Nasopharyngeal Cancer

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Nasopharyngeal Cancer Stages

If you are diagnosed with nasopharyngeal cancer (NPC), 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.

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.

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How is NPC staged?

Each stage of NPC 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 NPC is the American Joint Committee on Cancer (AJCC) TNM system. This system uses 3 key pieces of information to stage a cancer:

  • Extent of the main tumor (T): How far has the tumor grown into nearby structures?
  • Spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes in the neck? If so, how large are they? Are they on the same side as where the cancer started (left or right) or both sides of the neck?
  • Spread (metastasis) to distant sites (M): Has the cancer spread to distant parts of the body? The most common sites of spread are the bones, lungs, liver, or lymph nodes in distant parts of the body.

Numbers or letters after T, N, and M provide more details about each of these factors.

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.

Clinical vs. pathological stage

Clinical stage: Nasopharyngeal cancer is typically given a clinical stage based on the results of exams, biopsies, and imaging tests. The clinical stage can be used to help determine your treatment options.

Pathological stage: If surgery is done, the pathological stage can be determined. You might also hear this called the surgical stage.

Stages of nasopharyngeal cancer

NPC staging can be complex. If you have questions about your cancer's stage and what it might mean for you, ask your cancer care team to explain it to you in a way you understand. For more on this, see Cancer Staging.

NPC is stage 0 if:

  • The main tumor is only in the top layer of cells lining the inside of the nasopharynx and has not grown any deeper (Tis).
  • The cancer has not spread to nearby lymph nodes (N0). 
  • The cancer has not spread distant parts of the body (M0).

Stage IA

NPC is stage IA if:

  • The main tumor is just in the nasopharynx, or it has also grown into the oropharynx (the part of the throat in the back of the mouth) and/or the nasal cavity (T1) or the main tumor has grown into the tissues of the left or right sides of the upper part of the throat, but not into bone (T2).
  • The cancer has not spread to nearby lymph nodes (N0).
  • The cancer has not spread to distant parts of the body (M0).

Stage IB

NPC is stage IB if:

  • No tumor is seen in the nasopharynx, but cancer is found in lymph nodes in the neck and is positive for Epstein-Barr virus (EBV) DNA, which makes it very likely to be NPC (T0) or the tumor is just in the nasopharynx, or it has also grown into the oropharynx (the part of the throat in the back of the mouth) and/or the nasal cavity (T1) or the tumor has grown into the tissues of the left or right sides of the upper part of the throat, but not into bone (T2).
  • The cancer has spread to lymph nodes on one side of the neck or lymph nodes behind the throat. In either case, no lymph node is larger than 6 cm* across (N1).
  • The cancer has not spread to distant parts of the body (M0).

*6 centimeters = about 2½ inches

Stage grouping: T0 to T2, N2, M0

  • No tumor is seen in the nasopharynx, but cancer is found in lymph nodes in the neck and is positive for Epstein-Barr virus (EBV) DNA, which makes it very likely to be NPC (T0) or the main tumor is just in the nasopharynx, or it has also grown into the oropharynx (the part of the throat in the back of the mouth) and/or the nasal cavity (T1) or the main tumor has grown into the tissues of the left or right sides of the upper part of the throat, but not into bone (T2).
  • The cancer has spread to lymph nodes on both sides of the neck. No lymph node is larger than 6 cm* across (N2).
  • The cancer has not spread to distant parts of the body (M0).

OR

Stage grouping: T3, N0 to N2, M0

  • The main tumor has grown into the sinuses (spaces in the skull bones) and/or the bones nearby (T3).
  • The cancer might or might not have spread to nearby lymph nodes, but if so, no lymph node is larger than 6 cm* across (N0 to N2).
  • The cancer has not spread to distant parts of the body (M0).

*6 centimeters = about 2½ inches

Stage grouping: T4, any N, M0

  • The main tumor has grown inside the skull and/or into the cranial nerves, the hypopharynx (lower part of the throat), the main salivary gland, or the eye or its nearby tissues (T4).
  • The cancer might or might not have spread to nearby lymph nodes (any N).
  • The cancer has not spread to distant parts of the body (M0).

OR

Stage grouping: any T, N3, M0

  • The main tumor might or might not have grown into structures outside the nasopharynx (any T).
  • The cancer has spread to lymph nodes that are either larger than 6 cm* across or located in the shoulder area just above the collarbone (N3).
  • The cancer has not spread to distant parts of the body (M0).

*6 centimeters = about 2½ inches

Stage IVA

NPC is stage IVA if:

  • The main tumor might or might not have grown into structures outside the nasopharynx (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, but there are no more than 3 areas of cancer spread (M1a).

Stage IVB

NPC is stage IVB if:

  • The main tumor might or might not have grown into structures outside the nasopharynx (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, and there are more than 3 areas of cancer spread (M1b).

Other staging categories you might see

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

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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. Nasopharynx. In: AJCC Cancer Staging System. Version Nine. American College of Surgeons; 2024.

Last Revised: March 3, 2026

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.

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