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Hypopharyngeal Cancer Stages
If you are diagnosed with hypopharyngeal (lower throat) cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging.
The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.
Each person’s cancer experience is unique. But cancers with similar stages tend to have a similar outlook and are often treated in much the same way.
How is hypopharyngeal cancer staged?
Each stage of hypopharyngeal cancer is assigned a number. The earliest is stage 0, also known as carcinoma in situ (CIS). Other stages range from I through IV. Some stages are further divided using the letters A and B.
As a rule:
- The lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more.
- Within each numbered stage (I–IV), an earlier letter means a lower stage.
Stage grouping
The staging system most often used for head and neck cancers is the American Joint Committee on Cancer (AJCC) TNM system. The staging system in the tables below is based on the most recent AJCC system, effective January 2018.
This system uses 3 key pieces of information.
- Extent of the tumor (T): How large is the main (primary) tumor? Which tissues of the hypopharynx has it spread to, if any?
- Spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many? Are they on the same side as where the cancer started, and how large are they?
- Spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs?
Numbers or letters after T, N, and M give more detail about each of these factors. Higher numbers mean the cancer is more advanced.
Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.
Pathological vs. clinical stage
Pathological stage (surgical stage): The staging systems shown below use the pathologic stage, also called the surgical stage. This is determined by examining the tissue removed during an operation.
Clinical stage: If surgery is not possible right away or at all, the cancer will sometimes be given a clinical stage instead. This is based on the results of a physical exam, endoscopy exam, biopsy, and imaging tests. The clinical stage will be used to help plan treatment. However, sometimes the cancer has spread further than the clinical stage estimates. It may not predict a person’s outlook as accurately as a pathologic stage. Clinical stage is not shown in the tables below.
Cancer staging can be complex. If you have any questions about your cancer’s stage and what it might mean for you, ask your doctor to explain it in a way you understand.
Stages of hypopharyngeal cancer
- The cancer is still within the top layer of cells lining the hypopharynx. It has not yet grown into deeper layers (Tis, carcinoma in situ).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
- The tumor has grown deeper than the top layer of cells lining the hypopharynx, but it is only in one part of the hypopharynx. It is no more than 2 cm* across (T1).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
*2 cm = about ¾ inch
- The tumor has grown into more than one part of the hypopharynx, or it has grown into a nearby area, or it is larger than 2 cm but no larger than 4 cm* across and has not affected the vocal cords (T2).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
*4 cm = about 1½ inches
Stage grouping: T3, N0, M0
- The tumor is larger than 4 cm* across, or it is affecting the movement of the vocal cords, or it has grown into the esophagus (T3).
- The cancer has not spread to nearby lymph nodes (N0).
- It has not spread to distant parts of the body (M0).
3 cm = about 1¼ inches; 4 cm = about 1½ inches
Stage grouping: T1, T2, or T3, N1, M0
- The tumor can be any size. It might or might not have grown into structures outside the hypopharynx. It might or might not have affected a vocal cord (T1 to T3).
- It has spread to a single lymph node on the same side as the cancer. The lymph node is 3 cm* or smaller. The cancer has not grown outside the lymph node (N1).
- It has not spread to distant parts of the body (M0).
Stage grouping: T4a, N0 or N1, M0
- The tumor has grown into the thyroid or cricoid cartilage, the hyoid bone, the thyroid gland, or nearby areas of muscle or fat. This is also known as moderately advanced local disease (T4a).
- The cancer has not spread to nearby lymph nodes (N0). Or the cancer has spread to a single lymph node on the same side as the cancer, is 3 cm* or smaller, and has not grown outside the lymph node (N1).
- It has not spread to distant parts of the body (M0).
3 cm = about 1¼ inches
Stage grouping: T1, T2, T3, or T4a, N2, M0
- The tumor can be any size. It might or might not have grown into structures outside the hypopharynx, as far as moderately advanced disease. It might or might not have affected a vocal cord (T1 to T4a).
- The cancer has spread to a single lymph node on the same side as the cancer, is 3 cm* or smaller, and has grown outside the lymph node. Or it has spread to lymph node(s) on the same or both sides as the cancer, is larger than 3 cm but less than 6 cm, and has not grown outside the lymph nodes (N2).
- It has not spread to distant parts of the body (M0).
Stage grouping: any T, N3, M0
- The tumor can be any size. It might or might not have grown into structures outside the hypopharynx. It might or might not have affected a vocal cord (any T).
- It has spread to a lymph node that is larger than 6cm*, but it has not grown outside the lymph nodes (N3a). Or it has spread to a single lymph node on the same side as the cancer, is larger than 3 cm, and has grown outside the lymph nodes (N3b). Or it has spread to multiple lymph nodes and has grown outside the lymph nodes (N3b). Or it has spread to a single lymph node on the opposite side as the cancer and has grown outside the lymph node (N3b).
- It has not spread to distant parts of the body (M0).
*3 cm = about 1¼ inches; 6 cm = about 2 ½ inches
Stage grouping: T4b, any N, M0
- The tumor is growing into the area of the neck in front of the spine, surrounds a carotid artery, or is growing down into the space between the lungs. This is also known as very advanced local disease (T4b).
- It might or might not have spread to nearby lymph nodes (any N).
- It has not spread to distant parts of the body (M0).
- The tumor can be any size. It might or might not have grown into structures outside the hypopharynx. It might or might not have affected a vocal cord (any T).
- It might or might not have spread to nearby lymph nodes (any N).
- It has spread to distant sites such as the lungs (M1).
Other staging categories you might see
- TX: Main tumor cannot be assessed due to lack of information.
- T0: No evidence of a primary tumor.
- NX: Regional lymph nodes cannot be assessed due to lack of information.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
American Joint Committee on Cancer. Oropharynx (p16-) and Hypopharynx. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 123-135.
Last Revised: May 28, 2026
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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