
- The front of the eye.
- The skin of the nose or cheek.
- Front parts of the skull.
- The base of the skull.
- The sphenoid or frontal sinuses.
- Cancer may have spread to one or more lymph nodes 6 centimeters or smaller, anywhere in the neck.
Stage IV-B
Cancer has spread to any of the following:
- The back of the eye.
- The brain.
- The middle parts of the skull.
- The nerves in the head that go to the brain.
- The upper part of the throat behind the nose.
- The base of the skull.
Cancer may be found in one or more lymph nodes of any size, anywhere in the neck. Or cancer is found in a lymph node larger than 6 centimeters. Cancer may also be found anywhere in or near the nasal cavity and ethmoid sinus.
Stage IV-C
Cancer may be anywhere in or near the nasal cavity and ethmoid sinus, may have spread to lymph nodes, and has spread to organs far away from the nasal cavity and ethmoid sinus, such as the lungs.