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H&N Staging - Coggle Diagram
H&N Staging
Nodes
N1
OP+ : single or multiple, Ipsi < 6 cm
N1b
Skin melanoma: One clinically detected: no In transit, satellite, or microsatellite mets
Parathyroid: Mets to unilateral bilateral or C/L Level 1,2 3, 4, 5 or retropharyngeal nodes
Thyroid, diff, med, Anaplastic: uni or B/L or C/l Levels 1,2,3,4,5 or retropharynx
N1c
Skin melanoma: No regional lymph node disease: yes In transit, satellite, or microsatellite mets
N1a:
Skin melanoma: One occult node (SLN biopsy)- no In transit, satellite, or microsatellite mets
Parathyroid: Level 6 or superior mediastinal nodes
thyroid med/diff/anaplastic: level 6-7, UL or B/L
Merkel cell: regional lymph nodes
mucosal melanoma: Regional lymph node mets present
Nasopharynx: Unilateral mets In cervical lymph nodes or bilateral mets In retropharyngeal nodes, <6cm above caudal border of cricoid cartilage
Sarcoma: nodes present
cut carcinoma; OC; nasal cavity and ethmoid; max sinus; supraglot;subglottis;hypopharynx; OP-; glottis; maj salivary gland: single, Ipsi, <3cm, ENE -
N2
OP + : contralateral or bilateral < 6 cm
Merkel cell: In transit mets located between prmiary tumor and draining reginal nodal basin, distal to primary tumor without lymph node mets
Nasopharynx: bilateral mets In cervical LN <6 cm, above caudal border of cricoid cartilage
N2a
Skin melanoma: 2/3 occult nodes: no In transit, satellite, or microsatellite mets
cut carcinoma; OC; nasal cavity and ethmoid, maxillary sinus, supraglottis, glottis, subglottis, OP-, hypopharynx; major salivary gland : single, Ipsi, 3-6 cm, ENE -
N2b
Skin melanoma: 2/3 clinically detected: no In transit, satellite, or microsatellite mets
cut carcinoma; nasal cavity and ethmoid, max sinus, supraglot, glot, op-, hypopharynx, subglot, maj salivary gland : multiple, Ipsi, <6 cm, ENE -
N2c
Skin melanoma: One clinically occult or detected nodes: yes In transit, satellite, or microsatellite mets
cut carcinoma; nasal cavity and ethmoid, max sinus, supraglot, subglot, Op-, hypopharynx, glottis, maj salivary gland, OC: B/L or C/L <6, ENE -
N3
OP +: > 6 cm
Merkel cell: In transit mets discontinuous from primary tumor, located between primary tumor and drianing regional nodal basin or distal to primary tumor WITH lymph node mets
Nasophraynx: uni or bilateral mets In cervical LN > 6 cm, extension below caudal border of cricoid
N3a
Skin melanoma: 4+ clinically occult nodes: no In transit, satellite, or microsatellite mets
OC; maj salivar gland, subglot, hypopharynx, OP-, glottis, supraglot, max sinus, nasal cavity and ethmoid, cut carcinoma: > 6 , ENE -
N3b
Skin melanoma: 4+ nodes, one of which clinically detected, any matted nodes: no In transit, satellite, or microsatellite mets
Nasal cavity and ethmoid; max sinus, supraglot, glottis, OP-, hypopharynx, subglottis, maj salivary gland, OC, cut carcinoma: ENE +
N3c:
Skin melanoma: 2+ clinically occult or detecetd nodes and any number of matted nodes: no In transit, satellite, or microsatellite mets
Tumor
T1
Subglottis: subglottis
Supraglot: One subsite with normal VC mob
Maxillary sinus: Maxillary sinus mucosa, no erosion or destruction of bone
Nasal cavity and ethmoid: one subsite with our without bone Invasion
Nasopharynx: confined to nasoharynx, etension to oropharynx and or nasal cavity without parapharyngeal Involvement
Parathyroid: localized to para
Cut carcinoma; Merkell cell; OP-, OP+, Sarcoma; OC(DOI <5), Hypopharynx (one subsite), Major sal gland (NO EPE): <2 cm
T2
Glottis: Supra/subglottis, Impaired VC mobility
Subglottis: to VC - normal or Impaired mobility
Supraglot: mucosa of +1 subsite of supraglot or glot or region outside (BOT, vallecula, medial pyriform) without larynx fixation
Maxillary sinus: erosion or destruction of bone, hard palate extension, middle meatus, (MEH)
T2a
skin melanoma: 1-2 mm, no ulc
T2B
skin melanoma: 1-2 mm, + ulc
Merkel cell carcinoma: 2-5 cm
Nasal cavity and ethmoid two subsites In single region or adjacent region within nasoethmoidal complex with or without bony Invasion
Nasopharynx: parapharyngeal space, soft tissue of pterygoid, prevertebral muscles (PPP)
OC: < 2 cm, DOI > 5 mm, or 2-4 cm with DOI < 10 mm
Parathyroid: Invasion Into thyroid
thyroid med/anaplastic/diff (limited to thyroid); maj salivary gland (No EPE) Hypopharynx (>1 subsite, no fixation of hemilarynx, OP-, OP+; sarcoma, : 2-4 cm
T3
Glottis: VC fixation, Invasion of paraglottic space, inner cortex of thyroid cartilage
Subglottis: larynx limited, VC fixation, Invasion of paraglottis space and Inner cortex of thyroid
Supraglot: larynx, VC fix, Invades: postcricoid, preepiglottic paraglottic, Inner cortex of thyroid
Maxillary sinus: Invades: Bone of post wall of max sinnus, subq tissues, floor or medial wall of orbit, pterygoid fossa, ethmoid (SPOPE)
T3a:
Thyroid diff/anaplastic/med: > 4 cm limited to thyroid
Skin melanoma: 2-4 mm, no ulc
T3b:
Skin melanoma: 2-4 mm, + ulc
Thyroid diff/anaplsatic/mod: ETE to strap
Merkel cell: > 5 cm
Mucosal melanoma: limited to mucosa and soft tissue- regardless of thickness or greatest dimension
Nasal cavity and ethmoid: tumor extens to Invade medial wall or floor of orbit, maxillary sinus, palate, cribriform plate
Nasopharynx: Infiltration of bony structures at skull base, cervical vertebra, pterygoid structures, paranasal sinuses (SPCS)
OC: 2-4 cm with DOI > 10 , or >4 cm with DOI < 10 mm
invasion Into RLN, esophagus, trachea, skeletal muscle, adjacent nodes, thymus
Sarcoma; Maj salivary gland (or EPE), Hyopharynx (fixation of hemilarynx or esophageal mucosa), OP- (or lingual epiglottis), OP+ (or lingual epiglottis): > 4 cm
Cut carinoma: > 4 cm or minor bone erosion or PNE or deep Invasion
T4a
OP - : Larynx, extrinsic muscles of tongue, medial pterygoid, hard palate, mandible (TLMHM)
Hypopharynx: thyroid/cricoid/hyoid/thyroidgland/ esophagus/ central compartment (CHEST)
Supraglot/glottis/subglottis: outer cortex of thryoid, or tissues beyond larynx: soft tissues of neck, deep extrinsic muscles of tongue, strap muscles, thyroid, esopahgus (TESTES)
Major salivary gland: skin , mandible, ear canal, CN7 (MESS)
Maxillary sinus: orbit, skin of cheek, pterygoid plates, Infratemproal fossa, cribriform plate, sphenoid or frontal sinus (ASSPIC)
T4a:
Skin melanoma: >4 mm, - ulc
T4b:
skin melanoma: >4 mm, + ulc
Mucosal melanoma: advanced disease Involving deep soft tissue, cartilage, bone or overlying skin
Nasal cavity and ethmoid: anterior orbital contents, skin of nose or cheek, minimal extension to anterior cranium, pterygoid, sphenoid or frontal sinus
OC: > 4 cm with DOI > 10 mm or Invasion - through cortical bone of mand/max, Involves maxillary sinus or skin of face. (SCM)
Sarcoma: Orbit, skull base, dura, centra viscera, facial skeleta, pterygoid muscles
Thyroid diff, med, Anaplastic: ETE Involving subq tissues, larynx, trachea, esophagus, RLN (NESTLE)
cut carcinoma: Gross cortical bone Invasion
T4b
OP - : Lateral pterygoid muscle, pterygoid plates, lateral nasopharynx, skull base or encases carotid carotid (SLLPC)
Supraglot/glottis/subglottis/hypopharynx: Prevertebral space, carotid, mediastium (CMP)
Major salivary gland: skull base, pterygoid plates, internal carotid (SIP)
nasal cavity/ethmoid/ maxillary sinus: orbital apex, dura, brain, CN (other than V2), nasopharynx, clivus (CONDM)
Mucosal melanoma: Very advanced: brain, dura, skull base, lower cranial nerves (9, 10, 11, 12) masticator space, carotid artery, prevertebral space, mediastinal structures
OC: Masticator space, ptergyoid plates, skull base, encases IC artery (SIMP)
Sarcoma: brain, parenchyma, carotid, prevertrabl muscle, CNS via perineural spread
Thyroid med/anaplastic/diff: spine, nearby large vessles, gross ETE Into prevertebral fascia, carotid, mediastinum (CMP)
cut carcinoma: skull base Invasion or skull base foramen Involvement
T4
OP + : Larynx, extrinsic muscle of tongue, medial pteryoid, hard palate, mandible or beyond, nasopharynx
Merkel cell: fascia, muscle, cartilage or bone
Nasopharynx: Intracranial extension, cranial nerves, hypopharynx, orbit, parotid, soft tissue beyond lateral surface of lateral pterygoid muscle (CHOLIP)
Parathyroid: Invasion Into major vessels or spine
T1a:
Glottis: one VC
Skin melanoma: < 0.8 mm deep, No Ulc
Thyroid med, diff, Anaplastic: < 1, limited to thyroid
T1b:
Glottis: both VC
Skin melanoma:
< 0.8 mm deep, with Ulc
0.8-1 mm deep: +/- Ulc
Thyroid med/diff/anaplastic: 1-2 cm limited to thyroid
Overal staging:
T or N+2 (Reg)
T or N+1 (NPC)
T-1 or N(OPSCC)
T-1 or N+1 (Thyroid)