2020年5月15日最終更新

pTis    Carcinoma in situ
pT1    ≤2 cm and ≤5 mm depth of invasion
pT2    ≤2 cm and >5 mm depth of invasion or
    　　>2 ≤4 cm and ≤10 mm depth of invasion
pT3　>2 ≤4 cm and >10 mm depth of invasion or
          >4 cm and ≤10 mm depth of invasion

pT4a Oral cavity:
          >4 cm and >10 mm depth of invasion or
tumor invades adjacent structures, e.g. cotical bone of the mandible or maxilla or involves the maxillary sinus or skin of the face

Depth of Invasion (DOI) ≠ 腫瘍の厚さ
浸潤の深さは，近接する非腫瘍粘膜の基底膜の高さから計測する
pT1-4a に対応する最大径と DOI はおよそ下記の通り：

pT2 ≤2 cm, >10 mm	pT3 >2 ≤4 cm, >10 mm	pT4a >4 cm, >10 mm
pT2 ≤2 cm, ≤10 mm	pT2 >2 ≤4 cm, ≤10 mm	pT3 >4 cm, ≤10 mm
pT1 ≤2 cm, ≤5 mm	pT2 >2 ≤4 cm, <5 mm	pT3 >4 cm, <5 mm

T4b Tumour invades masticator space, pterygoid plates,
                or skull base; or encases internal carotid artery

Note: Superficial erosion alone of bone/tooth socket by
gingival primary is not sufficient to classify a tumour as T4.

(Nは咽喉頭共通)
pN1    Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension without extranodal extension

pN2    Metastasis as specified in N2a, 2b, 2c
    N2a    A single ipsilateral, >3 ≤6 cm without extranodal extension, or
              A single ipsilateral, ≤3 cm with extranodal extension
       3cm以下で節外伸展（＋），または 3cmを超える大きさで節外伸展なし
    N2b    Multiple ipsilateral lymph nodes, ≤ 6 cm without extranodal extension
　　一側の複数のリンパ節に転移あり
    N2c    Bilateral or contralateral lymph nodes, ≤ 6 cm without extranodal extension
　　両側のリンパ節に転移あり，節外伸展なし

pN3a    > 6 cm without extranodal extension
　6 cmを超える転移巣あり，節外伸展なし
Note: Midline nodes are considered ipsilateral nodes.

pN3b　> 3 cm with extranodal or multiple, ipsilateral or contralateral or bilateral with extranodal extension
　　　3cｍを超えて節外伸展（＋），あるいは対側多発，あるいは対側で節外伸展（＋）

Stage 0 Tis
Stage I T1
Stage II T2
Stage III T12N1 or T3N01
Stage IVA  T123N2, T4a
Stage IVB T4b or N3
Stage IVC M1

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pT1 Nasopharynx, oropharynx, or nasal cavity

pT2 Parapharyngeal extension
    medial pterygoid, lateral pterygoid, and/or prevertebral muscles

pT3 Bony structures of skullbase/paranasal sinuses
    pterygoid structures

pT4 Intracranial, cranial nerves, hypopharynx, orbit,
infratemporal fossa/masticator space ⇒ beyond lateral surface of lateral pterygoid muscle

pN1 unilateral cervical, unilateral or bilateral retropharyngeal
lymph nodes, above supsraclavicular fossa caudal border of cricoid cartilage, ≤ 6 cm

pN2 bilateral cervical above supsraclavicular fossa caudal border of cricoid cartilage, ≤ 6 cm

pN3 >6 cm OR beyond supsraclavicular fossa caudal border of cricoid cartilage

Stage Grouping

0 Tis

I T1

II T1N1, T2N0-1

III T12N2, T3 N0-2

IVA T4 T4N0-2
IVA N3
IVB M1

p16-negative oropharynx
    pTis    Carcinoma in situ
    pT1    ≤ 2 cm;


    pT2    ≤ 4 cm;
    pT3    > 4 cm or extension to ligual surface of epiglottis

pT4a    Tumour invades any of the following:
larynx, deep/extrinsic muscle of tongue
(genioglossus, hyoglossus, palatoglossus, and styloglossus),
medial pterygoid, hard palate, and mandible

pT4b    Tumour invades any of the following:
lateral pterygoid muscle, pterygoid plates, lateral nasopharynx,
skull base; or encases the carotid artery

pN0    No regional lymph node metastasis
 
pN1    Metastasis in a single ipsilateral lymph node, 3 cm or less in great
est dimension without extranodal extension


pN2a    Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension without extranodal extension
    or single <3 cm with extranodal extension

pN2b    Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension without extranodal extension

pN2c    Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension without extranodal extension

pN3a    Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension

pN3b　> 3 cm with extranodal or multiple, ipsilateral or contralateral or bilateral with extranodal extension

Stage 0   Tis
Stage I　T1
Stage II　T2
Stage III　T3
　　　　　T1-3 N1
Stage IVA　T1-3 N2
                     T4a　N0-2
Stage IVB　T4b any N
                     anyT　N3
Stage IVC　M1

*****
p16-positive oropharynx
    pTis
    pT2
    pT3
    pT4 (no pT4a or pT4b)

    pNX pN0
    pN1　Metastatis in 1 to 4 lymph node (s)
    pN2　Metastasis in ≥ 5 lymph nodes

Stage 0　Tis
Stage I　T1-2　N0-1
Stage II　T1-2　N2
               T3-4　N0-1
Stage III　T4     N2
Stage IV　M1

T0    No evidence of primary tumour

Tis    Carcinoma in situ

T1    Tumour limited to one subsite of hypopharynx and 2 cm or less in
greatest dimension

T2    Tumour invades more than one subsite of hypopharynx or an adja
cent site, or measures more than 2 cm but not more than 4 cm in
greatest dimension, without fixation of hemilarynx

T3    Tumour more than 4 cm in greatest dimension, or with fixation of
hemilarynx or extension to esophageal mucosa

T4a    Tumour invades any of the following: thyroid/cricoid cartilage, hyoid
bone, thyroid gland, oesophagus, central compartment soft tissue*

T4b    Tumour invades prevertebral fascia, encases carotid artery, or
invades mediastinal structures.

*Note: Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat.

pN0    No regional lymph node metastasis
 
pN1    Metastasis in a single ipsilateral lymph node, 3 cm or less in great
est dimension without extranodal extension


pN2a    Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension without extranodal extension
    or single ≤3 cm with extranodal extension

pN2b    Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension without extranodal extension

pN2c    Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension without extranodal extension

pN3a    Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension

pN3b　> 3 cm with extranodal or multiple, ipsilateral or contralateral or bilateral with extranodal extension

Stage Grouping (unchanged)

Stage 0 Tis
Stage I T1
Stage II T2
Stage III T12N1 or T3N01
Stage IVA  T123N2, T4aN012
Stage IVB T4b or N3
Stage IVC M1

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Larynx

Staging, pNの定義はhypopharynxと同じ

Supraglottis
T1    Tumour limited to one subsite of supraglottis with normal vocal cord mobility
T2    Tumour invades mucosa of more than one adjacent subsite of 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
T3    Tumour limited to larynx with vocal cord fixation and/or invades any of the following: postcricoid area, pre-epiglottic tissues, paraglottic space, and/or with minor thyroid cartilage erosion (e.g. inner cortex)
T4a    Tumour invades through the thyroid cartilage and/or invades tissues beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid, oesophagus
T4b    Tumour invades prevertebral space, mediastinal structures, or encases carotid artery

Glottis
T1a    Tumour limited to one vocal cord
T1b    Tumour involves both vocal cords
T2    Tumour extends to supraglottis and/or subglottis, and/or with impaired vocal cord mobility
T3    Tumour limited to larynx with vocal cord fixation and/or invades
paraglottic space, and/or with minor thyroid cartilage erosion (e.g. inner cortex)
T4a    Tumour invades through the thyroid cartilage, or invades tissues
beyond the larynx, e.g., trachea, soft tissues of neck including deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid, oesophagus
T4b    Tumour invades prevertebral space, mediastinal structures, or encases carotid artery

Subglottis
T1    Tumour limited to subglottis
T2    Tumour extends to vocal cord(s) with normal or impaired mobility
T3    Tumour limited to larynx with vocal cord fixation
T4a    Tumour invades through cricoid or thyroid cartilage and/or invades
tissues beyond the larynx, e.g., trachea, soft tissues of neck includ ing deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), strap muscles, thyroid, oesophagus
T4b    Tumour invades prevertebral space, mediastinal structures, or encases carotid artery


pN - Regional lymph nodes

pN0    No regional lymph node metastasis
 
pN1    Metastasis in a single ipsilateral lymph node, 3 cm or less in great
est dimension without extranodal extension

pN2a    Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension without extranodal extension
    or single <3 cm with extranodal extension

pN2b    Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension without extranodal extension

pN2c    Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension without extranodal extension

pN3a    Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension

pN3b　> 3 cm with extranodal or multiple, ipsilateral or contralateral or bilateral with extranodal extension



亜部位 subsite の名称は ICD-O で確認のこと

https://training.seer.cancer.gov/head-neck/abstract-code-stage/codes.html

（例）
喉頭蓋谷（epiglottic vallecula）は、中咽頭 (C10.0)；舌と喉頭蓋の間
梨状陥凹 (pyriform sinus) は、下咽頭 (C12.9)
披裂喉頭蓋 aryepiglottic fold は、下咽頭側は下咽頭 (C13.1)、喉頭側は喉頭 (C32.1)

頸部リンパ節のレベル分類とリンパの流れ

Level Ia オトガイ下 → Level Ib 顎下
Level I → Level VI 前頸部
Level I, 耳下腺 → IIa 上内頚静脈 副神経より前方
Level IIb 上内頚静脈 副神経より後方
Level II → Level III 中内頚静脈 → Level IV 下内頚静脈
Level Va 副神経 → Level Vb 頸横、鎖骨上窩 → Level IV
他の所属リンパ節には、外側咽頭後（= ルビエル）（←下咽頭後壁癌）、舌骨傍（←口腔底・舌癌）がある。