Nasopharyngeal carcinoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2]


The staging of nasopharyngeal carcinoma is based on the TNM staging system.


The staging of nasopharyngeal carcinoma is based on the TNM staging system.

TNM staging

Primary tumor

  • Tx: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • Tis: carcinoma in situ
  • T1: tumor is confined to the nasopharynx
  • T2: tumor extends to soft tissues of the oropharynx and/or nasal fossa
    • T2a: without extension to the parapharyngeal region
    • T2b: with extension to the parapharyngeal region
  • T3: invasion of adjacent bony structures and/or paranasal sinuses
  • T4: invasion of any one or more of the following

Nodal status

  • Nx: nodes cannot be assessed
  • N0: no evidence of nodal involvement
  • N1: unilateral nodal involvement <6cm maximal diameter above supraclavicular fossa
  • N2: bilateral nodal involvement <6cm maximal diameter above supraclavicular fossa
  • N3
    • N3a: >6 cm maximal diameter (unilateral or bilateral)
    • N3b: involvement of the supraclavicular fossa


  • Mx: presence of metastases cannot be assessed
  • M0: no evidence of metastases
  • M1: distant metastases present

Stages of Nasopharyngeal carcinoma

Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T2a N0 M0
II T2b N0 M0
III T3 N0 M0
T1 N1 M0
T2 N1 M0
T3 N1 M0
IVA T4a N0 M0
T4a N1 M0
T1 N2 M0
T2 N2 M0
T3 N2 M0
T4a N2 M0
IVB AnyT N3 M0
T4b AnyN M0
IVC AnyT AnyN M1


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