Nasopharyngeal Cancer – TNM Staging and Treatment

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TNM is the most commonly used system for staging nasopharyngeal cancer. “T” stands for “Tumor Size”, “N” for “Lymph Nodes”, and “M” for “Metastasis”. Numbers and/or letters after T (is, 0, 1, 2, 3, and 4), N (0, 1, 2, and 3), and M (0 and 1) provide more details about each of these factors. Once T, N, and M categories are determined through different diagnostic techniques, this information is combined to assign an overall stage (from 0 to IV) to the disease.

nasopharyngeal cancer anatomy and T staging
Nasopharyngeal Cancer T Staging
Nasopharyngeal Cancer T Staging (T3, T4)
nasopharyngeal cancer N staging
Nasopharyngeal Cancer N Staging

Apart from the stage of disease, the selection of treatment usually depends upon the stage, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of nasopharyngeal cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.

STAGETNMSTAGETREATMENT
IT1 N0 M0The primary tumor is limited to the nasopharynx, or extension to the oropharynx and/or nasal cavity without para-pharyngeal involvement. No spread to nearby lymph nodes or distant body parts.For Stage I cancer, radiotherapy is considered as the preferred treatment. Prophylactic radiation treatment to nearby lymph nodes is also generally recommended to be employed as the primary treatment.
IIT2 N0-1 M0The primary tumor has invaded into the para-pharyngeal space, and/or an adjacent structure such as medial pterygoid, lateral pterygoid, or prevertebral muscles. The disease might or might not have spread to cervical lymph node(s) on one side and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.For Stage II to IVA cancers (locoregionally advanced disease), a combination of radiotherapy and chemotherapy is usually employed as the first-line treatment. This may be followed by more chemotherapy to treat any remaining cancer cells. 
Chemotherapy may also be given first (induction therapy), followed by a combination of radiotherapy and chemotherapy.
T0-1 N1 M0No primary tumor or primary tumor limited to the nasopharynx. The disease has spread to cervical lymph node(s) on one side and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.See Above
IIIT3 N0-2 M0The primary tumor has invaded into the skull base, cervical vertebra, pterygoid structures, and/or paranasal sinuses. The disease might or might not have spread to cervical lymph node(s) on both sides and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.See Above
T0-2 N2 M0No primary tumor or the primary tumor with invasion into the para-pharyngeal space, and/or an adjacent structure. The disease has spread to cervical lymph node(s) on both sides and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.See Above
IVAAny T N3 M0No primary tumor to the primary tumor with invasion into the para-pharyngeal space, and/or an adjacent structure, and/or intracranial extension. The disease has spread to cervical lymph node(s) on one or both sides with lymph nodes measuring >6 cm. No spread to distant body parts.See Above
T4 N0-2 M0The primary tumor has invaded into the cranium, cranial nerves, hypopharynx, orbit, parotid gland, and/or extensive invasion beyond the lateral pterygoid muscle. The disease might or might not have spread to cervical lymph node(s) on both sides and/or retropharyngeal lymph node(s) with lymph nodes measuring </=6 cm. No spread to distant body parts.See Above
IVBAny T Any N M1No primary tumor or a primary tumor that might have invaded an adjacent structure or a vital structure. The disease might or might not have spread to nearby lymph nodes. The disease has spread to a distant body part, such as the lungs.For Stage IVB cancer, chemotherapy is usually employed as the first-line treatment. Radiation therapy may be employed as palliative treatment.

Palliative Treatment: It helps in improving the overall quality of life by providing relief from the symptoms and by reducing the suffering caused by HNC and its treatment. It is generally given as supportive care for advanced staged HNCs, along with other treatments. It may include but not limited to: using drugs or other interventions to reduce pain, bleeding, and other symptoms; surgical interventions like gastrostomy or tracheostomy to support nutrition or respiration; support and counselling for speech, swallowing, and oral hygiene-related problems; and radiation therapy to palliate pain, bleeding, obstructive problems, etc.

Non Metastatic Nasopharyngeal Cancer Treatment
Non Metastatic Nasopharyngeal Cancer Treatment
Metastatic Nasopharyngeal Cancer Treatment
Metastatic Nasopharyngeal Cancer Treatment

It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes, a patient’s choice and health condition are also important to make a treatment choice.

Following are the goals of Treatment of Nasopharyngeal Cancer:

  • Prolongation of life
  • Reduction of symptoms
  • Improvement of overall quality of life
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