Stages of Oropharyngeal Cancer

Cancer stage describes the extent of cancer in the body.

Cancer stage describes the extent of cancer in the body, such as the size of the tumor, whether it has spread, and how far it has spread from where it first formed. Knowing the cancer stage helps plan treatment. 

There are several staging systems for cancer that describe the extent of the cancer. Oropharyngeal cancer staging usually uses the TNM staging system. The cancer may be described by this staging system in your pathology report. Based on the TNM results, a stage (I, II, III, or IV, also written as 1, 2, 3, or 4) is assigned to the cancer. When talking to you about your diagnosis, your doctor may describe the cancer as one of these stages.

Learn more about Cancer Staging. 

The following stages are used for HPV-positive oropharyngeal cancer:

Stage I (also called stage 1) oropharyngeal cancer

In stage I, one of the following is true:

• one or more lymph nodes with cancer that is HPV 16–positive are found but the place where the cancer began is not known. The lymph nodes with cancer are 6 centimeters or smaller, on one side of the neck; or
• cancer is found in the oropharynx (throat) and the tumor is 4 centimeters or smaller. Cancer may have spread to one or more lymph nodes that are 6 centimeters or smaller, on the same side of the neck as the primary tumor.

Stage II (also called stage 2) oropharyngeal cancer

In stage II, one of the following is true:

• one or more lymph nodes with cancer that is HPV 16–positive are found but the place where the cancer began is not known. The lymph nodes with cancer are 6 centimeters or smaller, on one or both sides of the neck; or
• the tumor is 4 centimeters or smaller. Cancer has spread to lymph nodes that are 6 centimeters or smaller, on the opposite side of the neck as the primary tumor or on both sides of the neck; or
• the tumor is larger than 4 centimeters or cancer has spread to the top of the epiglottis (the flap that covers the trachea during swallowing). Cancer may have spread to one or more lymph nodes that are 6 centimeters or smaller, anywhere in the neck.

Stage III (also called stage 3) oropharyngeal cancer

In stage III, one of the following is true:

• cancer has spread to the larynx (voice box), front part of the roof of the mouth, lower jaw, muscles that move the tongue, or to other parts of the head or neck. Cancer may have spread to lymph nodes in the neck; or
• the tumor is any size and cancer may have spread to the larynx, front part of the roof of the mouth, lower jaw, muscles that move the tongue, or to other parts of the head or neck. Cancer has spread to one or more lymph nodes that are larger than 6 centimeters, anywhere in the neck.

Stage IV (also called stage 4) oropharyngeal cancer

In stage IV, cancer has spread to other parts of the body, such as the lung or bone.

Stage IV oropharyngeal cancer is also called metastatic oropharyngeal cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if oropharyngeal cancer spreads to the lung, the cancer cells in the lung are actually oropharyngeal cancer cells. The disease is called metastatic oropharyngeal cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

The following stages are used for HPV-negative oropharyngeal cancer:

Stage 0 (also called carcinoma in situ of the oropharynx)

In stage 0, abnormal cells are found in the lining of the oropharynx (throat). These abnormal cells may become cancer and spread into nearby normal tissue.

Stage I (also called stage 1) oropharyngeal cancer

In stage I, cancer has formed. The tumor is 2 centimeters or smaller.

Stage II (also called stage 2) oropharyngeal cancer

In stage II, the tumor is larger than 2 centimeters but not larger than 4 centimeters.

Stage III (also called stage 3) oropharyngeal cancer

In stage III, the cancer:

• is either larger than 4 centimeters or has spread to the top of the epiglottis (the flap that covers the trachea during swallowing); or
• is any size. Cancer has spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor.

Stage IV (also called stage 4) oropharyngeal cancer

Stage IV is divided into stages IVA, IVB, and IVC.

• In stage IVA, cancer:
  • has spread to the larynx (voice box), front part of the roof of the mouth, lower jaw, or muscles that move the tongue. Cancer may have spread to one lymph node that is 3 centimeters or smaller, on the same side of the neck as the primary tumor; or
  • is any size and may have spread to the top of the epiglottis, larynx, front part of the roof of the mouth, lower jaw, or muscles that move the tongue. Cancer has spread to one of the following:
    • one lymph node that is larger than 3 centimeters but not larger than 6 centimeters, on the same side of the neck as the primary tumor; or
    • more than one lymph node that is 6 centimeters or smaller, anywhere in the neck.
• In stage IVB, cancer:
  • has spread to the muscle that moves the lower jaw, the bone attached to the muscle that moves the lower jaw, the base of the skull, or to the area behind the nose or around the carotid artery. Cancer may have spread to lymph nodes in the neck; or
  • may be any size and may have spread to other parts of the head or neck. Cancer has spread to a lymph node that is larger than 6 centimeters or has spread through the outside covering of a lymph node into nearby connective tissue.
• In stage IVC, cancer has spread to other parts of the body, such as the lung, liver, or bone.

Stage IV oropharyngeal cancer is also called metastatic oropharyngeal cancer. Metastatic cancer happens when cancer cells travel through the lymphatic system or blood and form tumors in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor. For example, if oropharyngeal cancer spreads to the lung, the cancer cells in the lung are actually oropharyngeal cancer cells. The disease is called metastatic oropharyngeal cancer, not lung cancer. Learn more in Metastatic Cancer: When Cancer Spreads.

Oropharyngeal cancer can recur (come back) after it has been treated.

Recurrent oropharyngeal cancer is cancer that has come back after it has been treated. If oropharyngeal cancer comes back, it may come back in the oropharynx, lymph nodes, or other parts of the body, such as the lungs, bone, or liver. Tests will help determine where in the body the cancer has returned. The type of treatment that you have for recurrent oropharyngeal cancer will depend on where it has come back.

Learn more in Recurrent Cancer: When Cancer Comes Back. Information to help you cope and talk with your health care team can be found in the booklet When Cancer Returns.