Staging and grading of head and neck cancer

The stage of a cancer describes its size and whether it has spread from where it started. The grade is how the cancer cells look under the microscope.  This gives doctors an idea of how quickly the cancer may grow.  Knowing the stage and grade helps doctors advise you on the best treatment for you.

Staging is slightly different for each type of head and neck cancer. Your doctor or nurse can tell you more about the stage of the cancer.  

The most used staging systems for head and neck cancer are the TNM and number staging systems.

TNM stands for tumour, node and metastases.

• T describes the size of the tumour, how far it has grown and sometimes the depth of the tumour. It is numbered between 0 to 4.

• T0 means that there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous.
• T1 and T2 means the tumour is small and has not started to spread.
• T3 tumours are bigger, or may have started to spread into nearby tissue.
• T4 is when a tumour has spread into nearby muscles, bones or skin.

• N describes whether the cancer has spread to the lymph nodes.

• N0 means that no lymph nodes are affected.
• N1, N2 or N3 means there are cancer cells in the lymph nodes. The number depends on how many lymph nodes contain cancer cells, the size and where they are in the body.

• M describes whether the cancer has spread to another part of the body. This is called metastatic cancer.

• M0 means the cancer has not spread.
• M1 means the cancer has spread to distant organs, such as the liver or lungs.

This system combines all the information from the TNM staging system and gives it a number from 1 to 4.

Stage 0

This is sometimes called carcinoma in situ or precancerous. There are abnormal cells in the lining of the affected area, but they are contained (in situ) and have not spread. If not treated, they are very likely to become cancerous.

Stage 1 and stage 2 of head and neck cancer

This describes cancers at an early stage that are usually small and have not spread. Your doctor may call this early or localised cancer.

Stage 3 and stage 4 of head and neck cancer

This describes bigger cancers that have spread further into nearby lymph nodes, surrounding tissue or both. Doctors sometimes call this locally advanced cancer.

Some stage 4 cancers may have spread to other parts of the body, such as the lungs or liver. This is called metastatic or secondary cancer. But it is more common for head and neck cancer to only spread in the area where it started.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. We're here if you need someone to talk to. You can:

• Call the Macmillan Support Line on 0808 808 00 00.
• Chat to our specialists online.

The grade of a cancer gives the doctors an idea of how quickly it may develop. Doctors will look at a sample of the cancer cells under a microscope to find the grade of the cancer.

• Grade 1 or low grade – the cancer cells look like normal cells and usually grow slowly.
• Grade 2 and 3 – the cancer cells look different to normal cells and are slightly faster growing.
• Grade 4 or high grade – the cancer cells look very different to normal cells and may grow more quickly.