Σταδιοποίηση σε Ca Φάρυγγος

 

Ca Φάρυγγος

AJCC Stages - Ρινοφάρυγγας

Stages

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T1

N1

M0

T2

N0

M0

T2

N1

M0

III

T1

N2

M0

T2

N2

M0

T3

N0

M0

T3

N1

M0

T3

N2

M0

IVA

T4

N0

M0

T4

N1

M0

T4

N2

M0

IVB

Any T

N3

M0

IVC

Any T

Any N

M1

AJCC Stages – Οροφάρυγγας & Υποφάρυγγας

0

Tis

N0

M0

I

T1

N0

M0

II

T2

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

T4b

Any N

M0

Any T

N3

M0

IVC

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ

Ρινοφάρυγγας

 

T1

Tumor confined to the nasopharynx or tumor extends to oropharynx &/or nasal cavity without parapharyngeal extension¹

T2

Tumor with parapharyngeal extension¹

T3

Tumor involves bony structures of skull base &/or paranasal sinuses

T4

Tumor with intracranial extension &/or involvement of cranial nerves, hypopharynx, orbit, or with extension to the infratemporal fossa/masticator space

Οροφάρυγγας

 

T1

Tumor ≤ 2 cm in greatest dimension

T2

Tumor > 2 cm but ≤ 4 cm in greatest dimension

T3

Tumor > 4 cm in greatest dimension or extension to lingual surface of epiglottis

T4a

Moderately advanced local disease: Tumor invades the larynx, extrinsic muscle of tongue, medial pterygoid, hard palate, or mandible²

T4b

Very advanced local disease: Tumor invades lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, or skull base or encases carotid artery

Υποφάρυγγας

 

T1

Tumor limited to 1 subsite of hypopharynx &/or ≤ 2 cm in greatest dimension

T2

Tumor invades > 1 subsite of hypopharynx or an adjacent site, or measures > 2 cm but ≤ 4 cm in greatest dimension without fixation of hemilarynx

T3

Tumor > 4 cm in greatest dimension or with fixation of hemilarynx or extension to esophagus

T4a

Moderately advanced local disease: Tumor invades thyroid/cricoid cartilage, hyoid bone, thyroid gland, or central compartment soft tissue³

T4b

Very advanced local disease: Tumor invades prevertebral fascia, encases carotid artery, or involves mediastinal structures

¹Parapharyngeal extension denotes posterolateral infiltration of tumor. 
²Mucosal extension to lingual surface of epiglottis from primary tumors of the base of the tongue and vallecula does not constitute invasion of larynx. 
³Central compartment soft tissue includes prelaryngeal strap muscles and subcutaneous fat.

(N) Regional Lymph Nodes

Ρινοφάρυγγας

 

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Unilateral metastasis in cervical lymph node(s), ≤ 6 cm in greatest dimension, above the supraclavicular fossa, &/or unilateral or bilateral, retropharyngeal lymph nodes, ≤ 6 cm, in greatest dimension¹

N2

Bilateral metastasis in cervical lymph node(s), ≤ 6 cm in greatest dimension, above the supraclavicular fossa

N3

Metastasis in a lymph node(s) > 6 cm &/or to supraclavicular fossa²

N3a

> 6 cm in dimension

N3b

Extension to the supraclavicular fossa²

The distribution and the prognostic impact of regional lymph node spread from nasopharyngeal cancer, particularly of the undifferentiated type, are different from those of other head and neck mucosal cancers and justify the use of a different N classification scheme. 
¹Midline nodes are considered ipsilateral nodes. 
²Supraclavicular zone or fossa is relevant to the staging of nasopharyngeal carcinoma and is the triangular region originally described by Ho. It is defined by 3 points: 1) The superior margin of the sternal end of the clavicle, 2) the superior margin of the lateral end of the clavicle, and 3) the point where the neck meets the shoulder. Note that this would include caudal portions of levels IV and VB. All cases with lymph nodes (whole or part) in the fossa are considered N3b.

Οροφάρυγγας & Υποφάρυγγας

 

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis in a single ipsilateral lymph node, ≤ 3 cm in greatest dimension

N2

Metastasis in a single ipsilateral lymph node, > 3 cm but ≤ 6 cm in greatest dimension, or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension

N2a

Metastasis in a single ipsilateral lymph node > 3 cm but ≤ 6 cm in greatest dimension

N2b

Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension

N2c

Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension

N3

Metastasis in a lymph node > 6 cm in greatest dimension

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

(G) Histologic Grade

GX

Grade cannot be assessed

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

G4

Undifferentiated

Χαρακτηριστικά Επέκτασης

Nasopharyngeal carcinoma

  • Direct extension
  • Lymphatic spread
    • 90% of patients have nodal metastases at presentation
    • Commonly involved nodes include
      • Retroperitoneal (primary site)
      • Deep cervical (level II)
      • Spinal accessory chains (level V)
  • Distant metastases
    • Rare at presentation (< 10%)
    • High metastatic potential
      • Among highest metastatic rates of head and neck malignancies
      • High rate of multi-organ involvement (57%)
    • Commonly involved organs include
      • Lung, Bone, Liver

Oropharyngeal carcinoma

  • Direct extension
  • Lymphatic-rich lymphatic drainage
    • Primarily to level I-IV nodes
      • Level II: Most common node
    • Base of tongue carcinomas
      • 30% of patients have bilateral nodal metastasis
    • Soft palate carcinomas
      • Nodal metastasis common
      • Nodal spread present in 60% of patients at time of diagnosis
  • Distant metastasis
    • Lung, Bone

Hypopharyngeal carcinoma

  • Direct extension
    • Carcinomas of medial wall of pyriform sinuses often extend across mucosa to aryepiglottic folds, potentially with further invasion into paraglottic space and larynx
  • Lymphatic spread
    • Rich lymphatic drainage present with frequent regional nodal metastasis
    • Asymptomatic neck mass is present in 20% of cases, which generally represents regional nodal metastasis, most typically jugulodigastric or jugulo-omohyoid lymph node
    • Nodal involvement in pharyngeal wall carcinomas according to study of neck dissections
      • Level I (0%)
      • Level II (67%)
      • Level III (33%)
      • Level IV (7%)
    • Nodal involvement in pyriform sinus carcinomas according to study of neck dissections
      • Level I (20%)
      • Level II (80%)
      • Level III (40%)
      • Level IV (40%)
  • Distant metastasis
    • Lung, Bone

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

WHO classification for nasopharyngeal tumors

  • Malignant epithelial tumors
    • Squamous cell carcinomas (SCCa)
      • Nonkeratinizing carcinoma
      • Keratinizing squamous cell Ca
      • Basaloid squamous cell Ca
    • Nasopharyngeal papillary adenoCa
    • Salivary gland-type carcinomas
  • Soft tissue neoplasms
    • Nasopharyngeal angiofibroma
  • Hematolymphoid tumors
    • Hodgkin lymphoma
    • Diffuse large B-cell lymphoma
    • Extranodal NK-/T-cell lymphoma
    • Follicular dendritic cell sarcoma/tumor
    • Extramedullary plasmacytoma
  • Tumors of bone and cartilage
    • Chordoma
  • Secondary tumors

 

WHO classification for oropharyngeal tumors

  • Malignant epithelial tumors
    • Squamous cell carcinomas
      • Verrucous carcinoma
      • Basaloid squamous cell Ca
      • Papillary squamous cell Ca
      • Spindle cell carcinoma
      • Acantholytic squamous cell Ca
      • Adenosquamous carcinoma
      • Carcinoma cuniculatum
    • Lymphoepithelial carcinoma
  • Salivary gland tumors (numerous subtypes)
  • Soft tissue tumors
    • Kaposi sarcoma
    • Lymphangioma
    • Ectomesenchymal chondromyxoid tumor
    • Focal oral mucinosis
    • Congenital granular cell epulis
  • Hematolymphoid tumors
    • Diffuse large B-cell lymphoma
    • Mantle cell lymphoma
    • Follicular lymphoma
    • Extranodal marginal zone B-cell lymphoma of MALT type
    • Burkitt lymphoma
    • T-cell lymphoma (including anaplastic large cell lymphoma)
    • Extramedullary plasmacytoma
    • Langerhans cell histiocytosis
    • Extramedullary myeloid sarcoma
    • Follicular dendritic cell sarcoma/tumor
  • Mucosal malignant melanoma
  • Secondary tumors

WHO classification for hypopharyngeal tumors

  • Malignant epithelial tumors
    • Squamous cell carcinomas
      • Verrucous carcinoma
      • Basaloid squamous cell Ca
      • Papillary squamous cell Ca
      • Spindle cell carcinoma
      • Acantholytic squamous cell Ca
      • Adenosquamous carcinoma
    • Lymphoepithelial carcinoma
    • Giant cell carcinoma
    • Malignant salivary gland-type tumors
      • Mucoepidermoid carcinoma
      • Adenoid cystic carcinoma
  • Neuroendocrine tumors
    • Typical carcinoid
    • Atypical carcinoid
    • Small cell Ca, neuroendocrine type
    • Combined small cell Ca, neuroendocrine
  • Benign epithelial tumors
    • Papilloma
    • Papillomatosis
    • Salivary gland-type adenomas
      • Pleomorphic adenoma
      • Oncocytic papillary cystadenoma
  • Soft tissue tumors
    • Malignant tumors
      • Fibrosarcoma
      • Malignant fibrous histiocytoma
      • Liposarcoma
      • Leiomyosarcoma
      • Rhabdomyosarcoma
      • Angiosarcoma
      • Kaposi sarcoma
      • Malignant peripheral nerve sheath
      • Synovial sarcoma
  • Tumors with low malignant potential/borderline
    • Inflammatory myofibroblastic tumor
  • Benign tumors
    • Schwannoma
    • Neurofibroma
    • Lipoma
    • Leiomyoma
    • Rhabdomyoma
    • Hemangioma
    • Lymphangioma
    • Granular cell tumor
  • Hematolymphoid tumors
  • Tumors of bone and cartilage
    • Chondrosarcoma
    • Osteosarcoma
    • Chondroma
    • Giant cell tumor
  • Mucosal malignant melanoma
  • Secondary tumors