Grade and stage of mouth cancers
This page has information about the stages and grades of mouth and oropharyngeal cancers. Because saying 'mouth and oropharyngeal cancer' is a bit long, we've tended to just say mouth cancer in the text. But these pages include both. You can find information about
Grade and stage of mouth cancers
The stage of a cancer tells the doctor how far a cancer has grown or spread. The staging information helps your doctor decide on the best treatment. The two main ways are the TNM system and number system.
TNM stages of mouth and oropharyngeal cancer
‘TNM’ stands for Tumour, Node and Metastasis. The system describes
- The size of a primary tumour (T)
- Whether the cancer has spread to the lymph nodes (N)
- Whether the cancer has spread to a different part of the body (M)
Number stages of mouth cancers
There are four main stages in this system – stages 1 to 4. Some doctors also refer to stage 0, which is an early stage before a true cancer develops. Further down this page, there is detailed information about the TNM and number stages.
Grade
The grade of a cancer tells you what the cells look like under a microscope. They are 'graded' according to how normal or abnormal they appear. The more abnormal they look, the higher the grade. Low grade cancers are usually slower growing and less likely to spread. High grade cancers are likely to be faster growing and more likely to spread. But this is only a guide. Mouth and oropharyngeal cancer is graded from 1 (low grade) to 4 (the highest grade).
You can view and print the quick guides for all the pages in the Treating mouth cancer section.
The stage of a cancer tells the doctor how far a cancer has grown or spread. The staging information helps your doctor decide on the best treatment. The tests and scans that you had when your doctor was diagnosing your cancer will give some staging information. But if you need surgery your doctor may not be able to tell you the exact stage until after the operation.
There are different ways of staging cancers. The two main ways are the TNM system and number system.
Understanding your cancer stage may help you understand why your specialist has recommended a particular treatment for you. If you don't understand and would like to know more, ask your doctor. There is a list of questions for your doctor at the end of this section that may help you. Also, there is more about staging cancers in the about cancer section of CancerHelp UK.
‘TNM’ stands for Tumour, Node and Metastasis. The system describes
- The size of a primary tumour (T)
- Whether the cancer has spread to the lymph nodes (N)
- Whether the cancer has spread to a different part of the body (M)
‘T’ stages
There are 4 main 'T' stages of mouth and oropharyngeal cancer
- T1 means the tumour is contained within the tissue of the mouth or oropharynx and is no larger than 2cm (3/4 inch)
- T2 means the tumour is larger than 2cm, but smaller than 4cm (about
1 ½ inches)
- T3 means the tumour is bigger than 4cm
- T4 means the tumour has grown further than the mouth or oropharynx and into nearby body tissues such as bone, tissues of the neck, neck muscles, tongue, skin, sinuses, or the voice box (larynx)
‘N’ stages
There are 4 main lymph node stages in cancer of the mouth and oropharynx. One of these, stage N2, is broken down into 3 sub-stages. The important points here are whether there is cancer in any of the lymph nodes and if so, the size of the node and which side of the neck it is on.
- N0 means there are no cancer cells in the lymph nodes
- N1 means there are cancer cells in 1 lymph node on the same side of the neck as the cancer, but the node is less than 3cm across
- N2a means there is cancer in 1 lymph node on the same side of the neck, and the node is more than 3cm across but less than 6cm across
- N2b means there is cancer in more than 1 lymph node, but none of these nodes are more than 6cm across. All the affected nodes are on the same side of the neck as the cancer.
- N2c means there is cancer in nodes on the other side of the neck, or in nodes on both sides, but none of these nodes are more than 6cm across
- N3 means that at least 1 node containing cancer is more than 6cm across
‘M’ stages
There are two stages to describe spread of cancer of the mouth and oropharynx to other parts of the body
- M0 means there is no cancer spread to other parts of the body
- M1 means the cancer has spread to other parts of the body, such as the lungs
Together, the T, N and M stages give a complete description of the stage of your cancer. For example, if you have a T2, N0, M0 cancer, you have a tumour larger than 2cm but not larger than 4cm. The lymph nodes are clear and there is no spread of your cancer to other parts of the body.
There are four main stages in this system - stages 1 to 4. Some doctors also refer to stage 0.
Stage 0 or carcinoma in situ (CIS)
If you have CIS or stage 0 cancer of the mouth or oropharynx, you have a very early stage cancer. Some doctors prefer to call this pre-cancer. There are cancer cells there. But they are all contained entirely within the lining of the mouth or oropharynx. So they have not spread. As the cells have not spread, this is not yet a true cancer. If the pre-cancer is not treated, there is a high chance of this condition going on to develop into an invasive cancer.
Stage 1
This is the earliest stage of invasive cancer. It means that cancer has begun to grow through the tissues lining the mouth or oropharynx and into the deeper tissues underneath. The cancer is no more than 2 cm across and has not spread to nearby tissues, lymph nodes or other organs.
Stage 2
If you have stage 2 cancer, the tumour is larger than 2 cm across, but less than 4cm. The cancer has not spread to lymph nodes or any other organs.
Stage 3
Having stage 3 mouth or oropharynx cancer can mean one of two things. Either the cancer is bigger than 4cm but has not spread to any lymph nodes or other parts of the body. Or the tumour is any size but has spread to one lymph node on the same side of the neck as the cancer. In this case the lymph node involved is no more than 3cm across.
Stage 4
This means the cancer is advanced. Stage 4 can mean one of 3 things
- The cancer has grown through the tissues around the lips and mouth - lymph nodes in the area may or may not contain cancer cells
- The cancer is any size and has spread to more than 1 lymph node on the same side of the neck as the cancer, or to lymph nodes on both sides of the neck, or any lymph node is bigger than 6cm
- The cancer has spread to other parts of the body such as the lungs or bones
The grade of a cancer tells you what the cells look like under a microscope. The cells are graded according to how normal or abnormal they appear. There are 4 grades of oral and oropharyngeal cancer cells
- Grade 1 (low grade) - the cancer cells look very much like normal mouth or oropharyngeal cells
- Grade 2 (intermediate grade) - the cancer cells look slightly different to normal mouth or oropharyngeal cells
- Grade 3 (high grade) - the cancer cells look very abnormal and not much like normal mouth or oropharyngeal cells
- Grade 4 (high grade) - the cancer cells do not look anything like normal mouth or oropharyngeal cells
Differentiation means how developed or mature a cell is. So doctors may describe grade 1 cancer cells as 'well differentiated'. Grade 2 cancer cells are 'moderately differentiated'. Grade 3 cancer cells are 'poorly differentiated'.
The grade of the cancer gives your specialist an idea of how the cancer is likely to behave. Low grade cancers are usually slower growing and less likely to spread. High grade cancers are likely to be faster growing and more likely to spread. This is only a guide. Your specialist will consider all your test results when deciding which treatment options are best for you.
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