Stages

If orophyaryngeal cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.

The Spreading of Cancer

There are three ways that cancer spreads in the body:

Through tissue. Cancer invades the surrounding normal tissue.

Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.

Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, another, or secondary tumor, may form. This process is called metastasis. The secondary, or metastatic, tumor is the same type of cancer as the primary tumor. For example, if oropharyngeal cancer spreads to the bones, the cancer cells in the bones are actually oropharyngeal cancer cells. The disease is metastatic oropharyngeal cancer, not bone cancer.

Stages of Oropharyngeal Cancer

These are the main features of each stage of the disease:

Stage 0 (Carcinoma in Situ) - In stage 0, abnormal cells are found in the lining of the oropharynx. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I - In stage I cancer has formed and is two centimeters or smaller. It is also only found in the oropharynx.

Stage II - In Stage II, the cancer is larger than two centimeters but not larger than four centimeters and is found in the oropharynx only.

Stage III - In stage III, cancer is either four centimeters or smaller; spread to one lymph node on the same side of the neck as the tumor and the lymph node is three centimeters or smaller; or it is larger than four centimeters or has spread to the epiglottis (the flap that covers the trachea during swallowing). Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is three centimeters or smaller.

Stage IV - Stage IV is divided into stage IVA, IVB and IVC as follows:

In stage IVA - Cancer has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing. Cancer may have spread to one lymph node on the same side of the neck as the tumor and the lymph node is three centimeters or smaller. OR, cancer has spread to one lymph node on the same side of the neck as the tumor - the lymph node is larger than three centimeters but not larger than six centimeters - or to more than one lymph node anywhere in the neck. One of the following must also be true:

A tumor in the oropharynx is any size and may have spread to the epiglottis.

A tumor has spread to the larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue or are used for chewing.

In stage IVB - The tumor surrounds the carotoid artery or has spread to the muscle that opens the jaw, the bone attached to the muscles that move the jaw, nasopharynx or base of the skull. Cancer may have spread to one or more lymph nodes (which can be any size) or may be any size and has spread to one or more lymph nodes that are larger than six centimeters.

In Stage IVC - The tumor may be any size and has spread beyond the oropharynx to other parts of the body.

Knowing the stage assists the doctor in determining a prognosis. It also better helps you understand the care and treatment that will be required. Generally, treatment for the different stages are as follows:

Stage I
- Treatment of stage I may include radiation therapy, surgery or a clinical trial of fractionated radiation therapy.

Stage II - Treatment of stage II, may include radiation therapy (external or internal) and/or surgery.

Stage III - Treatment of stage III may include surgery followed by radiation therapy or chemotherapy given at the same time as radiation therapy, radiation therapy alone (for patients with tongue or tonsil cancer), chemotherapy given at the same time as radiation therapy and/or clinical trials of chemotherapy, fractionated therapy or internal radiation therapy.

Stage IV - Treatment of stage IV that can be treated by surgery may include surgery (followed by radiation and chemotherapy), radiation therapy (for tonsil cancer) and/or clinical trials in chemotherapy, fractionated therapy or internal radiation therapy. Treatment of stage IV that cannot be treated by surgery may include radiation therapy (with or without chemotherapy) and/or clinical trials of fractionated, radiation and hyperthermia therapy.

Following treatment, it is important to have careful head and neck examinations to look for recurrence. Check-ups will be done monthly in the first year, every 2 months in the second year, every 3 months in the third year, and every 6 months thereafter.

In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique.

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