Version June 2024
| Regional lymph nodes (N) | |||
| Clinical N (cN) | |||
| For patients who are treated with primary nonsurgical treatment without a cervical lymph node dissection. | |||
| N category | N criteria | ||
| NX | Regional lymph nodes cannot be assessed | ||
| N0 | No regional lymph node metastasis | ||
| N1 | Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(–) | ||
| N2 | Metastasis in a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(–); or Metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(–); or In bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension, ENE(–) | ||
| N2a | Metastasis in a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(–) | ||
| N2b | Metastases in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension and ENE(–) | ||
| N2c | Metastases in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(–) | ||
| N3 | Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(–); or Metastasis in any node(s) with clinically overt ENE(+) (ENEc)* | ||
| N3a | Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(–) | ||
| N3b | Metastasis in any node(s) with clinically overt ENE(+) (ENEc)* | ||
| * ENEc is defined as invasion of skin, infiltration of musculature, dense tethering or fixation to adjacent structures, or cranial nerve, brachial plexus, sympathetic trunk, or phrenic nerve invasion with dysfunction. NOTES: 1. Midline nodes are considered ipsilateral nodes. 2. A designation of "U" or "L" may be used for any N category to indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L). Similarly, clinical and pathological ENE should be recorded as ENE(–) or ENE(+). | |||
| Pathological N (pN) | |||
| For patients who are treated surgically with a cervical lymph node dissection. | |||
| N category | N criteria | ||
| NX | Regional lymph nodes cannot be assessed | ||
| N0 | No regional lymph node metastasis | ||
| N1 | Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(–) | ||
| N2 | Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(+); or Larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(–); or Metastases in multiple ipsilateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(–); or In bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(–) | ||
| N2a | Metastasis in a single ipsilateral node 3 cm or less in greatest dimension and ENE(+); or A single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(–) | ||
| N2b | Metastases in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension and ENE(–) | ||
| N2c | Metastases in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(–) | ||
| N3 | Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(–); or Metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+); or Multiple ipsilateral, contralateral, or bilateral nodes any size and ENE(+) in any node; or A single contralateral node of any size and ENE(+) | ||
| N3a | Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(–) | ||
| N3b | Metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+); or Multiple ipsilateral, contralateral, or bilateral nodes any size and ENE(+) in any node; or A single contralateral node of any size and ENE(+) | ||
| NOTES: 1. Midline nodes are considered ipsilateral nodes. 2. ENE detected on histopathologic examination is designated as ENEmi (microscopic ENE ≤2 mm) or ENEma (major ENE >2 mm). Both ENEmi and ENEma qualify as ENE(+) for definition of pN. 3. A designation of "U" or "L" may be used for any N category to indicate metastasis above the lower border of the cricoid (U) or below the lower border of the cricoid (L). Similarly, clinical and pathological ENE should be recorded as ENE(–) or ENE(+). | |||
| Prognostic stage groups | |||
| Prognostic stage groups for metastatic cervical adenopathy and unknown primary tumor except for EBV-related and HPV-related tumors. | |||
| When T is... | And N is... | And M is... | Then the stage group is... |
| T0 | N1 | M0 | III |
| T0 | N2 | M0 | IVA |
| T0 | N3 | M0 | IVB |
| T0 | Any N | M1 | IVC |
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