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Staging (Lip and Oral Cavity)
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Staging (Lip and Oral Cavity)
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Pathologic Staging (pTNM)
CAP Approved Head and Neck • Lip and Oral Cavity 4.0.0.0 (AJCC 8th ed.)
TNM Descriptors (required only if applicable) (select all that apply)
___ m (multiple primary tumors)
___ r (recurrent)
___ y (posttreatment)
For All Carcinomas Excluding Mucosal Melanoma
Primary Tumor (pT)
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___ pTX: |
Cannot be assessed |
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___ pT0: |
No evidence of primary tumor |
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___ pTis: |
Carcinoma in situ |
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___ pT1: |
Tumor 2 cm or less in greatest dimension, ≤5 mm depth of invasion (DOI) |
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___ pT2: |
Tumor ≤2 cm, DOI >5 mm and ≤10 mm or Tumor more than 2 cm but not more than 4 cm in greatest dimension and ≤10 mm DOI |
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___ pT3: |
Tumor more than 4 cm in greatest dimension or any tumor >10 mm DOI |
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___ pT4a: |
Moderately advanced local disease. Lip: Tumor invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin of face, ie, chin or nose Oral cavity: Tumor invades adjacent structures only (eg, through cortical bone [mandible, maxilla], or involves the maxillary sinus, skin of the face) |
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___ pT4b: |
Very advanced local disease. Tumor invades masticator space, pterygoid plates, or skull base, and/or encases internal carotid artery |
Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumor as T4.
Regional Lymph Nodes (pN)#
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___ pNX: |
Cannot be assessed |
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___ pN0: |
No regional lymph node metastasis |
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___ pN1: |
Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension and ENE(−) |
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___ pN2a: |
Metastasis in single ipsilateral node 3 cm or smaller in greatest dimension and ENE(+); Or a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension and ENE(−) |
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___ pN2b: |
Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension and ENE(−) |
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___ pN2c: |
Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension and ENE(−) |
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___ pN3a: Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−)
___ pN3b: Metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+);
or multiple ipsilateral, contralateral or bilateral nodes any with ENE(+);
or a single contralateral node 3 cm or smaller and ENE(+)
#Superior mediastinal lymph nodes are considered regional lymph nodes (level VII). Midline nodes are considered ipsilateral nodes.
Distant Metastasis (pM)
___ Not applicable
___ pM1: Distant metastasis
Specify site (s), if known
For Mucosal Melanoma
Primary Tumor (pT)
___ pT3: Mucosal disease and immediately underlying soft tissue, regardless of thickness or greatest dimension; for example, polypoid nasal disease, pigmented or nonpigmented lesions of the oral cavity, pharynx, or larynx
___ pT4a: Moderately advanced disease. Tumor involving deep soft tissue, cartilage, bone, or overlying skin
___ pT4b: Very advanced disease. Tumor involving brain, dura, skull base, lower cranial nerves (IX, X, XI, XII), masticator space, carotid artery, prevertebral space, or mediastinal structures
Regional Lymph Nodes (pN)
___ pNX: Regional lymph nodes cannot be assessed
___ pN0: No regional lymph node metastases
___ pN1: Regional lymph node metastases present
Distant Metastasis (pM)
___ Not applicable
___ pM1: Distant metastasis present
LIP and Oral Cavity CAP 4.0.0.0 summary of pTNM changes AJCC 7th to 8th edition
- Depth of invasion is part of pT stage (DOI is measured from the basement membrane of adjacent normal to the deepest point of invasion of the tumor).
- ENE negative or positive is part N stage pN1, N2a, 2b, 2c, 3a, 3b
- Separate section of main specimen margins and separately submitted margins