Hypopharyngeal Cancer Stages

After someone is diagnosed with hypopharyngeal 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.

The earliest stage of hypopharyngeal cancer is stage 0, also known as carcinoma in situ (CIS). The other main stages range from I (1) through IV (4). Some stages also use capital letters (A, B, etc.).  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. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is the stage determined?

The staging system most often used for hypopharyngeal cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

  • The size extent of the main tumor (T): How big is the tumor? How far has it grown into the hypopharynx and nearby structures? 
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes in the neck? If so, how many are affected, and how large are they?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body? (The most common sites of spread are the lungs, liver, or bones.)

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. 

Once the T, N, and M categories of the cancer have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more information, see Cancer Staging.

The system described below is the most recent AJCC system, effective January 2018. 

Hypopharyngeal cancer typically is given a clinical stage based on the results of any exams, biopsies, and imaging tests that might have been done (as described in How Are Laryngeal and Hypopharyngeal Cancers Diagnosed?). If surgery has been done, the pathologic stage (also called the surgical stage) can be determined.

Hypopharyngeal cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

Stages of hypopharyngeal cancer

AJCC Stage

Stage grouping

Stage description*

0
 

Tis
N0
M0

The tumor is only in the top layer of cells lining the inside of the hypopharynx and has not grown any deeper (Tis).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

I

T1
N0
M0

The tumor has grown deeper, but it is only in one part of the hypopharynx, and it is no more than 2 centimeters (cm) across (T1).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

II

T2
N0
M0

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 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) or to distant parts of the body (M0).

 

 

III

T3
N0
M0

The tumor is larger than 4 cm across, OR the tumor is affecting the movement of the vocal cords, OR the tumor has grown into the esophagus (T3).

The cancer has not spread to nearby lymph nodes (N0) or to distant parts of the body (M0).

OR

T1 to T3
N1
M0

The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (T1 to T3).

The cancer has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0).

 

 

IVA

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 it has spread to a single lymph node on the same side of the neck as the tumor, which is no larger than 3 centimeters (cm) across (N1). The cancer has not spread to distant parts of the body (M0).

OR

T1-T4a
N2
M0

The tumor can be any size and might or might not have grown into structures outside the hypopharynx (as far as moderately advanced disease), and it might or might not have affected a vocal cord (T1 to T4a). The cancer is N2:

  • It has spread to a single lymph node on the same side of the neck as the tumor, which is larger than 3 centimeters (cm) but no larger than 6 cm across, OR
  • It has spread to more than one lymph node on the same side of the neck as the tumor, none of which is larger than 6 cm across, OR
  • It has spread to at least one lymph node on the other side of the neck, none of which is larger than 6 cm across.

The cancer has not spread to distant parts of the body (M0).

 

 

IVB

T4b
Any N
M0

The tumor is growing into the area in front of the spine in the neck, surrounds a carotid artery, or is growing down into the space between the lungs. This is also known as very advanced local disease (T4b).

The cancer might or might not have spread to nearby lymph nodes (any N). It has not spread to distant parts of the body (M0).

OR

Any T
N3
M0

The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (any T).

The cancer has spread to at least one lymph node that is larger than 6 cm across, OR it has spread to a lymph node and then grown outside of the lymph node (N3). It has not spread to distant parts of the body (M0).

IVC

Any T
Any N
M1

The tumor can be any size and might or might not have grown into structures outside the hypopharynx, and it might or might not have affected a vocal cord (any T).

The cancer might or might not have spread to nearby lymph nodes (any N). The cancer has spread to distant parts of the body (M1).

 

 *The following additional categories are not listed on the table above: 

  • TX: Main tumor cannot be assessed due to lack of information.
  • NX: Regional lymph nodes cannot be assessed due to lack of information.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

American Joint Committee on Cancer. Oropharynx (p16-) and Hypopharynx. In: AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017: 123-135.

Last Medical Review: December 20, 2017 Last Revised: December 20, 2017

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