Staging and grading of tongue cancer

The stage of a cancer describes its size and position and if it has spread to nearby tissue or other parts of the body. In tongue cancer, staging also looks at how deep the cancer is.

The most commonly used staging systems for tongue cancer are the TNM and number staging systems.

TNM stands for tumour, node and metastases.

• T describes the size of the tumour and whether it has grown into areas around the tongue. It is numbered between 0 and 4 depending on the size and extent of the tumour.
  • T0 means that there are no signs of a tumour, but there may be abnormal cells that are pre-cancerous.
  • T1 tumours are smaller than 2cm and less than 5mm deep. They are only in the tongue.
  • T2 tumours may be smaller than 2cm and are deeper than 5mm but not more than 10mm. Or tumours may be larger than 2cm but no bigger than 4cm and are not deeper than 10mm.
  • T3 tumours may be larger than 2cm but not bigger than 4cm, and are deeper than 10mm. Or tumours may be larger than 4cm but not deeper than 10mm.
  • T4 tumours may be larger than 4cm and deeper than 10mm. Or the tumour may have spread into nearby areas, such as muscles or bones.
• N describes whether the cancer has spread to the lymph nodes.
  • N0 means that no lymph nodes are affected.
  • N1, N2 or N3 means that 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.
• 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 lungs or liver.

The number staging system is less commonly used. There are usually 3 or 4 number stages for each cancer type. Your doctor can tell you more about the stage of your cancer.

Your doctor may use other terms to describe the stage of the cancer, such as:

• early or local – a small cancer that has not spread
• locally advanced – cancer that has started to spread into surrounding tissues or nearby lymph nodes, or both
• local recurrence – cancer that has come back in the same area after treatment
• secondary, advanced, widespread or metastatic – cancer that has spread to other parts of the body.

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.