Lip and Oral Cavity
TNM 7 Classification
TNM 6 Classification
1. Rules for Classification
The classification applies only to carcinomas of the vermilion surfaces of the lips and of the oral cavity, including those of minor salivary glands. There should be histological confirmation of the disease.
The following are the procedures for assessing T, N, and M categories:
T categories. Physical examination and imaging
N categories. Physical examination and imaging
M categories. Physical examination and imaging
2. Anatomical Sites and Subsites
2.1 Lip (C00)
1. External upper lip (vermilion border) (C00.0)
2. External lower lip (vermilion border) (C00.1)
3. Commissures (C00.6)
2.2 Oral Cavity (C02-C06)
1. Buccal mucosa
i. Mucosa of upper and lower lips (C00.3, 4)
ii. Cheek mucosa (C06.0)
iii. Retromolar areas (C06.2)
iv. Bucco-alveolar sulci, upper and lower (vagina of mouth) (C06.1)
2. Upper alveolus and gingiva (upper gum) (C03.0)
3. Lower alveolus and gingiva (lower gum) (C03.1)
4. Hard palate (C05.0)
i. Dorsal surface and lateral borders anterior to vallate papillae (anterior two-thirds) (C02.0, 1)
ii. Inferior (ventral) surface (C02.2)
6. Floor of mouth (C04)
3. Regional Lymph Nodes
The regional lymph nodes are the cervical nodes.
4. TNM Clinical Classification
4.1. T - Primary Tumour
TX. Primary tumour cannot be assessed
T0. No evidence of primary tumour
Tis. Carcinoma in situ
T1. Tumour 2 cm or less in greatest dimension
T2. Tumour more than 2 cm but not more than 4 cm in greatest dimension
T3. Tumour more than 4 cm in greatest dimension
T4a. (lip) Tumour invades through cortical bone, inferior alveolar nerve, floor of mouth, or skin (chin or nose)
T4a. (oral cavity) Tumour invades through cortical bone, into deep/extrinsic muscle of tongue (genioglossus, hyoglossus, palatoglossus, and styloglossus), maxillary sinus, or skin of face
T4b. (lip and oral cavity) Tumour invades masticator space, pterygoid plates, or skull base, or encases internal carotid artery
Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify a tumour as T4.
4.2. N - Regional Lymph Nodes
NX. Regional lymph nodes cannot be assessed
N0. No regional lymph node metastasis
N1. Metastasis in a single ipsilateral lymph node, 3 cm or less in greatest dimension
N2. Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension; or in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension; or in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
N2a. Metastasis in a single ipsilateral lymph node, more than 3 cm but not more than 6 cm in greatest dimension
N2b. Metastasis in multiple ipsilateral lymph nodes, none more than 6 cm in greatest dimension
N2c. Metastasis in bilateral or contralateral lymph nodes, none more than 6 cm in greatest dimension
N3. Metastasis in a lymph node more than 6 cm in greatest dimension
Note: Midline nodes are considered ipsilateral nodes.
4.3. M - Distant Metastasis
MX. Distant metastasis cannot be assessed
M0. No distant metastasis
M1. Distant metastasis
5. pTNM Pathological Classification
The pT, pN, and pM categories correspond to the T, N, and M categories.
pN0. Histological examination of a selective neck dissection specimen will ordinarily include 6 or more lymph nodes. Histological examination of a radical or modified radical neck dissection specimen will ordinarily include 10 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.
When size is a criterion for pN classification, measurement is made of the metastasis, not of the entire lymph node.
6. G Histopathological Grading
See definitions here.
7. Stage Grouping