Ajcc Staging

Front 1

Define boundaries of oral cavity

Back 1

The anterior border is the junction of the skin and vermilion border of the lip. The posterior border is formed by the junction of the hard and soft palates superiorly, the circumvallate papillae inferiorly, and the anterior tonsillar pillars laterally.

Front 2

Subsites within the oral cavity?

Back 2

The various sites within the oral cavity include the lip, gingival, hard palate, buccal mucosa, floor of mouth, anterior 2/3 of tongue, and retromolar trigone.

Front 3

Define T1 of the oral cavity

Back 3

Tumor is 2 cm or less in greatest dimension.

Front 4

Define T2 of the oral cavity

Back 4

Tumor is more than 2 cm but not greater than 4 cm in greatest dimension.

Front 5

Define T3 of the oral cavity

Back 5

Tumor is more than 4 cm in greatest dimension.

Front 6

Define T4 (lip)

Back 6

Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face—i.e., chin or nose.

Front 7

Define T4a (oral cavity)

Back 7

Tumor invades adjacent structures (e.g., through cortical bone, into deep [extrinsic] muscle of tongue [genioglossus, hypoglossus, palataglossus, and sty- loglossus], maxillary sinus, skin of face).

Front 8

Define T4b oral cavity

Back 8

Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery.

Front 9

Define boundaries of the oropharynx

Back 9

The oropharynx includes the base of the tongue, the inferior surface of the soft palate and uvula, the anterior and posterior tonsillar pillars, the glossotonsillar sulci, the pharyngeal tonsils, and the lateral and posterior pharyngeal walls.

Front 10

Define T1 of the oropharynx

Back 10

Tumor is 2 cm or less in greatest dimension.

Front 11

Define T2 of the oral oropharynx

Back 11

Tumor is more than 2 cm but not more than 4 cm in greatest dimension

Front 12

Define T3 of the oropharynx

Back 12

Tumor is more than 4 cm in greatest dimension.

Front 13

Define T4a oropharynx

Back 13

Tumor invades the larynx, deep/extrinsic muscle of the tongue, medial pterygoid, hard palate, or mandible.

Front 14

Define T4b oropharynx

Back 14

Tumor invades the lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base or encases the carotid artery.

Front 15

What are the sites of the larynx?

Back 15

Supraglottis, glottis, subglottis

Front 16

What are the subsites of the supraglottis?

Back 16

Suprahyoid epiglottis Infrahyoid epiglottis Aryepiglottic folds (laryngeal aspect) Arytenoids Ventricular bands (false cords)

Front 17

Define the glottis

Back 17

True vocal cords, including anterior and posterior commisures, including the region 1 cm below the plane of the true vocal folds

Front 18

Define the subglottis

Back 18

Region extending from 1 cm below the true vocal folds to the cervical trachea

Front 19

Define T1 of the supraglottis

Back 19

Tumor is limited to one subsite of the supraglottis, with normal vocal cord mobility.

Front 20

Define T2 of the supraglottis

Back 20

Tumor invades mucosa of more than one adjacent subsite of the supraglottis or glottis or region outside the supraglottis (e.g., mucosa of base of tongue, vallecula, medial wall of pyriform sinus), without fixation of the larynx.

Front 21

Define T3 o the supraglottis

Back 21

Tumor is limited to the larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space, and/or minor thyroid cartilage ero- sion (e.g., inner cortex).

Front 22

Define T4a of the supraglottis

Back 22

Tumor invades through the thyroid cartilage and/or invades tis- sues beyond the larynx (e.g., trachea, soft tissues of neck, in- cluding deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus).

Front 23

Define T4b of the supraglottis

Back 23

Tumor invades prevertebral space, encases the carotid artery,or invades mediastinal structures.

Front 24

Define T1 of the glottis

Back 24

Tumor is limited to the vocal cords(s) (may involve anterior or posterior commissure), with normal mobility.

Front 25

Define T1a of the glottis

Back 25

Tumor is limited to one vocal cord.

Front 26

Define T1b of the glottis

Back 26

Tumor involves both vocal cords.

Front 27

Define T2 of the glottis

Back 27

Tumor extends to the supraglottis and/or subglottis, and/or with impaired vocal cord mobility.

Front 28

Define T3 of the glottis

Back 28

Tumor is limited to the larynx with vocal cord fixation and/or invades paraglottic space, and or minor thyroid cartilage ero- sion (e.g., inner cortex).

Front 29

Define T4a of the glottis

Back 29

Tumor invades through the thyroid cartilage and/or invades tis- sues beyond the larynx (e.g., trachea, soft tissues of the neck, including deep extrinsic muscle of the tongue, strap muscles, thyroid, or esophagus).

Front 30

Define T4b of the glottis

Back 30

Tumor invades prevertebral space, encases the carotid artery,or invades mediastinal structures.

Front 31

Define T1 of the subglottis

Back 31

Tumor is limited to the subglottis.

Front 32

Define T2 of the subglottis

Back 32

Tumor extends to the vocal cord(s), with normal or impaired mobility.

Front 33

Define T3 of the subglottis

Back 33

Tumor is limited to the larynx, with vocal cord fixation.

Front 34

Define T4a of the subglottis

Back 34

Tumor invades cricoid or thyroid cartilage and/or invades tis- sues beyond the larynx (e.g., trachea, soft tissues of neck, including deep extrinsic muscles of the tongue, strap muscles, thyroid, or esophagus).

Front 35

Define T4b of the subglottis

Back 35

Tumor invades prevertebral space, encases the carotid artery,or invades mediastinal structures.

Front 36

Define the boundaries of the hypopharynx

Back 36

The hypopharynx includes the pyriform sinuses, the lat- eral and posterior hypopharyngeal walls, and the postcricoid region.

Front 37

Define T1 of the hypopharynx

Back 37

Tumor is limited to one subsite of the hypopharynx and 2 cm or less in greatest dimension.

Front 38

Define T2 of the hypopharynx

Back 38

Tumor invades more than one subsite of the hypopharynx or an adjacent site, or measures more than 2 cm but not more than 4 cm in greatest dimension without fixation of the hemilarynx.

Front 39

Define T3 of the hypopharynx

Back 39

Tumor is more than 4 cm in greatest dimension or with fixation of the hemilarynx.

Front 40

Define T4a of the hypopharynx

Back 40

Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, esophagus, or central compartment soft tissue.

Front 41

Define T4b of the hypopharynx

Back 41

Tumor invades prevertebral space, encases the carotid artery,or invades mediastinal structures.

Front 42

Define the paranasal sinuses

Back 42

The paranasal sinuses include the ethmoid, maxillary, sphenoid, and frontal sinuses.

Front 43

Define the boundaries of the maxillary sinus

Back 43

The maxillary sinus is a pyramid-shaped cavity within the maxillary bone. The medial border is the lateral nasal wall. Su-periorly, the sinus abuts the orbital floor and contains the infraorbital canal. The posterolateral wall is anterior to the infratemporal fossa and pterygopalatine fossa. The anterior wall is posterior to the facial skin and soft tissue. The floor of the maxillary antrum extends below the nasal cavity floor and is in close proximity to the hard palate and maxillary tooth roots.

Front 44

Define T1 of the maxillary sinus

Back 44

Tumor is limited to the maxillary sinus mucosa, with no erosion or destruction of bone.

Front 45

Define T2 of the maxillary sinus

Back 45

Tumor is causing bone erosion or destruction, including extension into the hard palate and/or middle nasal meatus, except extension to the posterior wall of the maxillary sinus and pterygoid plates.

Front 46

Define T3 of the maxillary sinus

Back 46

Tumor invades any of the following: bone of the posterior wall of the maxillary sinus, subcutaneous tissues, floor, or medial wall of the orbit, pterygoid fossa, or ethmoid sinuses.

Front 47

Define T4a of the maxillary sinus

Back 47

Tumor invades anterior orbital contents, skin of cheek, pterygoid plates, infratemporal fossa, cribriform plate, sphenoid or frontal sinuses.

Front 48

Define T4b of the maxillary sinus

Back 48

Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than maxillary division of trigeminal nerve (V2), nasopharynx, or clivus.

Front 49

What is included in the nasal cavity?

Back 49

The nasal cavity includes the nasal antrum and the olfactory region.

Front 50

What are subsites of the nasal cavity

Back 50

septum; superior, middle, and inferior turbinates; and olfactory region of the cribriform plate.

Front 51

What are the boundaries of the ethmoid sinus?

Back 51

Laterally, the ethmoid sinus is bound by a thin bone called the lamina papyracea, which separates it from the medial orbit. The posterior border of the ethmoid sinus is close to the optic canal. The anterosuperior border or roof of the ethmoid is formed by the fovea ethmoidalis, which separates it from the anterior cranial fossa. The perpendicular plate of the ethmoid bone separates the ethmoid cavity into left and right sides.

Front 52

Define T1 of the nasal cavity/ethmoid sinus

Back 52

Tumor is confined to the ethmoid sinus with or without bone erosion.

Front 53

Define T2 of the nasal cavity/ethmoid sinus

Back 53

Tumor invades two subsites in a single region or extends to in- volve an adjacent region within the nasoethmoidal complex, with or without bony invasion.

Front 54

Define T3 of the nasal cavity/ethmoid sinus

Back 54

Tumor extends to invade the medial wall or floor of the orbit, maxillary sinus, palate, or cribriform plate.

Front 55

Define T4a of the nasal cavity/ethmoid sinus

Back 55

Tumor invades any of the following: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranial fossa, pterygoid plates, sphenoid or frontal sinuses.

Front 56

Define T4b of the nasal cavity/ethmoid sinus

Back 56

Tumor invades any of the following: orbital apex, dura, brain, middle cranial fossa, cranial nerves other than (V2), nasopharynx, or clivus.

Front 57

Define the salivary glands:

Back 57

The salivary glands include the parotid, submandibular, sublingual, and minor salivary glands.

Front 58

T1 salivary glands

Back 58

Tumor is 2 cm or less without extraparenchymal extension.

Front 59

T2 salivary glands

Back 59

Tumor is greater than 2 cm but not more than 4 cm without extraparenchymal extension.

Front 60

T3 salivary glands

Back 60

Tumor is more than 4 cm and/or extraparenchymal extension.

Front 61

T4a salivary glands

Back 61

Tumor invades the skin, mandible, ear canal, and/or facial nerve.

Front 62

T4b salivary glands

Back 62

Tumor invades the skull base and/or pterygoid plates and/or encases the carotid artery.

Front 63

Define N1

Back 63

Metastasis is in a single ipsilateral lymph node, 3 cm or less in greatest dimension.

Front 64

Define N2

Back 64

Metastasis is in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or metastasis is in multiple ipsilateral lymph nodes, none more that 6 cm in greatest dimension; or metastasis is in bilateral or contralateral lymph nodes, none greater than 6 cm in greatest dimension.

Front 65

Define N2a

Back 65

Metastasis is in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension.

Front 66

Define N2b

Back 66

Metastasis is in multiple ipsilateral lymph nodes, none more that 6 cm in greatest dimension.

Front 67

Define N2c

Back 67

Metastasis is in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension.

Front 68

Define N3

Back 68

Metastasis is in a lymph node more than 6 cm in greatest di mension.

Front 69

What does the U or L designation to neck staging signify

Back 69

indicate the level of metastasis above the lower border of the cricoid cartilage (U) or below the lower border of the cricoid cartilage (L).