Stages of oral cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. The healthcare team uses information from tests to find out the size of the tumour, which parts of the organ have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Doctors use the stage to plan treatment and estimate the outcome (prognosis).

The most common staging system for oral cancer is the TNM system. For oral cancer there are 4 stages. Often the stages are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread.

When describing the stage, doctors may use the words local, regional or distant.

Local means that the cancer is only in the mouth and has not spread to other parts of the body.

Regional means the cancer has spread to the lymph nodes in the neck (cervical lymph nodes).

Distant means in a part of the body farther from the mouth.

Talk to your doctor if you have questions. Find out more about staging cancer.

The tumour is 2 cm or smaller and less than 5 mm deep.

The tumour is 2 cm or smaller. It is more than 5 mm but less than 10 mm deep.

OR

The tumour is larger than 2 cm but no more than 4 cm. It is less than 10 mm deep.

The tumour is larger than 2 cm but no more than 4 cm. It is more than 10 mm deep.

OR

The tumour is larger than 4 cm and less than 10 mm deep.

OR

The tumour can be of any size or depth and has spread to one lymph node in the neck on the same side as the tumour. The lymph node is 3 cm or smaller.

The tumour is larger than 4 cm and more than 10 mm deep. The cancer has also spread to one lymph node and the lymph node is 3 cm or smaller.

OR

The tumour is any size and depth and has grown into any of the following:

• the bone in the palate
• the upper jawbone or lower jawbone
• the maxillary sinus (the sinus within the upper jawbone)
• floor of the mouth
• skin of the face

The cancer has also spread to 1 or more lymph nodes in the neck, and the lymph nodes are 6 cm or smaller.

The tumour is any size and depth. The cancer has also spread to 1 or more lymph nodes in the neck, and the lymph nodes are larger than 6 cm.

OR

The tumour has grown into the soft tissues of the cheek such as muscles, nerves or blood vessels, or into the base of the skull, or the tumour is wrapped around the internal carotid artery of the neck. The cancer has spread to multiple lymph nodes.

The cancer has spread to other parts of the body (called distant metastasis), such as to the lungs, liver or bone. This is also called metastatic oral cancer.

Recurrent oral cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.