Oral cancer diagnosis and staging

Because no two people develop head and neck cancer in the same way, we offer a wide array of resources for proper evaluation of your case.

Your UCHealth provider will start by taking your medical history and performing a physical exam to feel for swollen lymph nodes in the neck, look down your throat with a small, long-handled mirror, and check your lips and oral cavity for abnormal areas.

Then, we may use any combination of these tests and procedures to find and stage oral cancer:

  • Barium swallow (upper GI series). A liquid containing barium coats the lining of the esophagus and stomach for diagnostic X-rays.
  • Biopsy. The only definitive way to diagnose cancer cells. We remove cells or tissues for viewing under a microscope.
    Bronchoscopy. We insert a thin, lighted tube called a bronchoscope into the trachea and lungs through the nose or mouth to check for abnormal areas or to take tissue samples for biopsy.
  • Computed tomography scan (CT). A type of X-ray creates detailed, highly accurate, cross-sectional images of the body.
  • Endoscopy. We insert a thin, lighted tube called an endoscope through a body opening or a small incision in the skin to examine internal organs and tissues for abnormalities; may also be used to take tissue samples or lymph nodes for biopsy.
  • Esophagoscopy. We insert a thin, lighted tube called an esophagoscope into the esophagus through the nose or mouth to check for abnormal areas or take tissue samples for biopsy.
  • Exfoliative cytology. We use a piece of cotton, a brush or a small wooden stick to gently scrape cells from the lips, tongue, mouth, or throat to check for abnormalities by viewing under a microscope.
  • Laryngoscopy. We use a thin, lighted tube called a laryngoscope or a hand-held mirror to examine the voice box, or larynx.
  • Magnetic resonance imaging (MRI). A magnetic field instead of X-rays provides detailed images of body structures.
  • Positron emission tomography (PET scan). An injection of a short-lived radioactive substance creates detailed images of body structures that help identify cancer and areas of inflammation in different parts of the body.
  • Serum tumor marker test. We check a blood sample for amounts of certain substances called tumor markers released by organs, tissues, or tumor cells in the body that indicate specific types of cancer when found at increased levels.
  • Ultrasound. High-energy sound waves bounce off internal tissues or organs and make images of body tissues, called a sonogram.
  • X-ray.

UCHealth follows the American Joint Committee on Cancer (AJCC) TNM system to stage oral and throat cancer, which is based on three key pieces of information:

  1. The extent of the tumor (T): How large is the main (primary) tumor and which, if any, tissues of the oral cavity or oropharynx it has spread to?
  2. The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
  3. The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs?

Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

AJCC stage Stage grouping Lip, oral cavity and p16 negative oropharynx stage description*
0 Tis
N0
M0
The cancer is still within the epithelium (the top layer of cells lining the oral cavity and oropharynx) and has not yet grown into deeper layers.

It has not spread to nearby lymph nodes (N0) or distant sites (M0). This stage is also known as carcinoma isitu (Tis).

I T1
N0
M0
The cancer is 2 cm (about ¾ inch) or smaller. It’s not growing into nearby tissues (T1). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
 

II

T2
N0
M0
The cancer is larger than 2 cm but no larger than 4 cm (about 1½ inch). It’s not growing into nearby tissues (T2). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
III

 

T3
N0
M0
The cancer is larger than 4 cm (T3). For cancers of the oropharynx, T3 also includes tumors that are growing into the epiglottis (the base of the tongue). It has not spread to nearby lymph nodes (N0) or to distant sites (M0).
–OR–
T1, T2, T3
N1
M0
The cancer is any size and may have grown into nearby structures if oropharynx cancer(T1-T3) AND has spread to 1 lymph node on the same side as the primary tumor. The cancer has not grown outside of the lymph node and the lymph node is no larger than 3 cm (about 1¼ inch) (N1). It has not spread to distant sites (M0).
IVA T4a
N0 or N1
M0
The cancer is any size and is growing into nearby structures such as:

For lip cancers: nearby bone, the inferior alveolar nerve (the nerve to the jawbone), the floor of the mouth, or the skin of the chin or nose (T4a)

For oral cavity cancers: the bones of the jaw or face, deep muscle of the tongue, skin of the face, or the maxillary sinus (T4a)

For oropharyngeal cancers: the larynx (voice box), the tongue muscle, or bones such as the medial pterygoid, the hard palate, or the jaw (T4a).

This is known as moderately advanced local disease (T4a).

AND either of the following:

It has not spread to nearby lymph nodes (N0)

It has spread to 1 lymph node on the same side as the primary tumor, but has not grown outside of the lymph node and the lymph node is no larger than 3 cm (about 1¼ inch) (N1).

It has not spread to distant sites (M0).

–OR–
T1, T2, T3 or T4a
N2
M0
The cancer is any size and may have grown into nearby structures (T0-T4a). It has not spread to distant organs (M0). It has spread to one of the following:

1 lymph node on the same side as the primary tumor, but it has not grown outside of the lymph node and the lymph node is larger than 3 cm but not larger than 6 cm (about 2½ inches) (N2a) OR

It has spread to more than 1 lymph node on the same side as the primary tumor, but it has not grown outside of any of the lymph nodes and none are larger than 6 cm (N2b) OR

It has spread to 1 or more lymph nodes either on the opposite side of the primary tumor or on both sides of the neck, but has not grown outside any of the lymph nodes and none are larger than 6 cm (N2c).

 

IVB

Any T
N3
M0
The cancer is any size and may have grown into nearby soft tissues or structures (Any T) AND any of the following:

It has spread to 1 lymph node that’s larger than 6 cm but has not grown outside of the lymph node (N3a) OR

It has spread to 1 lymph node that’s larger than 3 cm and has clearly grown outside the lymph node (N3b) OR

It has spread to more than 1 lymph node on the same side, the opposite side, or both sides of the primary cancer with growth outside of the lymph node(s) (N3b) OR

It has spread to 1 lymph node on the opposite side of the primary cancer that’s 3 cm or smaller and has grown outside of the lymph node (N3b).

It has not spread to distant organs (M0).

–OR–
T4b
Any N
M0
The cancer is any size and is growing into nearby structures such as the base of the skull or other bones nearby, or it surrounds the carotid artery. This is known as very advanced local disease (T4b). It might or might not have spread to nearby lymph nodes (Any N). It has not spread to distant organs (M0).
IVC Any T
Any N
M1
The cancer is any size and may have grown into nearby soft tissues or structures (Any T) AND it might or might not have spread to nearby lymph nodes (Any N). It has spread to distant sites such as the lungs (M1).

Source: American Cancer Society